Orthopedic emergencies in cancer patients.

The most frequent orthopedic emergency in oncology patients is fracture. Stabilization of the entire fractured bone restores function and relieves pain. The site, quality, and extent of the lesion can identify impending fractures that should be stabilized. New methods of pelvic stabilization effectively bypass periacetabular bone deficiency. Spinal cord decompression is important to maintain neurologic function. Advances in segmental fixation of the spine have improved the outcome over what was achieved by radiation alone. Infection is common in neutropenic patients, and should be treated aggressively with antibiotics and drainage of abscesses of the musculoskeletal system. Extravasation of doxorubicin requires prompt local debridement to limit the extent of necrosis propagation. These treatments can effectively improve the quality of life of patients with metastatic cancer. They should be included as "best supportive care" for patients with more than 1 month to live.

Gastrocnemius muscle transfer in limb-sparing surgery for bone tumors around the knee.

Limb-sparing surgery for bony tumors around the knee, resulting in large segmental defects, involves its replacement with an endoprosthesis. The viability of the overlying skin flaps is of utmost importance. Their healing without breakdown is essential or else leads to prosthesis exposure, infection and perhaps prosthesis removal. In this situation, gastrocnemius muscle transfer is a robust vascular option, not only providing soft padding to cover the endoprosthesis, but also supporting the vascularity of the skin flaps. Out of 16 such muscle transfers done, 15 survived completely with good wound healing. One patient developed a severe infection of the wound associated with skin flap breakdown and necrosis of part of the muscle flap. There was 1 case of wound haematoma which was treated successfully.