Bilateral pseudarthrosis of the femur after stress fracture.

Stress fractures of the diaphysis of the femur are very rare, particularly bilateral ones. We describe here a woman patient with bilateral pseudoarthrosis of the femoral diaphysis which was the result of a stress fracture. The case is a rarity because the in question is of a dwarfism stature with great deformation of the lower extremities due to rickets. The patient has been closely examined for over 30 years. Our own explanation for the beginnings of stress fracture as well as for the pseudarthrosis development are given.

[Stress fractures]. / Prijelom zamora.

In spite of the fact that the first description of stress fracture appeared 130 years ago, its origins still remain unknown. There are numerous potential factors causing fractures in some circumstances. It is sure that this is the result of disharmony of overstrain (bending force or compression force) of groups of muscles on the one hand and skeletal carrying capacity, i. e. one skeletal segment on the other hand. In differential diagnosis, particular attention is to be paid to some localizations, firstly to tibia and femur, since sometimes they are similar to osteomyelitis, osteoid-osteoma or osteogenic sarcoma. It may be supposed that the number of cases constantly grows, corresponding to higher number of participants of various sports and of different age, to be determined by the application of new diagnostic methods, revealing the development of the process far earlier than x-ray (scintiphotography, thermography, ultrasonography and CT). The majority of cases are successfully treated and cured by conservative methods, frequently only by resting, while only rarely there are cases with shift of segments and indicated surgical treatment. A lot of cases are asymptomatic. In the period from 1981 to 1986, we clinically registered 113 cases of stress fractures with soldiers, 105 of them of metatarsus bones, 4 of tibia, 3 of fibular malleolus and 1 of cuboid bone.

Prosthetic replacement of the knee in the treatment of infected and recurring giant cell tumor of the distal femur.

Giant cell bone tumors represent a specific problem in surgery. While excochleation of the tumor and insertion of the bone transplant (with the potential development of local recurrence or even malignant alterations) were the former procedures of treatment, today it is recognized that block resection of the tumor and replacement of the defect with a special endoprosthesis gives better and longer lasting results and complete functional restitution of the joint. The case report of a 25-year-old patient with recurring giant cell tumor of the distal femur is presented. Due to the failure of surgical treatment and repeated recurrence with infection, 15 cm of the distal femur was resected and a knee endoprosthesis was inserted. Two years after surgery, functional findings of the knee are excellent and there are no signs of infection.

[Giant cell tumor (osteoclastoma) of the scaphoid bone of the hand (author's transl)]. / Riesenzellgeschwulst (Osteoklastom) des Kahnbeins der Hand.

The article describes a giant cell tumour in the scaphoid bone of the hand in a 26-year-old man. No reports have so far been published in literature on this localisation. Total extirpation of the entire scaphoid bone and of the tumour was performed. 2 years after the operation, there was no sign of any relapse.