We undertook a retrospective review of 33 patients who underwent total femoral endoprosthetic replacement as limb salvage following excision of a malignant bone tumour. In 22 patients this was performed as a primary procedure following total femoral resection for malignant disease. Revision to a total femoral replacement was required in 11 patients following failed segmental endoprosthetic or allograft reconstruction. There were 33 patients with primary malignant tumours, and three had metastatic lesions. The mean age of the patients was 31 years (5 to 68). The mean follow-up was 4.2 years (9 months to 16.4 years). At five years the survival of the implants was 100%, with removal as the endpoint and 56% where the endpoint was another surgical intervention. At five years the patient survival was 32%. Complications included dislocation of the hip in six patients (18%), local recurrence in three (9%), peri-prosthetic fracture in two and infection in one. One patient subsequently developed pulmonary metastases. There were no cases of aseptic loosening or amputation. Four patients required a change of bushings. The mean Musculoskeletal Tumour Society functional outcome score was 67%, the mean Harris Hip Score was 70, and the mean Oxford Knee Score was 34. Total femoral endoprosthetic replacement can provide good functional outcome without compromising patient survival, and in selected cases provides an effective alternative to amputation

1. Five cases of pseudomalignant osseous tumour of soft tissue are reported. 2. Clinical and histological observations suggest that this lesion is a reactive condition initiated by an infection. 3. Tomography is helpful in demonstrating the characteristic peripheral ossification around non-ossified central regions of the lesion

Osteochondral fractures of the talus are uncommon. They are classified according to Berndt and Harty, as progressing in severity through four stages. This classification, however, does not address extra-articular extrusion of the osteochondral fragment. We report an osteochondral lesion of the talar dome which presented as an extruded extra-articular fragment in a closed injury of the ankle. This type of lesion may offer a continuation to the four original stages. Clinicians should be aware that this pattern of fracture can occur, and thus allow a more accurate diagnosis and the provision of some aid in the treatment of these injuries

1. A lesion of the median nerve after reduction of a dislocated elbow in a boy of nine is recorded. 2. The nerve lesion was progressive, and at operation on the seventh day after injury the nerve was found to be trapped in the joint between the humerus and the ulna. 3. The nerve was freed and gradual recovery occurred

The clinical and pathological findings in a case of early avascular necrosis of the femoral head following renal transplantation are described. Regions of subchondral bone distant from the principal lesions showed increased numbers of empty osteocytic lacunae. This has been quantified and it is suggested that a loss of osteocytes is perhaps one of the earliest lesions leading to established avascular necrosis

We present a retrospective study of patients suffering from a variety of benign tumours in whom external fixators were used to treat deformity and limb-length discrepancy, and for the reconstruction of bone defects. A total of 43 limbs in 31 patients (12 male and 19 female) with a mean age of 14 years (2 to 54) were treated. The diagnosis was Ollier’s disease in 12 limbs, fibrous dysplasia in 11, osteochondroma in eight, giant cell tumour in five, osteofibrous dysplasia in five and non-ossifying fibroma in two. The lesions were treated in the tibia in 19 limbs, in the femur in 16, and in the forearm in eight. The Ilizarov frame was used in 25 limbs, the Taylor Spatial Frame in seven, the Orthofix fixator in six, the Monotube in four and the Heidelberg fixator in one. The mean follow-up was 72 months (22 to 221). The mean external fixation period was 168 days (71 to 352). The mean external fixation index was 42 days/cm (22.2 to 102.0) in the 22 patients who required limb lengthening. The mean correction angle for those with angular deformity was 23° (7° to 45°). At final follow-up all patients had returned to normal activities. Four patients required a second operation for recurrent deformity of further limb lengthening. Local recurrence occurred in one patient, requiring further surgery

Injuries to the hamstring muscle complex are common in athletes, accounting for between 12% and 26% of all injuries sustained during sporting activities. Acute hamstring injuries often occur during sports that involve repetitive kicking or high-speed sprinting, such as American football, soccer, rugby, and athletics. They are also common in watersports, including waterskiing and surfing. Hamstring injuries can be career-threatening in elite athletes and are associated with an estimated risk of recurrence in between 14% and 63% of patients. The variability in prognosis and treatment of the different injury patterns highlights the importance of prompt diagnosis with magnetic resonance imaging (MRI) in order to classify injuries accurately and plan the appropriate management.

Low-grade hamstring injuries may be treated with nonoperative measures including pain relief, eccentric lengthening exercises, and a graduated return to sport-specific activities. Nonoperative management is associated with highly variable times for convalescence and return to a pre-injury level of sporting function. Nonoperative management of high-grade hamstring injuries is associated with poor return to baseline function, residual muscle weakness and a high-risk of recurrence. Proximal hamstring avulsion injuries, high-grade musculotendinous tears, and chronic injuries with persistent weakness or functional compromise require surgical repair to enable return to a pre-injury level of sporting function and minimize the risk of recurrent injury.

This article reviews the optimal diagnostic imaging methods and common classification systems used to guide the treatment of hamstring injuries. In addition, the indications and outcomes for both nonoperative and operative treatment are analyzed to provide an evidence-based management framework for these patients.

Cite this article: Bone Joint J 2020;102-B(10):1281–1288.

Clavicular fractures are occasionally responsible for lesions of the brachial plexus. The symptoms are usually delayed and due to compression by hypertrophic callus, nonunion or a subclavian pseudoaneurysm. We describe a patient in whom a displaced bone fragment was pressing on the retroclavicular part of the brachial plexus, leading to early symptoms of a lesion of the posterior cord. Internal fixation of the clavicle and external neurolysis of the brachial plexus gave an almost full recovery

1. Three cases of aneurysmal bone cyst are recorded. It is suggested that the condition is a type of cavernous haemangioma and the term haemangiomatous bone cyst is preferred. 2. A survey of the published cases suggests that in its early stages the lesion is amenable to local surgery, which is the treatment of choice, but for inaccessible lesions deep x-ray therapy may be effective

1. The clinical, radiological and pathological features in seven cases of subchondral bone cyst are described. 2. Various hypotheses on the etiology of the lesion are discussed. 3. Although the hypothesis of vascular disturbance is thought to be the most attractive one, it is concluded that study of material from much earlier lesions than that hitherto available is essential if any justifiable theory is to be propounded

Debate continues about the origin of Dupuytren’s disease, which is usually in the palm but is seen elsewhere as ectopic lesions. We describe a young patient with Dupuytren’s disease extending proximal to the wrist crease in continuity with the palmar lesion. Our findings support the view that the condition starts within the palmar connective tissue, but there is no palmar aponeurosis in the forearm and the proximal extension probably started in the deep layer of the superficial fascia

Aims

The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death.

1. Fifty knees affected by rheumatoid arthritis were studied in detail at synovectomy. 2. The destructive lesions found were relatively constant and are described in detail. 3. Cartilage lesions were much more common than was expected radiologically. 4. The pattern described suggests that articular cartilage is destroyed by contact with diseased synovial membrane but protected by contact with another cartilaginous surface

1. Two cases are reported in which reappearance of an osteochondroma after excision was shown to represent a second independent lesion and not a true recurrence. 2. The significance of this observation is discussed in relation to the pathogenesis and prognosis of this lesion. 3. A plea is made for greater discrimination in using the ominous description "recurrence," because the rare true recurrence must strongly favour a diagnosis of malignancy

Two cases are described in which a traction lesion of the brachial plexus was complicated by sensory loss and anhidrosis in the second, third, and fourth cervical dermatomes. Both patients recovered spontaneously, though in one the recovery of muscle power in the limb was incomplete. It is believed that both were examples of a traction lesion of the cervical plexus. No similar case appears to have been recorded

Aims

Stiffness is a common complication after total knee arthroplasty (TKA). Pathogenesis is not understood, treatment options are limited, and diagnosis is challenging. The aim of this study was to investigate if MRI can be used to visualize intra-articular scarring in patients with stiff, painful knee arthroplasties.

A white child with a long history of illness from the age of six was thought at first to have Hodgkin's disease. There followed an acute illness with lesions involving glands, lungs, bone and skin. Mycobacterium avium-intracellulare group (Battey) was isolated from various lesions at the age of thirteen. After six years of continuous treatment the patient, now eighteen, is living a normal life

We describe a case of pyoderma gangrenosum which presented with severe wound breakdown after elective hip replacement. The patient was treated successfully with minimal wound debridement and steroids. This diagnosis should always be considered when confronted with an enlarging painful skin lesion which does not grow organisms when cultured and fails to respond to antibiotic therapy, especially if there are similar lesions in other sites. In patients who have a past history of pyoderma gangrenosum, prophylactic steroids may be indicated at the time of surgery or may be required early in the postoperative period

A lesion similar to that described by Bankart in recurrent dislocation of the shoulder was seen in seven patients with recurrent dislocation of the peroneal tendons. Detachment of the periosteum had resulted in the formation of a false pouch on the surface of the lower end of the fibula; into this pouch the peroneal tendons could easily dislocate. Reattachment of the periosteum to drill holes in the fibula prevented dislocation, and this anatomical method of repair is described. This lesion is one of the causes of recurrent dislocation of the peroneal tendons

We reviewed the long-term results at ten to 12 years of 118 total hip replacements in 109 patients using a second-generation hemispherical cementless acetabular component (Reflection) designed to address the problem of backside wear. Five patients (five hips) died and six patients (seven hips) were lost to follow-up. The remaining 98 patients (106 hips) had a mean age of 62.9 years (34.0 to 86.2) A rate of revision for aseptic loosening of 0.9%, and predictable results were found with respect to radiological evidence of fixation, lack of pain, walking ability, range of movement and function. One component was revised for aseptic loosening, and of the 101 hips (95.2%) that did not have a revision, minor osteolytic lesions of the pelvis were seen in six (5.9%). Kaplan-Meier survival analysis for the total cohort of 118 hips revealed a 96.4% survival at both ten (95% confidence interval 90 to 98) and 12 years (95% confidence interval 86 to 98)