Purpose Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in prophylactic and therapeutic intramedullary nailing in femoral metastasic implants. Methods Sixty-five patients with metastasis of the femur were analysed retrospectively (37 females; 28 males) between 1995 and 2011 (follow-up 15 months). Forty-four presented with pathological fractures and 21 impending fractures (Mirel ≥7). The operative treatments used were intramedullary fixation with reamed long Gamma nails. The studied parameters were survival, radiological and analytical findings, and functional outcomes. Results Prophylactic nailing resulted in immediate postoperative deaths in 5 % vs. 11.4 % in therapeutic, and one technical complication was detected in each group. Among the surviving patients 75.9 % of the fractures and 100 % of impending lesions were able to walk after the operation. The mean survival time was 11 months in the therapeutic (range 1-49) and 14 in the prophylactic group (1-34). The prophylactic intramedullary nails required a lower transfusion rate (1.4 concentrates vs. 3.0), mobilised earlier (day 4.0 vs. 9.7) and needed a shorter hospital stay (eight days vs. 16 days) compared to therapeutic nails (p <0.05). Conclusion Femoral intramedullary nailing of metastasic lesions provides satisfactory results both clinically and radiologically. Early treatment of the metastases prevents fractures and gives better results, improving life quality of these patients.

In this study we validated intraoperatively the analysis of polymorphonuclear leucocyte frozen sections for diagnosis of infection in hip and knee revisions. Between 1996 and 2002 we examined sections and cultured periprosthetic tissues in prosthetic revision in 170 cases, including 146 cases (83 hips and 63 knees). We assessed sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We compared intraoperative findings and paraffin-embedded samples. The results in the knee group were SE=66.7%, SP=89.7% [95% confidence interval (CI)], PPV=81% (95% CI), NPV=81.4% (95% CI), Youden index=0.56, PLR=6.5 (95% CI) and NLR=0.4 (95% CI). In the paraffinembedded samples the results were SE=91%, SP=87% (95% CI), PPV=81% (95% CI), NPV=94% (95% CI), PLR=7 (95% CI) and NLR=8.7 (95% CI). We found a significant difference. The results in the hip group were SE=50%, SP=100% (95% CI), PPV=100% (95% CI), NPV=94.9% (95% CI), Youden index=0.5 and PLR=0.5 (95% CI). In hip and knee prosthetic revision surgery the presence of polymorphonuclear cells correlates with infection, but their absence does not exclude it. It is a quick and inexpensive test that should be included in the diagnostic protocol in revision surgery. Level of evidence: diagnostic Study (investigating a diagnostic test), level I. See instructions to authors for a complete description of levels of evidence.Résumé Nous avons analysé des coupes de leucocytes polymorphonucléaires, prélevés per-opératoirement pour le diagnostic des infections de hanche et de genou lors des révisions prothétiques. Entre 1996 et 2002, nous avons examiné les coupes et les cultures des tissus périoprothétiques prélevés lors des révisions de prothèses (170 cas), 146 cas ont été inclus dans cette étude (83 hanches et 63 genoux). Nous avons évalué la sensibilité (SE), la spécificité (SP), la valeur prédictive positive (PPV), la valeur prédictive négative (NPV), l'index de Youden, le ratio positif de probabilité (PLR) et le ratio négatif de probabilité (NLR). Nous avons comparé les prélèvements per-opératoires et les échan-tillons inclus dans la paraffine. Résultats : Dans le groupe des genoux : SE=66,7%; SP=89,7% (CI 95%); PPV=81% (CI 95%); NPV=81,4% (CI 95%). L'index de Youden=0,56; PLR=6,5 (CI 95%); NLR=0,4 (CI 95%). Paraffine: SE=91%; SP=87% (CI 95%); PPV=81% (CI 95%); NPV=94% (CI 95%); PLR=7 (CI 95%); NLR=8,7 (CI 95%). Nous avons trouvé une différence significative. Dans le groupe de la hanche SE=50%; SP=100% (CI 95%); PPV=100% (CI 95%); NPV=94,9%) (CI 95%); l'index de Youden=0,5; PLR=0,5 (CI 95%). Conclusions: Dans la chirurgie de révision des prothèses de hanches et des prothèses de genoux, la présence de cellules polymorphonucléaires est bien corrélée avec l'infection, mais, son absence n'exclue pas celle-ci. Il s'agit là d'un test rapide, peu invasif qui peut être pratiqué systém-atiquement dans le protocole de ce diagnostic dans la chirurgie de révision a...

Tarsal coalitions have an incidence of 2% and are often underdiagnosed. These are considered to be one of the causes of chronic ankle and foot pain. Among all tarsal coalitions, the talonavicular type represents a rare and uncommon condition. The purpose of this article was to present the case of a 35-year-old male patient with a bilateral talonavicular coalition treated conservatively. A review of the literature was also performed to understand the management of this rare condition.

Background Femoroacetabular impingement syndrome (FAIS) is a common hip pathology that causes pain and functional limitation in young patients. subspine femoroacetabular impingement (SFAI) is an increasingly diagnosed extra-articular subtype that occurs from mechanical conflict of the anteroinferior iliac spine (AIIS) with the cervico-diaphyseal junction during hip flexion, which is poorly described in the literature. Questions/purposes We aimed to describe the clinical, functional, and radiological results of the arthroscopic treatment of a group of patients with SFAI treated in our Hip Unit. Study design Case series. Methods We present a retrospective study of ten patients with SFAI treated between 2013 and 2020 with arthroscopic resection. Clinical results were assessed with scales such as visual analog scale (VAS); modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Radiological results were assessed with radiological measurements, magnetic resonance imaging (MRI), and computed tomography (CT) reconstructions. Results Six patients had a Type III AIIS and four of them had Type II. Two patients had previously been surgically treated for FAIS. The range of motion improved in flexion from 107 ± 11 degrees before surgery to 127.5 ± 6 degrees (p = 0.005). MHHS improved from 48.1 (38–75.3) before surgery to 83.1 (57–91) (p = 0.007) and HOOS improved from 65.2 (58–75) to 89 (68.1–100) (p = 0.007). VAS improved from 7.3 (5–9) pre-surgical to 2.5 (0–8) post-surgical (p = 0.005). We did not have significant complications except for an asymptomatic case of heterotopic ossification (Brooker I). Conclusion Arthroscopic decompression of AIIS in SFAI patients is a safe procedure that provides satisfactory short-term functional results, improving clinical symptoms, function, sports performance, and range of motion in our study.

No abstract