A review of the treatment of pelvic discontinuity.

Pelvic discontinuity is a complex entity with a high surgical complication rate and no standardized treatment to date. Revision hip arthroplasty in cases of massive bone loss remains a difficult and unsolved problem. The goal of the surgeon is to preserve limb function by restoring bone stock and the biomechanics of the hip. In cases of severe acetabular bone loss, biologic fixation is often inadequate, requiring extensive bone grafting and reconstructive cages. Reconstructive cages are the most commonly used devices and are designed to bridge bone defects, protect the bone graft, and reestablish the rotation center of the hip. A major limitation of current cages is that they do not allow for biologic fixation. We review the options for treating patients with massive bone loss and pelvic discontinuity and discuss therapeutic options and the clinical and radiological criteria for success.

Dificultades de planificación y quirúrgicas en artoplastia de cadera sobre displasia tipo Crowe IV / Preoperative and surgical difficulties of total hip arthoplasty in Crowe type IV dysplasia of the hip

Analizamos las dificultades de planificación preoperatoria y su aplicación quirúrgica en la artroplastia total de cadera en un caso con displasia alta de cadera o displasia tipo IV de Crowe. Los principales problemas fueron: la elección de la vía de abordaje, la restitución del centro de rotación en el paleocotilo deficiente y la prevención de la lesión del nervio ciático. La elección de una prótesis modular no cementada permitió cumplir estos objetivos garantizando la mayor fiabilidad y versatilidad intraoperatorias y creemos que es el implante de elección para minimizar las complicaciones. La artroplastia total de cadera en displasia Crowe IV es un procedimiento complejo pero reproducible

Performing a total hip arthroplasty in a patient with Crowe IV type dysplasia of the hip requires a careful preoperative planning and surgical technique. Selection of surgical exposure, restitution of hip center, prevention of nerve lesions as well as obtaining good fixation and long term survivorship of the implant are the main difficulties and goals for the orthopaedic surgeon. These goals can be accomplished with an uncemented, modular prosthesis. The procedure is complex but reproducible and complications can be minimised by a combination of careful preoperative planning and intraoperative decision making

Aneurysmal bone cyst in children involving infrequent locations. Report on two cases.

Aneurysmal bone cyst is a benign but locally destructive lesion of bone. We present two cases of ABC in uncommon locations in two children. The first case concerns a 14 year old boy who had a mass located in the internal side of the talus. An ABC type V of Campanacci's classification is diagnosed. Complete curettage was carried out with a high-speed burr. We implanted an Orthofix external fixation with a mobil bottom bolster and distal pins located in the calcaneum. Case 2 concerns an ABC in the clavicle of a 9 years old boy. A selective arterial embolization (SAE) with polyvinyl alcohol was carried out. Curettage of the lesion and filling with a cortico-spongy graft were implemented. Two years later, both of the patients are asymptomatic. We believe that external fixation with a bolster is an efficient and valid alternative to traditional immobilization with a cast. The use of SAE also prevented profuse bleeding of the lesion during surgical procedure.