Closed flexible intramedullary biopsy of metastatic carcinoma.

Closed flexible intramedullary biopsy was performed in 24 patients requiring surgical stabilization of 17 pathologic and ten impending pathologic fractures from metastatic carcinoma. The biopsy was positive for carcinoma in 25 of 27 cases and either confirmed the diagnosis of metastatic disease or revealed a carcinoma cell type of unknown origin. The technique of closed biopsy using an intramedullary flexible, large bore, plastic catheter in patients with metastatic carcinoma produced information comparable to other biopsy techniques.

Flexible intramedullary nails for ipsilateral femoral and tibial fractures.

Between June 1981 and August 1983, six patients were treated with flexible intramedullary nails for both femoral and tibial fractures in six floating knees. All six patients were males averaging 26 years of age and all six were involved in motor vehicle accidents. Concomitant associated injuries were common. Two femoral and five tibial fractures were open. All fractures were stabilized within 24 hours of injury by closed intramedullary nailing with Ender nails. At final followup, there was one femoral and one tibial nonunion in the same patient. For the remaining patients, femoral union averaged 10.3 weeks and tibial union averaged 18 weeks. Five patients regained full motion at the hip, and four regained full motion at the knee and ankle. Four patients returned to their preinjury level of function; two were less active, one ambulating without the use of external assistive devices, and one using a cane.

Hip arthroscopy by the lateral approach.

This report describes a new technique by which arthroscopy of the hip provides complete visualization of the joint space. The arthroscope and operative instruments are inserted by a direct lateral approach over the greater trochanter, with the patient in the lateral decubitus position. The involved leg is held in an abducted and flexed position with traction by pulleys hung overhead. Hip abduction and flexion relaxes the capsule and traction separates the joint so that insertion of the arthroscope is facilitated. Arthroscopic examination of the hip joint was performed in 11 patients. The indications for surgery included diagnosis of unresolved hip pain following failure of conservative treatment, removal of loose bodies, exploration and debridement following fracture and/or dislocation, and evaluation of the arthritic hip prior to definitive surgery.

Giant dermoid associated with foot duplication.

After resection at birth of an accessory left foot, a white male infant was followed up for a slowly enlarging posterior calf mass of the same leg. When the patient was 8 years old, the mass was thought to have enlarged sufficiently to warrant excisional biopsy. Histologic examination of the tumor was consistent with the diagnosis of a dermoid cyst, revealing a lesion lined with stratified squamous epithelium and containing cutaneous adnexal structures represented by eccrine sweat glands. A congenital dermoid in the extremities is unusual. The prognosis following removal is good, and recurrence is rare.

The treatment of pathologic and impending pathologic fractures of the proximal femur in the elderly.

Forty-eight pathologic and impending pathologic fractures of the proximal femur were surgically treated in 38 patients averaging 70 years of age. The most common tumors were breast (45%), multiple myeloma (24%), and lung (11%). Tumor size, aggressiveness, and location influenced the type of fixation. Sixty-four percent of the lesions were treated by flexible intramedullary nails. This "stress sharing" device afforded sufficient stability to provide pain relief, restore function, and permit healing. Pain was relieved in 92% of the patients, and 84% became ambulatory. The rate of fracture union for patients surviving more than two months was 89%. The average postsurgical survival was nine months. Internal fixation of pathologic and impending pathologic fractures has been recommended in the literature and should not be precluded by advanced age.

Knee arthrodesis for failed total knee arthroplasty.

The use of arthrodesis to salvage failed total knee arthroplasty is reviewed in nine patients. Prosthetic failure was due to infection in six cases, aseptic loosening in two cases, and instability in one case. The techniques of arthrodesis included six Hoffman external fixators, two fluted intramedullary rods (3M-Orthopedic Products Division, St Paul), and one pulsing electromagnetic field stimulator. Arthrodesis was successful in eight of nine patients, averaging 5.4 months to union. All eight patients resumed a painfree functional level of activity. Meticulous surgical technique and appropriate method of arthrodesis are emphasized.