Arthroscopic intra-articular biopsy using a suction trap device.

Biopsy of the synovium and other intra-articular structures is frequently performed arthroscopically. We describe a technique of arthroscopic biopsy using a suction punch device linked in series with a Lukens tube suction trap. This technique allows for the controlled biopsy of intra-articular pathology, collects material in a tube which is convenient for handling, prevents the loss of biopsy material in the joint or portal tracks, and saves time by limiting the number of instrument passages into the joint.

Interlocking intramedullary nailing of pathological fractures of the shaft of the humerus.

We performed a retrospective study of thirteen patients who had had sixteen pathological fractures of the shaft of the humerus secondary to metastatic disease. All but one fracture was stabilized with interlocking intramedullary nailing with use of a closed technique. The mean operative time for the sixteen procedures was ninety-two minutes (range, fifty to 180 minutes), the mean blood loss was 116 milliliters (range, fifty to 200 milliliters), and the mean duration of hospitalization was five days (range, two to ten days). Fourteen extremities had a return to nearly normal function within three weeks after nailing. Relief of pain was rated as good or excellent in all but one patient. Eleven patients (fourteen humeri) received radiation therapy at a mean of seven days (range, three to fourteen days) after the operation. Nine patients died at a mean of four months (range, one to twelve months) postoperatively; the remaining four patients were still alive at a mean of ten months (range, nine to fifteen months). There were no problems related to the wound, deep infections, nerve palsies, or failures of the implant. The fracture was united in all seven of the eleven extremities in patients who survived for at least three months and had radiographs available. Interlocking intramedullary nailing of the humerus for pathological fractures provides immediate stability and can be accomplished with a closed technique, brief operative time, and minimum morbidity, with a resultant early return of function to the extremity.

Management of humeral nonunion after the failure of locking intramedullary nails.

We reviewed 21 cases of humeral nonunion following the failure of "locking" humeral nails. The nails had been inserted as the primary operative procedure following humeral fracture in fifteen cases or after the failure of closed treatment in six cases. Reconstruction after the failure of these implants was complicated by poor bone stock and difficulty in achieving union. Although technically difficult, open reduction and internal fixation with plating and bone grafting (successful in nine of nine cases) was more consistent than exchange nailing (successful in four of 10 cases) in achieving union (p = 0.01). Two patients refused further surgical intervention. The degree of bone loss associated with a loose nail, the lack of success of exchange nailing, and the insertion site morbidity associated with humeral nail removal differentiate these nonunions from similar lower extremity problems. The degree of bone loss following failed locking nailing of the humerus is a major concern, and exchange nailing alone may not be an acceptable option to deal with this problem.