Breast cancer bone metastasis in femur: surgical considerations and reconstruction with Long Gamma Nail.

AIM: The femur is the most common long bone involved in metastatic breast cancer. Several studies have been published on the surgical management of metastatic disease of the femur. However, only few studies have been published specifically on the outcomes following reconstruction of femoral metastasis from breast cancer using a third generation intramedullary nail. The aim of this study is to review the outcomes after intramedullary surgical stabilization of femoral metastases from breast cancer. This is often associated with significant bone destruction. METHODS: A retrospective study of 18 femoral metastatic lesions in 15 patients treated with a Long Gamma Nail over a 6-year period was carried out. Pain relief, mobilization status and implant related complications were the main outcome measures analyzed. RESULTS: Thirteen out of 15 patients had complete pain relief and all patients regained their preoperative mobilization status with or without walking aids. There were no implant failures or perioperative deaths. Four (26%) patients developed minor complications. Ten patients died with an average survival of 9 months and five patients are alive with an average survival of 32 months. CONCLUSION: Stabilization of femoral metastases due to breast cancer with Long Gamma Nail is a safe and effective method with acceptable risks.

Proximal interphalangeal joint release in Dupuytren's disease of the little finger.

We present a prospective study, with 3-year follow-up, of the role and outcome of fasciectomy plus sequential surgical release of structures of the proximal interphalangeal joint in Dupuytren's contracture of the little finger. Our treatment programme involves fasciectomy for all patients followed by sequential release of the accessory collateral ligament and volar plate as necessary. Of the 19 fingers in the study, eight achieved a full correction by fasciectomy alone, and in these cases there was a fixed flexion deformity of 6 degrees at 3 months and 8 degrees at 3 years. The remaining 11 fingers (initial mean deformity 70 degrees flexion) were left with a fixed flexion deformity of 42 degrees after fasciectomy which reduced to 7 degrees with capsulo-ligamentous release. This increased to 26 degrees at 3 months but then remained relatively stable, increasing only to 29 degrees at 3 years. In our experience sequential proximal interphalangeal joint release has led to consistently good results with few complications in the correction of severe Dupuytren's disease of the little finger.

Treatment of patello-femoral arthritis using the Lubinus patello-femoral arthroplasty: a retrospective review.

There are few published results in the literature on patello-femoral arthroplasty. The aim of this study was to help to define the place of patello-femoral arthroplasty in the treatment of isolated patello-femoral arthritis. All patients who underwent patello-femoral arthroplasty using the Lubinus prosthesis for patello-femoral arthritis between 1992 and 1998 in two neighbouring district general hospitals were studied. There were 34 patients who underwent 45 arthroplasties. The modified Hungerford and Kenna scoring system and the Insall and Crosby scoring system were used to clinically evaluate the patients. Serial radiographs were assessed for patellar malalignment, mechanical failure and progressive arthritic change. Twenty-three knees (64%) had a good or excellent result, six (17%) had an unsatisfactory result and seven (19%) were revised to either a total knee arthroplasty (5 knees) or patellofemoral arthroplasty (2 knees). Although the results do not compare favourably with those of total knee replacement for generalised arthritis of the knee; we believe that with careful patient selection coupled with careful surgical technique, patello-femoral arthroplasty can be successfully used to treat isolated patello-femoral osteoarthritis.

Dall-Miles cable and plate fixation for the treatment of peri-prosthetic femoral fractures-analysis of results in 13 cases.

We present a retrospective review of 13 patients with periprosthetic femoral fractures treated with the Dall-Miles cable and plate fixation system between 1995 and 1999. Of these, 12 fractures were in relation to hip arthroplasty and one was proximal to the femoral component of a total knee replacement. Mean age at presentation was 77 years (range 66-87) with the male female ratio of 6:7. All patients were followed up until there was evidence of clinical and radiological union. The average follow-up period was 6.5 months (range 2.5-24). We achieved satisfactory results in ten patients with average time to union of 4.4 months. The results were unsatisfactory in three patients who required further revision procedures due to failure of fixation or non-union. Internal fixation of the fracture with the loose femoral component left in-situ led to failure of union in one patient. Varus mal-alignment of the femoral component to the shaft of more than 6 degrees was associated with unsatisfactory outcome in two patients. The Dall-Miles cable and plate system is a useful method of internal fixation for majority of periprosthetic femoral fractures. This method may not be suitable if the femoral component is loose or if it is in varus angulation of more than 6 degrees to the shaft of the femur.