Proximal ulna endoprosthetic replacement for bone tumours in young patients.

PURPOSE: The optimal reconstructive method after resection of malignant bone tumours of the proximal ulna is unknown.We report the outcome of endoprosthetic replacement in a young patient population. METHODS: This was a retrospective review of four patients[three males and one female; mean age 17.5 (range 11­31)years] who underwent limb salvage with a proximal ulnar endoprosthetic replacement following excision of malignant bone tumour. Mean follow-up was 85 (range 14­194) months. RESULTS: All patients were alive at final follow-up and reported an improvement in pain. One patient required transhumeral amputation for intralesional excision complicating a local recurrence at one month. Two patients developed fixed flexion deformities of the elbow, one of whom required radial-head excision. Mean Musculoskeletal Tumour Society (MSTS)score and Toronto Extremity Salvage Score (TESS) were 27(range 25­28) and 81 (73­88), respectively. CONCLUSIONS: Custom-made proximal ulna endoprosthetic replacement following resection of malignant bone tumours in young patients provides a stable reconstruction option with satisfactory function and without apparent compromise in patient survival.

Proximal femoral replacements for metastatic bone disease: financial implications for sarcoma units.

Metastatic pathological fractures of the proximal femur are increasingly treated by endoprosthetic proximal femoral replacement. We report the results and the costs incurred performing these procedures at our supra-regional sarcoma unit. Sixty-two patients underwent 63 proximal femoral replacements for metastatic bone disease over a seven-year period. Breast cancer was the most common primary pathology. One patient underwent a revision procedure for infection. Twenty-two patients suffered dislocations, most commonly those undergoing a conventional arthroplasty articulation. The estimated cost of a proximal femoral replacement is 18,002 pounds at our centre. Less than half of this is reimbursed under Payment by Results. Endoprosthetic replacement of the proximal femur is an effective treatment of metastases, but is poorly reimbursed under current funding arrangements.

Neuritis ossificans of the common peroneal nerve: a case report.

Neuritis ossificans is an extremely rare reactive process affecting peripheral nerves, which can be challenging to diagnose and treat. Magnetic resonance imaging (MRI) is an excellent imaging modality for these lesions, showing inflammatory reaction around the nerve. Only a few cases have been previously reported, and all of the patients underwent surgical resection. In this article we report the first case of neuritis ossificans affecting the common peroneal nerve, treated non-operatively, and we review the literature.

Atypical pseudotumour after metal-on-polyethylene total hip arthroplasty causing deep venous thrombosis.

We describe a patient who developed a mass extending into the pelvis, five years after a metal-on-polyethylene total hip arthroplasty (THA). The histological pattern of perivascular lymphocytic infiltrate and fibrinoid necrosis was more in keeping with a metal-on-metal bearing failure. The pseudotumour compressed the femoral vein causing a deep venous thrombosis.