Aims. The aim of this study was to establish a reliable method for producing 3D reconstruction of sonographic callus. Methods. A cohort of ten closed tibial shaft fractures managed with intramedullary nailing underwent ultrasound scanning at two, six, and 12 weeks post-surgery. Ultrasound capture was performed using infrared tracking technology to map each image to a 3D lattice. Using echo intensity, semi-automated mapping was performed to produce an anatomical 3D representation of the fracture site. Two reviewers independently performed 3D reconstructions and kappa coefficient was used to determine agreement. A further validation study was undertaken with ten reviewers to estimate the clinical application of this imaging technique using the intraclass correlation coefficient (ICC). Results. Nine of the ten patients achieved union at six months. At six weeks, seven patients had bridging callus of ≥ one cortex on the 3D reconstruction and when present all achieved union. Compared to six-week radiographs, no bridging callus was present in any patient. Of the three patients lacking sonographic bridging callus, one went onto a nonunion (77.8% sensitive and 100% specific to predict union). At 12 weeks, nine patients had bridging callus at ≥ one cortex on 3D reconstruction (100%-sensitive and 100%-specific to predict union). Presence of sonographic bridging callus on 3D reconstruction demonstrated excellent reviewer agreement on ICC at 0.87 (95% confidence interval 0.74 to 0.96). Conclusion. 3D fracture reconstruction can be created using multiple ultrasound images in order to evaluate the presence of bridging callus. This imaging modality has the potential to enhance the usability and accuracy of identification of early fracture healing. Cite this article: Bone Joint Res 2021;10(12):759–766

We aimed to investigate the treatment and outcome of patients over 65 years of age with tibial Pilon fracture. Patients were treated by primary open reduction and internal fixation or external fixation (EF) as determined by local soft tissue conditions. Patient course, incidence of radiological osteoarthritis and functional outcome using the SF-36 questionnaire were recorded. All patients were evaluated serially until discharge from final follow-up. The mean follow-up time was 28 months (12-45). Statistical analysis was performed using Analyse-it(tm) software for Excel.

In total 25 patients were studied. Two patients died before completion of treatment and were excluded from the final analysis. Therefore, 23 patients (10 male) were included with a mean age of 70.9 years (range 66-89) and a mean ISS of 10.25 (range 9-22). There were 4 grade IIIb open injuries.

Three patients suffered superficial tibial wound infection. Two patients underwent early secondary amputation due to deep bone sepsis within 8 weeks of injury. One patient in the ORIF group underwent primary arthrodesis, which was subsequently revised due to non-union. 3 patients underwent secondary bone grafting to enhance healing, performed at 2, 6 and 9 weeks. 2 patients with metal work failure underwent subsequent revision of ORIF and progressed to union; the mean time to union was 33.8 weeks. At final follow-up 7 (28%) patients had radiological features of osteoarthritis but none had symptoms severe enough to warrant ankle arthrodesis. There were significant differences from the USA norm in physical function score, role physical score, and physical component score, (p< 0.01).

Aims. The aim of this study was to evaluate the outcome of complex radial head fractures at mid-term follow-up, and determine whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) should be recommended for surgical treatment. Methods. Patients who underwent surgery for complex radial head fractures (Mason type III, ≥ three fragments) were divided into two groups (ORIF and RHA) and propensity score matching was used to individually match patients based on patient characteristics. Ultimately, 84 patients were included in this study. After a mean follow-up of 4.1 years (2.0 to 9.5), patients were invited for clinical and radiological assessment. The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score were evaluated. Results. Patients treated with ORIF showed significantly better postoperative range of motion for flexion and extension (121.1° (SD 16.4°) vs 108.1° (SD 25.8°); p = 0.018). Postoperative functional scores also showed significantly better results in the ORIF group (MEPS 90.1 (SD 13.6) vs 78 (SD 20.5); p = 0.004). There was no significant difference between the groups in terms of the complication rate (RHA 23.8% (n = 10) vs ORIF 26.2% (n = 11)). Implant-related complications occurred in six cases (14.3%) in the RHA group and in five cases (11.9%) in the ORIF group. Conclusion. Irrespective of the patient’s age, sex, type of injury, or number of fracture fragments, ORIF of the radial head should be attempted initially, if a stable reconstruction can be achieved, as it seems to provide a superior postoperative outcome for the patient compared to primary RHA. If reconstruction is not feasible, RHA is still a viable alternative. In the surgical treatment of complex radial head fractures, reconstruction shows superior postoperative outcomes compared to RHA. Good postoperative results can be achieved even after failed reconstruction and conversion to secondary RHA. Therefore, we encourage surgeons to favour reconstruction of complex radial head fractures, regardless of injury type or number of fragments, as long as a stable fixation can be achieved. Cite this article: Bone Joint J 2024;106-B(10):1158–1164

Abstract. Objectives. Three-dimensional visualisation of sonographic callus has the potential to improve the accuracy and accessibility of ultrasound evaluation of fracture healing. The aim of this study was to establish a reliable method for producing three-dimensional reconstruction of sonographic callus. Methods. A prospective cohort of ten patients with a closed tibial shaft fracture managed with intramedullary nailing were recruited and underwent ultrasound scanning at 2-, 6- and 12-weeks post-surgery. Ultrasound B-mode capture was performed using infrared tracking technology to map each image to a three-dimensional lattice. Using echo intensity, semi-automated mapping was performed by two independent reviewers to produce an anatomic three-dimensional representation of the fracture. Agreement on the presence of sonographic bridging callus on three-dimensional reconstructions was assessed using the kappa coefficient. Results. Nine of the ten patients achieved union at six months. At six weeks, seven patients had bridging callus at ≥1 cortex on the three-dimensional reconstruction; when present all united. Compared to radiographs, no bridging callus was present in any patient. Of the three patients lacking sonographic bridging callus, one went onto a nonunion (77.8%-sensitive and 100%-specific to predict union). At twelve weeks, nine patients had bridging callus at ≥1 cortex on three-dimensional reconstruction and all united (100%-sensitive and 100%-specific to predict union). Compared to radiographs, seven of the nine patients that united had bridging callus. Three-dimensional reconstruction of the anteromedial and anterolateral tibial surface was achieved in all patients, and detection of sonographic bridging callus on the three-dimensional reconstruction demonstrated substantial inter-observer agreement (kappa=0.78, 95% confidence interval 0.29–1.0, p=0.011). Conclusions. Three-dimensional fracture reconstruction can be created using multiple ultrasound images in order to evaluate the presence of bridging callus. This imaging modality has the potential to identify impaired healing at an early stage in fracture management. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

The October 2023 Oncology Roundup³⁶⁰ looks at: Are pathological fractures in patients with osteosarcoma associated with worse survival outcomes?; Spotting the difference: how secondary osteosarcoma manifests in retinoblastoma survivors versus conventional cases; Accuracy of MRI scans in predicting intra-articular joint involvement in high-grade sarcomas around the knee; Endoprosthetic reconstruction for lower extremity soft-tissue sarcomas with bone involvement; Local relapse of soft-tissue sarcoma of the extremities or trunk wall operated on with wide margins without radiation therapy; 3D-printed, custom-made prostheses in patients who had resection of tumours of the hand and foot; Long-term follow-up for low-grade chondrosarcoma; Evaluation of local recurrence and diagnostic discordance in chondrosarcoma patients undergoing preoperative biopsy; Radiological scoring and resection grade for intraosseous chondrosarcoma.

Aims. The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. Patients and Methods. A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. Results. The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (. sd. 27) in extension/flexion and 155° (. sd. 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. Conclusion. Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512–1519

Aims

The aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures.

Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs –. (A). Conventional cage ± structural or morselised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture, This reconstruction is used in young patients where restoration of bone stock is important. (B). Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage. (C). Cup-Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup-cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven cup-cage procedures with an average follow-up of 74 months (range, 24–135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Failure was defined as revision surgery for any cause, including infection. The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval, 83.1–97.4), and the 10-year survival rate was 85% (95% CI, 67.2–93.8). The Merle d'Aubigné-Postel score improved significantly from a mean of 6 pre-operatively to 13 post-operatively (p < 0.001). Four cup-cage constructs had non-progressive radiological migration of the ischial flange and they remain stable

Purpose: GSD, also known as massive osteolysis or disappearing bone disease, is rare, characterized by proliferation of vascular channels of hematic and lymphatic origin resulting in progressive distruction of bone. This study about Gorham-Stout disease is a retrospective review of the Rizzoli files with special attention given to treatment and outcome. Materials and Methods: This study is based on a retrospective analysis of a single institution experience. In the Rizzoli files we found 15 cases of GSD from 1968 to 2008. Two were excluded for insufficient documentation. For 13 cases clinical data, imaging and histology were analysed. Histopatologically benign vascular proliferation of thin-walled endothelial capillaries surrounded by a fibrous stroma is present. Adipose involution of the bone marrow and extreme thinning of bony trabeculae represent other histopatologic features. A final diagnosis was established based on clinical, radiological and histopathologic features, as recommended in the literature. Imaging included X-rays in 11 cases and CT or MRI in 5. All lesions were lytic, with an associated sclerosis in two cases. There was one lesion in four cases, several lesions in the same bone in one, and multiple bones involved in six patients. Primary sites were proximal femur in 7 cases, pelvis in 2, hip and knee, calcaneus, humerus and cervical spine in 1 case each. Results: Two patients had no treatment, 2 conservative treatment (cast or brace), 5 surgery, 6 medical treatment (byphosphonates, calcitonin, zoledronic acid, interferon, steroids), 1 radiotherapy, 2 selective arterial embolization. Surgery consisted of internal fixation of 4 pathologic fractures and reconstruction of the entire humerus with a double composite allograf in 1. Overall, surgery only in 2 patients, medical treatment only in 4 (1 also embolization), surgery and medical treatment in 2 (1 also embolization), radiotherapy only in 1, conservative treatment in 2. Four patients were lost at follow up. In the remaining 9 patients mean follow up was 17 ys.(min 2, max 30). These 9 patients had the following results: 2 dead, 3 healed, 3 with stable disease, 1 alive with asymptomatic disease at 24 ys. Conclusions: No clear treatment recommendations were desumed. Surgery is indicated in pathologic fractures or reconstruction of massively destroyed bones, medical treatment and selective embolization are helpful. In the literature prostheses are mostly recommended for reconstructions due to the risk of allografts resorption

Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs:. (A). Conventional cage ± structural or morselised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture. This reconstruction is used in young patients where restoration of bone stock is important. (B). Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage. (C). Cup Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity

Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs –. Conventional cage ± structural or morselised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture. This reconstruction is used in young patients where restoration of bone stock is important. Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage. Cup Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity

The October 2015 Children’s orthopaedics Roundup. 360 . looks at: Radiographic follow-up of DDH; When the supracondylar goes wrong; Apophyseal avulsion fractures; The ‘pulled elbow’; Surgical treatment of active or aggressive aneurysmal bone cysts in children; Improving stability in supracondylar fractures; Biological reconstruction may be preferable in children’s osteosarcoma; The paediatric hip fracture

Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs –. (A) Conventional cage ± structural or morselised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture. This reconstruction is used in young patients where restoration of bone stock is important. (B) Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage. (C) Cup Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven cup-cage procedures with an average follow-up of 74 months (range, 24–135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Failure was defined as revision surgery for any cause, including infection. The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval, 83.1–97.4), and the 10-year survival rate was 85% (95% CI, 67.2–93.8). The Merle d'Aubigné-Postel score improved significantly from a mean of 6 pre-operatively to 13 post-operatively (p < 0.001). Four cup-cage constructs had non-progressive radiological migration of the ischial flange and they remain stable

Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs –. (A) Conventional cage ± structural or morsellised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture. This reconstruction is used in young patients where restoration of bone stock is important. (B) Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage. (C) Cup Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity

Acetabular cages are necessary when an uncemented or cemented cup cannot be stabilised at the correct anatomic level. Impaction grafting with mesh for containment of bone graft is an alternative for some cases in centers that specialise in this technique. At our center we use three types of cage constructs: (A) Conventional cage ± structural or morselised bone grafting. This construct is used where there is no significant bleeding host bone. This construct is susceptible to cage fatigue and fracture. This reconstruction is used in young patients where restoration of bone stock is important; (B) Conventional cage in combination with a porous augment where contact with bleeding host bone can be with the ilium and then by the use of cement that construct can be unified. The augment provides contact with bleeding host bone and if and when ingrowth occurs, the stress is taken off the cage; (C) Cup Cage Construct – in this construct there must be enough bleeding host bone to stabilise the ultra-porous cup which functions like a structural allograft supporting and eventually taking the stress off the cage. This construct is ideal for pelvic discontinuity with the ultra-porous cup, i.e., bridging and to some degree distracting the discontinuity. If, however, the ultra-porous cup cannot be stabilised against some bleeding host bone, then a conventional stand-alone cage must be used. In our center the cup cage reconstruction is our most common technique where a cage is used, especially if there is a pelvic discontinuity

Aims

The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma.

Sub-muscular plating is an established technique in the management of long-bone fractures and reconstruction. In the femur, the presence of the vascular structures medially favours the lateral approach and as such, the technique of medial femoral sub-muscular plating has not, to the authors knowledge, been previously described. We report a series of 5 patients employing the medial approach to femoral sub-muscular plating. The indications and limitations of the technique are discussed with particular reference to reducing external fixation times, avoidance of stress risers and areas of previously traumatised or infected tissues. The surgical technique for medial femoral sub-muscular plating with emphasis on the role of vastus medialis in the protection of the vascular structures, together with cross sectional anatomy is described. Medial femoral sub-muscular plating is a useful technique in specific indications and can be performed safely with an understanding of the relevant anatomy

Purpose: The purpose of this study is to report the preliminary outcomes after open reduction and internal fixation of displaced proximal humerus fractures with a new device called “Da Vinci System. ®. (Arthrex)”. It is a triangle-shaped titanium cage whose opposite faces are pierced and represents the evolution of a triangle-shaped bone block technique performed in a previous series of 33 patients. Material and methods: Between May 2005 and May 2008 we treated 54 patients (26 males and 28 females), even though we included in our study 36 patients who had a minimum follow-up of 12 months. The mean age was 60.3 years. The fractures were classified according to Neer. According to the technique, the Authors position the correct size titanium cage into the metaepiphysis, so that the fragments are reduced upon the cage and are stabilized with a minimal osteosynthesis by Kirschner wires, titanium screws or transosseous sutures. Results: The functional results were evaluated by the Constant score; with a mean follow-up of 22 months (minimum 12, maximum 36 months), the results were excellent or good in 34 cases, bad in 1 case; the mean active anterior elevation was 165 degrees, while in one case a polar necrosis is present but clinical asymptomatic. All fractures but one healed; in one case, 80 days after the operation, we had a deep infection treated with a self-customed cement spacer. Discussion: Surgical management of displaced proximal humerus fractures is still a challenge to surgeons. Optimal fixation system remains controversial, especially in complex fractures with instable fragments and osteoporotic bone. The Authors underline it is important to reconstruct the medial part of the surgical neck, to fill the bone defect, and to provide stable osteosynthesis. The “Da Vinci System” is an interesting innovation to treat difficult problems such as fracture fragments reconstruction and stability, metaphyseal bone loss and proximal humerus revascularization

Gorham-Stout disease (GSD) is rare, characterized by proliferation of vascular channels resulting in progressive distruction of bone. In the Rizzoli files we found 15 cases of GSD from 1968 to 2008. Two were excluded for insufficient documentation. For 13 cases clinical data, imaging and histology were analysed. Histopathologic features included benign vascular proliferation, vascular pattern of osteolytic angioma, fibro-connective tissue component and bony destruction. A final diagnosis was established based on clinical, radiological and histopathologic features. Imaging included X-rays in 11 cases and CT or MRI in 5. All lesions were lytic, with associated sclerosis in two cases. There was one lesion only in 4 cases, multiple lesions in the same bone in 1 and multiple bones involved in 6. Primary sites were proximal femur in 7 cases, pelvis in 2, hip and knee, calcaneus, humerus and cervical spine in 1 case each. Two patients had no treatment, 2 conservative treatment (cast or brace), 5 surgery, 6 medical treatment (byphosphonates, calcitonin, zoledronic acid, interferon, steroids), 1 radiotherapy, 2 selective arterial embolization. Surgery consisted of internal fixation of pathologic fractures in 4 patients and reconstruction of the entire humerus with a double composite allograft in 1. Treatment was surgery only in 2 patients, medical treatment in 4 (1 also embolization), surgery and medical treatment in 2 (1 also embolization), radiotherapy only in 1, conservative treatment in 2. Four patients were lost at follow up. Mean follow up was 17 ys.(min 2, max 30) in 9 patients: 2 dead, 3 healed, 3 with stable disease, 1 alive with disease at 24 ys. No conclusive treatment recommendations are possible; surgery is indicated in pathologic fractures or reconstruction of massively destroyed bones, medical treatment and selective embolization are helpful. In literature prosthetic reconstruction is preferred due to the risk of allografts resorption

Introduction: Surgical removal by means of curettage is the mainstay of treatment of enchondromas of the hand. Methods of reconstruction after tumor removal usually entail no reconstruction or filling of the tumor cavity with a bone graft. These techniques necessitate a prolonged period of protected activity until bone healing of the tumor cavity occurs. The authors have utilized hardware and bone cement for the purpose of reconstruction of the tumor cavity. This technique provides immediate mechanical stability and allows early mobilization. Methods: Between 1986 and 1999 the authors treated 13 patients (8 females, 4 males) who ranged in age from 23 to 58 years (median, 32 years) and diagnosed with enchondroma of the hand. Eight patients presented with a pathological fracture. Anatomic locations included: metacarpal bones – 5, proximal phalanx – 4, and middle phalanx – 4. Tumors were approached through the retained thinned or destroyed cortex to minimize additional bone loss. Surgery included removal of all gross tumor with hand curettes; this was followed by high speed burr drilling of the inner reactive bone shell. Reconstruction included intramedullary metal wire along the longitudinal axis of the cavity and polyme-hylmethacrylate (PMMA). Full activity as tolerated was allowed immediately after surgery. All patients were followed for more than 2 years. Follow-up included physical and radiological evaluation and functional evaluation. Results: Following surgery, all patients returned to their presurgical functional capability within two weeks. At the last follow-up, none of the patients had local tumor recurrence and although three patients had 15° to 20° decrease in flexion of the metacarpophalangeal joint, none reported a functional limitation. There were no postoperative infections or fractures. Conclusions: Reconstruction of the tumor cavity, remaining after curettage of enchondroma of the hand, with intramedullary hardware and PMMA provides immediate mechanical stability and allows early mobilization. This technique is associated with good short- and long-term functional outcomes