Resection of Renal Cell and Prostate Carcinoma Sternum Metastases with Long-Term Follow-Up: A Report of 2 Cases.

Introduction: Rarely solitary sternum metastases are addressed by resection. Two additional cases are presented as they are interesting because of their long-term follow-up. Case Presentation: Case 1: A renal cell carcinoma was treated by transabdominal nephrectomy at age 64. Right iliac bone and sternum metastases were diagnosed 7 months later and treated by internal hemipelvectomy followed by sternum metastasectomy 6 weeks after the internal hemipelvectomy. At 12-year follow-up, the patient appears disease free. Case 2: Prostate cancer was treated by prostatectomy at age 67. A subsequent solitary sternum metastasis was resected 10 years later for persistent PSA-activity despite repeated radiotherapy. The patient remains asymptomatic for 3 years now. Conclusion: Resection of sternum metastases may have curative potential and should be considered in tumours known to be rather resistant to chemo- and/or radiotherapy.

Arthroscopic Synovectomy in Bilateral Lipoma Arborescens.

INTRODUCTION: Lipoma arborescens (LA) is an uncommon condition that consists of a villous lipomatous proliferation of the synovial membrane. Open synovectomy has been previously selected as a curative treatment option. In recent years, some authors have published good results with arthroscopic interventions. We describe a well-documented case of bilateral LA of the knees treated with staged arthroscopic synovectomy. CASE REPORT: A 48-year-old North American woman without a history of trauma presented with recurrent effusions and mild pain in both knee joints for many years. Magnetic resonance imaging examinations confirmed the diagnosis of bilateral LA with multiple villous lipomatous synovial proliferations pattern. Degenerative changes of the medial meniscus were detected bilaterally. The patient underwent bilateral arthroscopic anterior synovectomy and partial medial meniscectomy of the knee with three portal techniques. Arthroscopic the knee joint contained a large number or finger-shaped synovial proliferations with yellowish good vascularized diffuse villous masses in the suprapatellar bursa and intercondylar fossa. The cartilage showed degenerative changes with Outerbridge Grade II to III, which was particularly severe in the femoropatellar compartment. Histopathological examination of the villous masses demonstrated papillary hypertrophy, slight hyperplasia, vascular hyperplasia with a slight degree of stromal fibrosis, and interstitial lymphoplasmacytic inflammation. The adipose cells were reduced in number in relation to a normal finding but had a normal aspect without any pathological changes. 25 months after the first operation, the patient reported pain relief with the preserved function. Magnetic resonance examination of both knee joints at the last follow-up showed no relapse of the disease. The Knee injury and Osteoarthritis Outcome Score improved on the right knee joint from 39.3 preoperatively to 85.1 at the last follow-up, and on the left knee joint from 54.2 preoperatively to 86.3 at the last follow-up. CONCLUSION: Arthroscopic anterior synovectomy is an efficient method of achieving good results in LA with multiple villous lipomatous synovial proliferations pattern.

Intra-articular giant synovial osteochondroma: case reports of the ankle and knee joint.

Two cases of giant intra-articular osteochondromas (knee and ankle joint) are reported; pathologically they are rare representations of synovial chondromatosis. A 17-year-old man presented with a tumorous mass which had been localized in his left ankle for many years, increasing in volume during the last months. The lesion was removed by posteromedial ankle arthrotomy. The second case was observed in a 39-year-old woman with a slow-growing mass in her right knee joint. The lesion was removed from the Hoffa fat pad by open anteromedial arthrotomy.

Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study.

This study examines the effect of the tibial slope on the anterior cruciate ligament lesion (separately on the lateral and medial tibial condyle). The study consisted of 33 matched pairs of patients divided into two groups: an examined group with a diagnosed ACL lesion, and a control group with diagnosed patellofemoral pain. The patients were matched on the basis of four attributes: age, sex, type of lesion (whether it was profession-related), and whether the lesion was left- or right-sided. Measurements were carried out by radiography and MRI. In the examined group, the lateral tibial plateau was significantly greater than in the control group (P < 0.001), and the medial tibial plateau had lower tibial slope values than the control group; however, the difference was not statistically significant (P = 0.066). In both groups, the difference between the slopes on the lateral and medial plateaus was statistically significant (P < 0.001). In relation to ACL intact patients, population with ACL rupture have greater tibial slope of the lateral condyle. The greater tibial slope of the lateral tibial plateau may be the factor that leads to the injury of the anterior cruciate ligament. Compared to the medial plateau, the population with ACL rupture have a greater tibial slope on the lateral plateau, while the population of the intact ACL have greater tibial slope on the medial plateau. The tibial slope of the medial and lateral condyle should be compared separately because the values obtained from the two sets of data were different, revealing apparently opposing effects on the ACL lesion.

Corrective Imhäuser intertrochanteric osteotomy.

OBJECTIVE: Surgical correction of deformities of the proximal femur caused by epiphyseal displacement by restorative (usually inflection and internal rotation) osteotomy at the intertrochanteric level with the aim of reducing both the offset disorder of the coxal end of the femur that is causing impingement and the prevalence of secondary coxarthrosis. INDICATIONS: Chronic and subacute manifestations of slipped capital femoral epiphysis with an epiphyseal dislocation in the radiographic axial view of 30-60 degrees (ET angle) and DeltaED > 20 degrees (CCD angle minus ED angle) in the anteroposterior view. CONTRAINDICATIONS: Acute phase or course of slipped capital femoral epiphysis. Secondary coxarthrosis (after slipped capital femoral epiphysis). Traumatic epiphyseolysis. SURGICAL TECHNIQUE: Exposure of the proximal femur (anterior femoral neck, intertrochanteric plane, proximal femoral diaphysis) through an anterolateral approach; fixation of the femoral epiphysis with two 3.0-mm Steinmann nails positioned parallel in a posteromedial direction; the seating chisel is hammered in according to the planned, usually inflectional axial correction; intertrochanteric osteotomy by excision of a wedge oriented in accordance with preoperative planning; adaptation of the osteotomy surfaces and osteosynthesis with a 90 degrees AO adolescent plate under interfragmentary compression. POSTOPERATIVE MANAGEMENT: Mobilization on underarm crutches with unloading of the extremity for 2 months postoperatively; gradual increase in loading depending on osseous consolidation of the osteotomy; radiographic assessment 2 and 4 months postoperatively, further clinical and radiologic follow-up until growth is completed (closure of the growth plate); removal of implants at 1 year postoperatively or thereafter. RESULTS: Retrospective follow-up of 51 patients with unilateral, moderate to severe slipped capital femoral epiphysis (indication: epiphyseal displacement angle of 30-60 degrees, average preoperative displacement angle 45 degrees) that was corrected surgically by Imhäuser intertrochanteric osteotomy and epiphyseal nailing. After an average observation time of 24 years (range: 20-29 years), 28 (55%) of the 51 hip joints were clinically asymptomatic and radiologically free of degenerative changes; moderate clinical and radiologic changes were recorded for 14 hip joints (28%), and advanced changes for nine (17%). Complications related to surgery were apparent in a total of six hip joints: in one case, the Steinmann nail broke after being damaged by the plate blade; in two cases, revision osteosynthesis of the intertrochanteric osteotomy was necessary due to incorrect implant positioning; partial femoral head necrosis developed in one hip joint; there were two cases of low-grade osteomyelitis that healed after implant removal.

A simple capsulorrhaphy in a posterior approach for total hip arthroplasty.

In an attempt to decrease a 4% incidence of posterior hip dislocation following a posterior approach, a simple capsulorrhaphy was utilized in 255 consecutive primary total hip arthroplasties performed by 1 surgeon. All patients were reviewed at a minimum of 2 years' postoperatively, and no patient was lost to follow-up. One patient sustained a posterior hip dislocation, whereas there were no anterior hip dislocations. The dislocation rate of 0.4% is equal to or less than the rates of dislocation reported in the literature using other posterior repairs. This technique differs from other reported methods because of its simplicity and ease of repair. Only the capsule (and not the rotators) is sutured to the medius tendon (not to bone), creating an elastic endpoint that is less likely to disrupt during the healing process.