Ayman Bassiony

Resection arthrodesis for the management of aggressive giant cell tumor of the distal femur

Background: Giant cell tumors (GCTs) of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent, and extensive tumors. Wide resection and mobile joint reconstruction are preferable for treating tumors around the knee. In certain situations, resection arthrodesis or an amputation is suggested. In this prospective study we report the outcome of 8 patients of aggressive GCT of lower end of femur treated with resection arthrodesis. Materials and Methods: Eight patients with mean age of 37.25 years (range 30–45 years) with Campanacci Grade III (Enneking stage III) giant cell tumors at the distal femur were treated with wide resection and arthrodesis using dual free fibular graft and locked intramedullary nail from January 2003 to January 2008. There were four males and four females patients. The mean follow-up was 48.75 months (range 30–60 months). The functional evaluation was done using the standard system of musculoskeletal tumor society with its modification developed by Enneking et al. Results: At the final follow up the functional score ranged from 20 to 27 out of total score of 30. Graft union was achieved in all cases in a duration mean of 14.5 months (range 12-20 months).One case required secondary bone graft due to delayed union, and one case had superficial wound infection which healed on systemic antibiotics. At final followup, all the patients were disease free. Conclusion: Wide resection and arthrodesis in aggressive GCTs of the distal femur with involvement of all muscle compartments is a good treatment option. Resection arthrodesis offers a biological reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction.

Cemented calcar replacement hemiarthroplasty for unstable intertrochanteric fracture femur in elderly patients

Background Unstable intertrochanteric fractures in elderly patients are associated with a high rate of complications and poses difficulty in fixation. Cemented calcar replacement hemiarthroplasty may be a suitable treatment in these patients. The aim of this study is to assess the clinical and functional results of the use of such a prosthesis in old patients with an unstable intertrochanteric fracture of the femur. Patients and methods Thirty patients were included in this prospective study, mean age 66 years. All the patients had unstable intertrochanteric fractures. Only patients with type III, IV, or type V fractures according to the Evans’ classification were included in the study. Functional and radiological results were assessed after a mean follow-up period of 22 months. Results At the end of the study, only 24 patients were available for evaluation. The mean follow-up period was 22 months (range, 18–36 months). At the last follow-up, the mean Harris hip score was 85 points. Radiologically, all stems were stable, without significant changes in alignment or progressive subsidence. No infection or thromboembolic complications were encountered. Conclusion Cemented bipolar hemiarthroplasty with calcar replacement is a good option for unstable intertrochanteric fractures in the elderly. It allows early weight bearing and rapid return to prefracture activity and does not have the difficulty and complications of internal fixation of this complex fracture.

Endoprosthetic replacement for tumors of the proximal humerus

Background The proximal humerus is one of the primary sites of tumors. Amputation of the upper limb is highly mutilating and artificial limbs provide limited function and poor cosmesis. For these reasons, limb-preserving techniques were established. The most important aspect of limb-salvage surgery is to preserve elbow and hand function after excision of tumors of the proximal humerus, although the shoulder may remain flail, with a limited active range of movement. Endoprosthetic replacement of the proximal humerus is a well-established procedure in salvage of the upper limb that provides a reasonable shoulder function with maintained excellent elbow and hand function. Patients and methods Ten patients were included in this case-series study. According to the staging system of Enneking and colleagues, they were classified as having eight primary bone tumors; accordingly, there were six cases graded as stage IIB, two cases graded as IB, and two cases graded as solitary metastasis at the proximal humerus. Wide resection was carried out, followed by reconstruction by a modular replacement endoprosthetic system. The mean age of the patients was 36 years (ranging from 17 to 54 years). The follow-p period of the study ranged from 42 to 96 months, with a mean of 61 months. Results Excellent functional outcomes were achieved in seven patients at final evaluation, with a mean of 85.5%. Three patients died because of disease progression and were excluded from the functional evaluation. There were no local recurrences, prosthetic instability, dislocation, or infection. Two patients developed radial nerve palsy, one showed spontaneous improvement, and the second showed improvement after the release of adhesions. None of the patients required any revision surgery. Conclusion The use of endoprosthetic replacement as a method of reconstruction after major skeletal defects created after wide resection of a tumor at the proximal humerus represents a major progress that provides a stable functional spacer after surgery. It has also obviated the need for prolonged immobilization as in cases of biological reconstruction. It results in a low complication rate and immediate stability, which facilitates normal functioning of the elbow and hand.