Surgical management of neglected fractures of the patella.

Between April 1996 and May 2002, 22 people (18 men, 4 women) were treated for neglected fractures of the patella at our hospital. The median patient age was 43 (range 22-55) years. The majority of the fractures were caused by a direct fall on the knee. In all they comprised 18 transverse, 2 comminuted and 2 lower pole fractures, most of which had been treated by traditional methods initially. The median time between injury and surgery was 3 (range 2-6.5) months. Treatment methods in the orthopaedic department included tension band wiring in 16 cases, tension band wiring with cerclage in 3 cases and patellectomy in 3 cases. Results were evaluated after a median follow-up period of 5.5 (range 2-9) years and were based on Bostman criteria. Excellent results were achieved in 5 and good results in 15 cases. The poor results in two cases were due to infection and implant failure. Surgical treatment of neglected fractures of patella can thus lead to favourable outcomes.

The functional and oncological results after scapulectomy for scapular tumours: 2-16-year results.

Twenty-five patients underwent scapulectomy for various tumours between 1989 and 2005. We describe 23 patients with scapular tumours who were followed-up for a minimum of 2 years after scapulectomy. The average age was 29 years, and two-thirds of the patients were male. Nineteen patients had malignant neoplasms, of which chondrosarcoma was most common, followed by Ewing's sarcoma. Surgical staging was by Enneking's system, with stage IIB being the most frequent. Fifteen patients underwent total scapulectomy, and the rest had their glenoid retained. With an average follow-up period of 66.7 months (23-202 months), functional and oncological outcomes were evaluated for all patients. Two patients had superficial wound infections requiring antibiotics, and one had skin necrosis requiring skin cover. Functional outcome was satisfactory in 13 patients. Cosmetically and emotionally acceptable surgery, scapulectomy made 19 patients continuously disease free, while four patients died of disease. The 5-year survival rate of 19 patients with malignant tumours was 75.9%. Retention of the glenohumeral articulation (subtotal) resection gives superior functional results.