We reviewed retrospectively the results in 211 consecutive patients who had undergone limb salvage for bone neoplasia with endoprosthetic reconstruction of the proximal femur (96), distal femur (78), proximal tibia (30) and total femur (7). Their mean age was 50 years (11 to 86) and the mean follow-up period was 37.3 months (1 to 204). A total of 35 (16.6%) prostheses failed. Overall, implant survival was 78% (95% confidence interval (CI) 0.29 to 0.54) at five years, 60% (95% CI 0.93 to 2.35) at ten years and 60% (95% CI 1.27 to 3.88) at 15 years. Survivorship of the limb was 97.6% (95% CI 1.73 to 3.35) at ten years. The gender, age, diagnosis and location of the tumour were not prognostic variables for failure. Modular endoprosthetic replacement in the lower limb is a durable long-term reconstructive option, with the implants generally outlasting the patient.

Therapeutic study, level IV (case series).

Femoral and tibial shaft fractures are common injuries in the United States. Since their introduction, reamed intramedullary nails have become the treatment of choice for most of these fractures. However, delayed union and nonunion can complicate treatment in up to 10% of patients. Removal of interlocking screws, or dynamization, can promote fracture healing in cases of delayed union or nonunion. The efficacy of nail dynamization has been reported to range from 19% to 82%. This study was conducted to evaluate the efficacy of dynamization, identify the factors associated with its success or failure, and analyze the cost compared with exchange nailing. The authors retrospectively reviewed charts from 2011 to 2014 and searched billing records for Current Procedural Terminology codes 27506 and 27759, for intramedullary nailing of femoral and tibial shaft fractures, and code 20680, for removal of deep hardware. This search identified 34 patients with 35 fractures treated with dynamization for delayed union or nonunion. Dynamization was effective in creating union in 54% of patients. The factor that best correlated with the success of dynamization was the diameter of the fracture callus at the time of dynamization. Direct costs associated with dynamization were nearly $10,000 less than those associated with exchange nailing. Dynamization can be an effective first-line treatment for delayed union and nonunion of femoral and tibial shaft fractures. The union rate in the current study is similar to previously published rates, and cost data suggest that dynamization is a viable alternative to exchange nailing for some patients with delayed union or nonunion. [Orthopedics. 2016; 39(6):e1117-e1123.].