[Clinical signs and methods of treatment of enchondromas located outside the hand]. / Rozpoznawanie i leczenie chrzestniaków sródkostnych umiejscowionych poza koscmi reki.

160 patients (72 men and 88 women) in the age from 12 to 71 were admitted to Orthopaedic and Traumatology Department Skubiszewski Medical University in Lublin because of enchondromas. In 126 patients chondromas were located in hand, and in 34 remaining patients (21,3%) in: humerus, forearm, femur, tibia, fibula and foot. The typical signs of enchondroma were: pain, little limitation of movement, thickening of tissues or pathological fracture. 31 patients were operated on. Enchondroma was resected with cutterage, the walls of osseus cavity cleaned with reamer and bone loss filled up with bone grafts or bone cement. 1 case of recurrence of chondroma of toe was noted. In one patent malignant change of chondroma of proximal metaphysis of tibia to chondrosarcoma was observed. Lesion resection and filling up the bone defect is the best method of treatment of enchondroma.

Results of the megaprosthesis replacement reconstruction proximal femoral resection bone tumors.

Background. Proximal femur defects resulting from tumor resections can be repaired with various types of hip endoprostheses. Major surgical procedures involving muscle detachments and extensive endoprosthesis implantation are prone to deep infections and the hip instability. The purpose of our study was to assess the outcome of hip prosthesoplasty after resection of large tumors from the proximal femur. Material and methods. Over the last 5 years, 49 patients have undergone hip prosthesoplasty after tumor resection in the proximal femur for 37 bone metastases and 12 primary neoplasms during the last 5 years. Three total megaprostheses were used, as well as 34 conventional long stem endoprostheses, including 26 bipolar and 12 Austin Moore prostheses. Results. Two patients died shortly after surgery, and another 4 were nonambulatory due to diffusion of the cancer. There were 3 cases of endoprosthesis luxation, 1 deep implant infection and 1 metastasis recurrence. We had 28% excellent functional outcomes and 60% good; the latter were complicated by Trendelenburg gait. Conclusions. Hip instability is the most common complication in prosthesoplasty after tumor resection in the proximal femur.

Evaluation of the survivability of femoral shaft reconstructions after resection of tumor and tumor-like lesions.

Background. The reconstruction of femoral shaft defects after tumor resection involves joining healthy bone fragments with plates or intramedullary rods, using methyl metacrylate cement or bone grafts. Material and methods. 50 patients (35 females and 15 males) were operated over the last 24 years. The patients' ages ranged from 12 to 80 years (mean 56). Results. There were 37 bone metastases, 11 primary neoplasms, 1 eosiniphilic granuloma and 1 solitary bone cyst. Plates were used for reconstruction in 17 cases, and intramedullary rods in 31 cases. Long intramedullary fibula grafts were used to stabilize bone fragments in 2 patients with benign lesions. The post-resection defect was filled with methyl metacrylate cement in 47 cases, and with bone chips in 3 cases. One patient died shortly after surgery, 5 were nonambulatory because of diffusion of neoplastic changes. There were 4 deep infections and 4 tumor recurrences in other patients. Mechanical failures occurred in 10 patients from 2 to 30 months postoperatively because of methyl metacrylate loosening. Conclusions. Bone-cement union is the decisive factor in stabilizing fragments after a tumor has been resected from the femoral shaft and the defect filled with cement. The defect filling after resection of a segment of the femur is only stable for a short time; later, there is loosening and the resultant fracture of the rod. Bone cement should be used to fill the defect in patients treated for metastases to bone, but not in patients with a primary bone tumor. Plates should not be used to join the fragment of the femur.

Restoration of bone stock after aseptic loosening of a distal post-resections femoral prosthesis.

Background. The aseptic loosening of the stem is a frequent complication of post-resection endoprosthesis. Material and methods. Twenty-one patients were operated for primary neoplasm of the distal femoral epiphysis. In 3 cases (14.3%) loosening of the endoprosthesis stem appeared 4 to 8 years after the resection-reconstruction procedure. In all cases the endoprosthesis was reinserted with reconstruction of the femoral shaft, using cancellous femoral impaction grafting with cement (Exeter technique). Results. The early results of revision surgery were good in all 3 cases. Subtrochanteric fracture appeared at the site where the cortex of the femoral shaft cortex was perforated by the endoprosthesis stem tip, ca. 18 months after reinsertion. Loosening of the reinserted endoprosthesis appeared in another female patient. The outcomes of revision surgery were good 2 to 3.5 years post surgery in both patients. Conclusions. The outcome of revision surgery for loosening of the femoral component of a post-resection endoprosthesis is good if there is no perforation of the femoral cortex.

Advances in musculoskeletal oncology: experience of the Lublin Orthopedic Clinic.

Major milestones in the diagnosis and treatment of musculoskeletal tumors and tumor-like lesions are presented on the basis of the authors' 40 years of experience in the Lublin Orthopedic Clinic. A prompt, adequate and complex diagnosis should be established using clinical, radiological and laboratory data. The biopsy (usually trepano-biopsy) that is performed routinely can be omitted in some patients. lmmunohistochemistry tests enable adequate differential diagnosis in many cases. Great progress has also been observed in treatment methods. Burring of sclerotic bony walls in benign osteolytic lesions is a major improvement over traditional but ineffective curettage. A multidisciplinary approach using neoadjuvant chemotherapy has radically improved outcomes in the treatment of ostegenic sarcoma and Ewing's sarcoma. Progress in surgical methods is enabling limb salvage by reconstructing large bone defects with modular endoprostheses. Patients with bone metastases are routinely operated for pathological fractures, large bone destruction or spinal cord compression. The authors call for the establishment of several Musculoskeletal Oncology centers in Poland.

History of treatment of bone tumours in Poland.

Authors showed the most important events in orthopedic oncology development in Poland. "Biologic resectio" introduced in Poland by prof. Adam Gruca and continued by prof. Tadeusz Witwicki was mainly ineffective but started malignant tumors operative treatment without amputation. In Lublin Orthopedic Clinic from 1980 year wide resections - reconstructions of neoplasmatic bone were performed. Bone Tumors Registry was created in Oncology Institute in Warsaw. There were annual Registry conferences had miningfull role in bone tumors evaluation and treatment. Bone tumors are treated after Lublin Clinic in Warsaw Clinics, Poznan, Szczecin, Gdansk Orthopedic Clinics and Bone tumors Department in Piekary Slaskie. Oncologic problems in orthopedics were showed on Polish Traumatoogy Symposiums in Cracow 1974 and Lublin 1996.

Complications after surgical treatment of bone metastases to proximal femur.

Background. Bone metastases in proximal femur a frequently treated surgically.
Material and methods. The authors present complications in the operative treatment of bone metastases to proximal femur in 82 patients managed at the Departament of Orthopedics and Traumatology of the Lublin University of Medical Sciences between 1978 and 2002.
Results. Recidives, angulated plates fractures, endoprostheses luxations and deep infections complicated 20% of the procedures. Revision surgery restored good function of painless limbs. Poor results were noted in
3 patients with deep infections of the endoprostheses.
Conclusions. Recidives, angulated plates fractures and endoprosthesis luxations can be avoided by large resections of the tumor and reconstruction with bipolar postresection endoprosthesoplasty.

Technique and results of operative treatment of bone metastases to the knee.

Background. Bone metastases in the knee are rare. The most difficult challenge in this area is to achieve a stabile fixation. The aim of the study was to evaluate results of various techniques of operative treatment of bone metastases to the knee in relation to its localisation and lesion patomorphology.
Material and methods. We assed 13 patients (5,9%) out of 220 treated operatively. The destruction area was located in femur in 12 patients and in 1 in tibia. Bone metastases were found in physis of femur in 5 patients and cross the line drawn through epicondyles. In 8, metastases were located in the epicondylar area. Pathological fractures were noted in 7 patients.
Results. Successful stabilisation was achieved in 4 patients without pathological fracture and in one patient where we resected distal part of femur and stabilised it with tibia using Küntscher nail, plate and bone cement.
In 8 patients complications were observed. One died due to pulmonary embolism on the fifth day after operation. In 3 patients we observed local recurence of tumor if the curetage alone was performed. In 2 cases where we used 2 rods introduced from the epicondylar area the stabilisation become loose. It was due to short distal femoral part. In one patient we noticed stress fracture of plate and in one the stabilisation of tibia and femur become unstabile because of local progression of metastases.

[Pathological fractures of the knee]. / Patologiczne sródstawowe i przynasadowe zlamania okolicy stawu kolanowego.

The authors present the methods and results of treatment of 20 epiphyseal and low-metaphysis pathological knee fractures treated at the Department of Orthopedics of the Lublin University of Medical Sciences between 1962-1999. The average age was 39 years. Malignant tumours (2 lymphomas, 1 plasmocytoma, 1 hemangiopericitoma, 2 adenocarcinoma metastases) and benign lesions (10 giant cell tumours, 3 solitary bone cysts, 1 intraosseous extension of pigmented villonodular synovitis) causes 18 femur fractures and 2 tibia fractures. The fractures caused by lymphomas in 2 patients and plasmocytoma in 1 patients were treated with either a plaster cast or skeletal traction and healed within 16 weeks. Tumour resection and reconstruction with Rush rods, Kuntscher nail, plate and methylmetacrylate were performed in 2 cases. In 1 case with hemangiopericytoma hip exarticulation was performed. In 5 cases pain relief and weight bearing capacity of the limb was not achieved because of neoplasm recurrences; 5 deaths occurred within 6 months to 7 years after femur fracture because of pulmonary metastases. Benign bone lesions were treated by curettage of pathological tissues, burring bony walls of the lesions and filling the cavities with bone grafts or methylmetacrylate (1 case). Displaced fragments were reduced whenever possible. Limbs were immobilised in plaster casts. The follow-up period for patients with benign lesions was 8 years. All fractures healed. Arthritis with persistent pain and knee contracture was noted in 1 patient who underwent surgery 3 times for giant cell tumour recurrences, complicated by infection and varus deformity.

[Stress fractures of the tibia in elderly women]. / Zlamania zmeczeniowe goleni starszych kobiet.

Five women with stress fractures of the tibia with concomitant osteoarthritis of the knee were treated at the Department of Orthopaedics and Traumatology of the Lublin University of Medical Sciences between 1996 and 2001. The patients' age ranged from 57 to 78 years. Three fractures were located in the proximal part of the tibial shaft and 2 in the distal part of the tibial shaft. Two patients were unable to ambulate and 3 walked with crutches. In 2 cases the fracture healed after immobilisation in a walking cast for a period of 5 and 6 months respectively. Two cases with a concomitant varus or valgus deformity were treated surgically. In a 72-year-old woman the fracture healed 10 months after stabilisation with a locked intramedullary nail. In a 78-year-old woman the fracture healed 7 months after surgical correction of the tibial axis without internal fixation and a simultaneously performed Charnley knee arthrodesis. Immobilisation was achieved by a long plaster cast. A knee endoprosthesis was implanted in this patient a year after the first procedure because of advanced osteoarthrosis. A 72-years-old patient could not be treated because of poor general condition and advanced degenerative changes in both knee joints. All treated patients were pain free and ambulation parameters improved.