Calcitonin use in giant cell bone tumors.

INTRODUCTION: As osteoclast, giant cell tumors express calcitonin receptors. The aim of this paper is to assess treatment using salmon calcitonin after curettage. MATERIAL AND METHODS: We retrospectively reviewed 25 patients with giant cell tumor of the appendicular skeleton treated with a single protocol of calcitonin administration following curettage in order to assess the effectiveness of calcitonin in reducing the rate of local recurrence. RESULTS: The mean duration follow-up was 68 months. Thirteen patients (52%) had local recurrence. Eight of them were treated successfully after repeated curettage and calcitonin. Four patients had bone resection and one patient had curettage and cement filling. All patients with cavity left empty had ossified and the functional score as assessed by the MSTS score was 28.02/30. CONCLUSION: This study suggests that the use of calcitonin as adjuvant is not effective and that filling agents are not required after curettage of giant cell tumors. LEVEL OF EVIDENCE: Level 4.

Knee arthrodesis using a vascularized fibular rotatory graft after tumor resection.

INTRODUCTION: Knee arthrodesis is one of the reconstruction options for limb preservation after malignant tumor resection. Vascularised rotatory fibular transfer allows biological and, thus,definitive reconstruction. The goal of this work was to analyse the results of knee arthrodesis with vascularised fibular graft after tumor resection and to discuss the reliability of this technique. PATIENTS AND METHODS: We report a retrospective series of 13 patients with an average age of 29.6 years. The pathological diagnosis was bone sarcoma in 12 cases and synovial chondrosarcoma in one case. Resection/arthrodesis was undertaken as the primary procedure in 11 cases.In two cases, arthrodesis was indicated after failure of an endoprosthesis. Reconstruction was achieved with a vascularised fibular rotatory transfer in all cases. For stabilisation, an external fixator was utilised in eight cases, a femorotibial nail in three cases, and a plate in two cases.Mean follow-up was 6 years. RESULTS: We encountered infection in 53% of cases, mechanical complications in 53% of cases,and nerve palsy in 23% of cases. Four patients died from metastases (only one had arthrodesis complete union). In the nine surviving patients, arthrodesis was fully united in seven cases,after an average period of 36 months. The functional score average (Enneking classification)was 20 points. DISCUSSION: Knee arthrodesis after tumor resection is a complex technique. Septic complications and mechanical failure are frequent regardless of the technique employed. They are related to the extent of bone sacrifice but also to that of soft tissues. The use of vascularised fibula alone and stabilisation by external fixation were the main shortcomings in this series. TYPE OF STUDY RETROSPECTIVE: Level IV.

Total knee arthroplasty in a spinal cord-injured patient: a case report.

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as "water on the knee"), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery.

[Isokinetic, functional and proprioceptive assessment of soccer players two years after surgical reconstruction of the anterior cruciate ligament of the knee]. / Evaluation isocinétique, fonctionnelle et proprioceptive du footballeur à deux ans postopératoire de la reconstruction du ligament croisé antérieur du genou.

UNLABELLED: Injuries to the anterior cruciate ligament (ACL) of the knee are common in sport and are treated routinely in the world of sports medicine. In order to resume competitive sport in safety, it is important to know the actual level of performance achieved by the operated leg some time after the ligament repair. OBJECTIVES: The objective of this work was to evaluate the recovery of the operated leg in Tunisian sportsmen two years after surgery by using isokinetic testing (60 degrees s(-1)), the one-leg hop distance test (i.e. a functional activity that one often finds in sport) and proprioceptive assessment. A secondary objective was to detect any possible correlations between the various outcomes. MATERIALS AND METHOD: The ACL group was composed of 26 top-level Tunisian footballers having undergone ACL ligament repair. Two years after surgery, the following assessments were performed: an isokinetic test with an angular velocity of 60 degrees s(-1), a proprioceptive assessment in both active and passive modes and the functional one-leg hop distance test. RESULTS: Our investigations confirmed a muscle deficit of 16% in the hamstring muscles of the injured leg. In both active and passive modes, normal proprioception is observed at a flexion of 60 degrees and in total extension but not in a mid-way position. The performance level of the operated leg (in terms of distance) had an average symmetry value of 93.40+/-2.7%. CONCLUSION: Playing football appears to influence the isokinetic strength profile in sportsmen after ACL repair. The repair procedure leads to bilateral proprioceptive disruption at 15 degrees of knee flexion, on average.

[Valgus osteotomy in the treatment of pseudoarthrosis of the femoral neck: 41 cases]. / Ostéotomie de valgisation dans les pseudarthroses du col du fémur: à propos de 41 cas.

PURPOSE OF THE STUDY: Treating hip trauma victims who develop nonunion of the femoral neck remains a challenge in orthopedic surgery. We studied the clinical and radiological outcome after Pauwels osteotomy for valgisation. MATERIAL AND METHODS: This retrospective series included 41 patients (25 men and 16 women), mean age 44.5 years. Initial treatment was surgical in 21 cases and had been insufficient in 91%. Nonunion (subcapital in 53%, transcervical in 40% and basicervical in 7%) had persisted for 16 months. A tight nonunion was present in 65.9% of the cases and the femoral head appeared normal in 70%. Femoral osteotomy was performed for simple valgisation in 78% of the cases with a mean 31.5 degrees correction (range 15 degrees to 50 degrees ). A nail or screwed plate was used for fixation. Results were analyzed at a mean 76 months post-surgery. RESULTS: Bone healing was achieved in 98% of the cases. The only failure was related to inappropriate surgical technique. Necrosis was observed in 16 cases. The functional outcome was very good or good in 82% of the patients. CONCLUSION: Osteotomy for valgisation remains a very good salvage procedure for nonunion of the femoral neck following hip trauma. It can be used for elderly subjects even in the presence of early stage or partial necrosis.

[Use of Ilizarov fixator in the treatment of post-osteomyelitis pseudoarthroses in children]. / Utilisation du fixateur d'Ilizarov dans le traitement des pseudarthroses post-ostéomyélitiques de l'enfant.

PURPOSE OF THE STUDY: The aim of this study was to emphasize the importance of the distraction osteogenesis technique in the treatment of post-osteomyelitis nonunion. We report 12 cases. PATIENTS AND METHODS: Mean patient age was 9.5 years. There were 7 cases of nonunion of the femur and 5 involving the tibia. Nonunion was associated with 5.9 cm shortening in 10 cases, 8.4 cm circumferential bone defect in 1 case, shortening and bone defects in 6 cases, and shortening and joint deformities in 2 cases. RESULTS: Consolidation was obtained in 11 cases with an average delay of 11.6 months. Infection was eradicated in 75 per cent of the cases. Average residual shortening was 0.4 cm. Joint deformities and axial deviations were corrected at the same time in all cases. DISCUSSION: The advantages of the Ilizarov technique are well known for the treatment of such deformities and musculoskeletal system disorders subsequent to osteomyelitis: nonunion, infection, shortening, joint deformities and malunion.

[Giant cell tumors of the distal end of the radius treated by resection-arthrodesis]. / Tumeurs à cellules géantes de l'extrémité inférieure du radius traitées par résection-arthrodèse.

The distal end of the radius is one of the sites commonly affected by giant-cell tumor of bone; it poses problems of reconstruction after resection of the distal radius. The authors present a retrospective study of 5 giant cells tumors treated by resection-arthrodesis of the wrist. These tumors were seen in 3 men and 2 women. From the radiological point of view, all tumors were extensive and lytic lesions centered in the epiphysis and involving the metaphysis; the wrist joint was respected. From the histological point of view, the tumors were grade I in 3 cases and grade II in 2 cases. With a mean follow up of 8 years, the results were considered good in 3 cases, fair in 1 case and poor in 1 case. A high incidence of bone complications was noted: delayed union (up to 11 months) and fracture of the graft, which occurred in 3 patients.

[Fracture-luxation of the femur head. Apropos of 10 cases]. / Fracture-luxation de la tête fémorale. A propos de 10 cas.

The authors report 10 segmental fractures of the femoral head associated with a dislocation of the hip. Using PIPKIN's classification, they noted 1 type I, 7 type II and 2 type III fractures. The initial treatment of the hip dislocation was conservative in all cases. Failure of reduction was noted in 6 cases and was complicated by fracture of the femoral neck in 2 cases. The attitude regarding the head fragment was: conservative in 5 cases, the reduction was considered satisfactory in 4 cases and poor in 1 case; surgical in the other 5 cases: screw fixation in 1 case, excision of the fragment in 1 case and prosthetic replacement of the femoral head in 3 cases. After a mean follow-up of 5 years, functional results were satisfactory in the majority of cases. The radiological assessment showed malunion without osteoarthrosis in one case and avascular necrosis of the femoral head in three cases. The authors propose a treatment policy based upon their experience and a review of the literature.