Vascularized fibular autograft as salvage technique in failure of allograft intercalary reconstructions after tumor resections.

Intercalary allografts after diaphyseal resections for bone tumors represent the most frequent option of reconstruction. Main complications are non-unions, fractures and infections. The purpose of the current study was to report our experience with the use of vascularized fibular autograft as rescue technique in failed previous reconstructions after intercalary bone tumor resection of the extremities. Twenty-eight patients were followed over time. Causes of failure were non-union, allograft fracture and infection. Vascularized fibular autograft was used with mechanical support of massive bone allograft in 13 cases. Functional results were excellent in 19 cases, good in 8 and fair in one patient. Among complications we reported 4 non-unions, 2 allograft fractures, 1 non-union with plate breakage, 1 plate breakage, 1 infection, 1 limb shortening and 1 knee varus deformity. The rationale of vascularized fibular autograft is to provide biologic support. The association with massive bone allograft provides mechanical strength and early stability.

Multidisciplinary approach to osteosarcoma.

Osteosarcoma is a malignant bone tumor composed of mesenchymal cells producing osteoid and immature bone. Osteosarcoma is the most frequent primary malignant bone tumor, if we excluded myeloma, a haematologic disease. The incidence of osteosarcoma is 2-3/million/year, but is higher in adolescence, in which the annual incidence peaks at 8-11/million/year at 15-19 years of age. Local pain, followed by localized swelling and limitation of joint movement, are the typical signs and symptoms. Correct diagnosis can be achieved through a correct approach to the disease and the combination of clinical and radiographic aspects. The final step to confirm the diagnosis is the biopsy. Computer Tomography of the chest and Positron-Emission Tomography are mandatory to complete the staging, which is performed according the Musculoskeletal Tumor Society staging system. A multidisciplinary approach is needed both to get to a correct diagnosis (orthopaedic surgeon, radiologist and histopathologist) and to perform definitive treatment. Multidisciplinary approach should be performed in reference centers able to provide access to the full spectrum of care and where orthopaedic surgeon, oncologist, histopathologist, radiologist and radiotherapist can cooperate. The management of osteosarcoma is based primarily on neo-adjuvant and adjuvant chemotherapy and surgical resection; radiotherapy is not effective as osteosarcomas are relatively radioresistant. Prognostic factors include metastases at presentation, histologic response to induction chemotherapy, the site of the primary tumor (with axial lesions having an inferior outcome), serum lactate dehydrogenase and alkaline phosphatase levels.

Bilateral unicompartmental knee arthroplasty: one stage or two stages?

BACKGROUND: Bilateral unicompartmental knee arthroplasty (UKA) may be performed as one- or two-stage procedure. Previous reports suggest that UKA provides a more rapid functional recovery than total knee arthroplasty. However, little data exist on whether bilateral UKA can be performed without increasing the perioperative risk compared with unilateral cases. METHODS: We retrospectively compared 51 patients treated between January 2014 and March 2017 with single-stage UKA (group A) with 51 patients who underwent unilateral procedure (group B) to evaluate perioperative complications. We noted no statistically significant difference between the two groups in terms of gender, age and body mass index. RESULTS: Patients who underwent single-stage bilateral UKA had longer operating room time with respect to single procedure (93.2 min vs. 50.7 min). However, the bilateral group had a shorter cumulative operating room time (93.2 min) compared to the unilateral group (101.5 min) with a statistically significant difference (p < 0.05). Average hemoglobin loss at discharge was 3.1 points for group A and 2.4 for group B, with a statistically significant difference (p < 0.05). CONCLUSION: Our results demonstrated that bilateral simultaneous UKA does not increase the risk for perioperative complications. Total blood loss at discharge is statistically higher in bilateral UKA rather than unilateral UKA; however, cumulative hemoglobin loss is statistically lower in bilateral group. Patients can benefit from a single hospital admission and anesthetic time, while the shorter total inpatient stay and lower blood loss can reduce hospital costs in cases of bilateral surgery. LEVEL OF EVIDENCE IV: Retrospective study.

Bicompartmental (uni plus patellofemoral) versus total knee arthroplasty: a match-paired study.

BACKGROUND: Osteoarthritis (OA) of the knee, whether primary or post-traumatic, does not always involve all three compartments (tibiofemoral medial and lateral and the patellofemoral ones). Bicompartmental knee arthroplasty (BKA) was proposed as a good alternative to total knee arthroplasty when two of the three knee compartments were affected. MATERIALS AND METHODS: We performed a retrospective comparative study collecting all BKAs performed between March 2010 and January 2016. During this period, we treated 27 patients with BKA for medial or lateral and patellofemoral OA. Seven of them were lost to follow-up and were not included in the study. Group A (BKA group) was compared to a homogeneous group of 20 patients who underwent TKA during the same period (group B). RESULTS: Patients treated with TKA were younger than those treated with BKA (mean age 65 vs. 67.2; p = 0.2149). BKA resulted in longer mean operating time (87 vs. 82.4 min; p = 0.2983), less blood loss (413 vs. 458 ml; p = 0.0052) but higher blood transfusion rate (12 vs. 10%). Medium follow-up was 34 months for BKA group and 38 months for TKA group. No statistically significant differences were found in KSS score between the two groups (KSS score 92.3 for BKA, 94.5 for TKA; p = 0.5221; KSS function was 87.2 for BKA and 89.2 for TKA; p = 0.4985). CONCLUSION: The most important finding of the present study was that although BKA seemed to be theoretically more favorable in terms of functional recovery and blood loss, patients of group A had lower KSS score and higher transfusion rate than those of group B. Our data confirm that BKA could be proposed as an alternative to TKA, especially in young and high-demanding patients.

Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up.

INTRODUCTION: The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. METHODS: The patient population was randomly placed in two groups: group A (58 patients), who underwent femoral screw fixation; group B (62 patients), who underwent femoral press-fit fixation. RESULTS: At last follow-up 9.2% of patients were lost; 28% of patients in group A and 64% of patients in group B had excellent International Knee Documentation Committee score (grade A); 66% of patients in group A and 32% of patients in group B had good International Knee Documentation Committee scores (grade B). The difference was statistically significant (p < 0.05). CONCLUSIONS: Femoral press-fit fixation of bone- patellar tendon- bone autograft provides stable fixation at low cost, it ensures unlimited bone-to-bone healing and high primary stability, avoiding the disadvantages of hardware and the need for removal in case of revision.

[Paralysis of the median nerve due to a lipofibrohamartoma in the carpal tunnel]. / Parálisis del nervio mediano secundaria a lipofibrohamartoma en el túnel carpiano.

INTRODUCTION: The lipofibrohamartoma is a rare entity of unknown origin that can affect any peripheral nerves, but mainly being found in the median nerve within the carpal tunnel. The lipofibrohamartoma is frequently associated with other conditions such as macrodactyly, the Proteus and Klippel-Trenaunay-Weber syndromes and multiple exostosis, among others. CLINICAL CASES: Two cases of lipofibrohamartoma in the carpal tunnel with associated median nerve palsy are described in the present article. They were treated by simple decompression of the median nerve by releasing the transverse carpal ligament and a palmaris longus tendon transfer to improve the thumb abduction (Camitz procedure). In one of the cases (a previously multi-operated median nerve entrapment at the carpal tunnel), a posterior interosseous skin flap was employed to improve the quality of the soft tissues on the anterior side of the wrist. DISCUSSION: A review of the literature is also presented on lipofibrohamartoma of the median nerve, covering articles from 1964 to 2010. The literature suggests that the most recommended treatment to manage this condition is simple release of the carpal tunnel, which should be associated with a tendon transfer when a median nerve palsy is noticed.

Parálisis del nervio mediano secundaria a lipofibrohamartoma en el túnel carpiano / Paralysis of the median nerve due to a lipofibrohamartoma in the carpal tunnel

Introducción. El lipofibrohamartoma es una rara entidad nosológica de etiología desconocida que puede afectar a cualquier nervio periférico, localizándose de forma preeminente en el nervio mediano en el interior del túnel carpiano. El lipofibrohamartoma se asocia con frecuencia a otras alteraciones como la macrodactilia, los síndromes de Proteus y Klippel-Trenaunay-Weber, y la exóstosis múltiple, entre otras. Casos clínicos. Los autores han tratado en 20 años 4 lipofibrohamartomas del nervio mediano, 2 de los cuales tenían parálisis mediana, motivo de este artículo. Estos pacientes se trataron con liberación simple del nervio mediano mediante apertura del ligamento anular del carpo y transposición tendinosa abductora con palmaris longus prolongado con la fascia palmar superficial (técnica de Camitz). En uno de los casos, multioperado previamente, se realizó también un colgajo interóseo posterior para mejorar la calidad de las partes blandas de la cara anterior de la muñeca. Discusión. Se hace una revisión de la literatura sobre el lipofibrohamartoma del nervio mediano desde 1964 hasta 2010. La revisión de la literatura sugiere que el tratamiento más recomendado es la liberación simple del túnel carpiano y se recomienda asociar una transposición tendinosa si hay parálisis del nervio mediano(AU)

Introduction. The lipofibrohamartoma is a rare entity of unknown origin that can affect any peripheral nerves, but mainly being found in the median nerve within the carpal tunnel. The lipofibrohamartoma is frequently associated with other conditions such as macrodactyly, the Proteus and Klippel-Trenaunay-Weber syndromes and multiple exostosis, among others. Clinical cases. Two cases of lipofibrohamartoma in the carpal tunnel with associated median nerve palsy are described in the present article. They were treated by simple decompression of the median nerve by releasing the transverse carpal ligament and a palmaris longus tendon transfer to improve the thumb abduction (Camitz procedure). In one of the cases (a previously multi-operated median nerve entrapment at the carpal tunnel), a posterior interosseous skin flap was employed to improve the quality of the soft tissues on the anterior side of the wrist. Discussion. A review of the literature is also presented on lipofibrohamartoma of the median nerve, covering articles from 1964 to 2010. The literature suggests that the most recommended treatment to manage this condition is simple release of the carpal tunnel, which should be associated with a tendon transfer when a median nerve palsy is noticed(AU)