Jig-assisted modified Harrington reconstruction for metastatic bone destruction of the acetabulum.

INTRODUCTION: We developed a technique using an indigenously designed jig to assist pin placement in producing a stable and long-lasting construct to augment the acetabulum combined with a cemented hip replacement in cases of metastatic destruction of the acetabulum. We describe our novel modified Harrington technique and retrospectively assess our cohort's clinical outcomes and complications. METHODS: Between 2006 and 2019, 27 patients with a median age of 69 (49-81) years and a median ASA grade of III (II-IV) were managed using our modified 'Harrington' technique. We assessed outcomes on the following criteria: mechanical complications, post-surgery mobility, and functional outcome using Musculoskeletal Tumour Society Score (MSTS). RESULTS: At the last follow-up, ten patients were alive with disease [median follow-up of 26 months (12-74)], and 17 patients died of their oncological disease [median follow-up of 15 months (9-22)]. There were no perioperative deaths or intra-operative complications in our series. In total, ten complications were noted in nine patients (33%). Mobility-wise, 13 patients (48%) mobilised unaided, ten patients (37%) required a stick or crutch, two patients (7%) required a frame and two patients (7%) were wheel chair-dependent. The median MSTS score of all patients during their latest follow-up was 18 (8-26). CONCLUSION: Our jig-aided modified Harrington reconstruction technique assists in safe placement of antegrade pins in acetabulum during surgery and offers a long-lasting solution to these high-risk patients. The use of large diameter pins, appropriate patient selection, and cage used during construction in the acetabulum demonstrated relief of pain, improved mobility, and favorable functional outcomes with minimal complication rates.

Diagnostic value of sinus tract culture versus intraoperative bone culture in patients with chronic osteomyelitis.

To compare the organisms isolated from the sinus tract culture and intraoperative bone culture in patients with chronic osteomyelitis. This cross sectional prospective study was conducted from February 2015 to March 2016. Ninety consecutive patients were enrolled in study (n=90). Inclusion criteria were patients with either sex, any age, chronic osteomyelitis having discharging sinus. Sample from sinus tracts and bone were taken through standardized aseptic technique and organism were cultured. There were 62 males and 28 females, male to female ratio 3:1, mean age was 40 years. 23 patients had primary osteomyelitis and 67 had secondary osteomyelitis. 68 patients had orthopaedic implant infections. In 61/90 (67%) patients the same organism was isolated on both sinus tract and intraoperative cultures.In our scenario we found that within the limitations of this study, there was a high ratio of agreement between the sinus tract and intraoperative cultures. We conclude that if used judiciously, sinus tract cultures can yield accurate results in the majority of cases.

The medial plantar artery flap: a series of cases over 14 years.

Coverage of the weightbearing heel poses a unique technical challenge to the reconstructive surgeon. In the present study, we share our clinical experience with the use of the medial plantar artery-based flap for coverage of tissue defects around the heel. Eighteen medial plantar artery flaps performed from January 1996 to December 2009 were included. All the procedures were performed by 2 surgeons at Aga Khan University and Hospital (Karachi, Pakistan) and Bahawal Victoria Hospital (Bahawalpur, Pakistan). Of the 18 patients, 16 were male and 2 were female. The indications were traumatic loss of the heel pad in 13, pressure sores in 2, and unstable plantar scars in 3. All the flaps were raised as sensate fasciocutaneous pedicled flaps based on the medial plantar artery. All the flaps healed uneventfully without major complications. The donor site was covered with a split-thickness skin graft, and we had partial graft loss in 1 case. The sensate flaps had slightly inferior protective sensation compared with the normal side. From our results, we suggest that the medial plantar artery flap is a good addition to the existing armamentarium. It provides tissue to the plantar skin with a similar texture and an intact protective sensation. The technique is easier to master compared with free microvascular flaps and has less risk of any functional donor site morbidity.