Curettage of benign bone tumors without grafts gives sufficient bone strength: A case-series of 78 patients

Background and purpose The defect that results after curettage of a bone tumor is usually filled in the same way. We report the outcome in patients with benign bone tumors that were treated with curettage but no filling.Patients and methods We retrospectively studied 78 patients (mean age at the time of operation was 27 (6–73) years, 44 men) who had had a benign bone tumor curetted with no filling of the defect. The commonest tumor types were giant cell tumor of bone (27), fibrous dysplasia (13), enchondroma (9), and simple bone cyst (7). The mean size of the lesions was 35 (2–196) cm³. Normal activities, including full weight bearing for lower extremity lesions, were allowed after 3 months or less. The patients were followed for an average of 10 (1.2–21) years.Results A postoperative fracture with a minor displacement occurred in 3 patients, in 2 of them because of local recurrence. All fractures healed. Local recurrence occurred in 9 patients; 7 of them had a giant cell tumor. Repeated local recurrences necessitated above-knee amputation in 1 patient. All other patients had unrestricted activities of daily living.Interpretation Routine filling of curetted bone lesions does not appear to be necessary from a mechanical point of view.     

Histologically verified lung metastases in benign giant cell tumours—14 cases from a single institution

From 1975 to 1997, 649 cases of benign giant cell tumours of the bone were treated at the Istituto Rizzoli. Fourteen patients (2.1%) experienced lung metastases after a mean of 35.2 months. The time interval between the diagnosis and the appearance of the lung metastases ranged from 3 months to 11.9 years. Metastasectomy was performed in all patients. Histologically, the metastases were identical to the primary bone lesions. Two patients with unresectable multiple metastases received additional chemotherapy. After a follow-up of 70 months (range: 8.2 to 185 months), all patients are alive. Ten patients showed no evidence of disease, one of these after a second resection of metastases, and four patients presented stable disease with multiple lung metastases. Local recurrence of the bone lesion occurred in seven patients before or simultaneously to the metastases. In contrast to previous reports, we could not detect a predominance of the distal radius, but all of the patients had a stage III tumour according to the Enneking criteria of benign lesions. We conclude that even metastatic benign giant cell tumours have an excellent prognosis after adequate resection. No prognostic factors despite high-grade lesions were detectable.     

Clinical and immunohistochemical characteristics of benign giant cell tumour of bone with pulmonary metastases: case series

PURPOSE: Giant cell tumour of bone with pulmonary metastases is rare. However, some patients die of pulmonary metastases, and histological examination cannot distinguish between benign tumour and malignant metastases. In this study, we present clinical and immunohistochemical findings associated with giant cell tumour of bone with pulmonary metastases. METHODS: Five patients with benign giant cell tumour of bone with pulmonary metastases (one man and 4 women) were studied. Patients' ages ranged between 20 and 23 years (mean age, 21.8 years). Tumours were in the distal femur in 2 cases, and in the proximal tibia, distal tibia, and lumbar spine in one case each. The tissue specimens from primary tumours, recurrent tumours, and pulmonary metastases were studied using immunohistochemical techniques. RESULTS: Three of the 5 primary tumours were of the spontaneous regression or growth cessation type, or the continuously slow-growing type, showing 4.2% to 6.2% of positive cells for Ki-67 after immunohistochemical staining. However, 2 patients with the rapid-growing type of disease died of pulmonary metastases; their primary, recurrent, and metastatic tumour specimens contained 9.0% to 11.5% of positive cells for Ki-67. CONCLUSION: Three of the 5 primary tumours had a benign clinical pattern and immunohistochemistry. Two of the 5 patients died of pulmonary metastases, which had an aggressive clinical pattern and a high prevalence of positive cells in Ki-67. Examination of Ki-67 should be carried out for aggressive type of giant cell tumour.     

Pathologic fractures of the proximal femur secondary to benign bone tumors.

Pathologic fractures of the proximal femur secondary to benign bone tumors often are difficult to treat because of specific anatomic features of this region and the aggressiveness of the tumors. Between 1986 and 1996, 11 patients presented with a pathologic fracture of the proximal femur secondary to a benign bone tumor. All were treated with a uniform approach consisting of biopsy, intralesional curettage, high-speed burring, and reconstruction using morselized allograft, autograft, and a fixed-angle implant. The average followup was 4 years 3 months (range, 24-114 months). One patient was lost to followup. All fractures healed, and there were no local recurrences and no cases of avascular necrosis. Functional evaluation revealed generally good results. Patients scored a mean of 32.6 on the original Musculoskeletal Tumor Society scale and 95.8 on the revised version. The average Toronto Extremity Salvage Score was 91.3. With the numbers available, there were no significant differences between the study group and population norms in the Short Form-36. These results suggest that a uniform approach based on preservation of the femoral head can be applied successfully to the treatment of these lesions with good local tumor control, fracture healing, and acceptable functional outcomes.     

骨膜下游离腓骨移植治疗儿童肢体良性骨肿瘤

目的 探讨儿童巨大良性骨肿瘤切除后骨支架重建的方式。方法 1995年6月～2000年10月，收治骨纤维异常增殖症4例，动脉瘤祥骨囊肿1例，单纯性骨囊肿1例，共6例。年龄6～14岁。其中位于肱骨2例，桡骨1例，股骨2例，胫骨1例。依次采用骨膜下病灶骨节段性切除，骨膜下自体腓骨游离移植，游离腓骨移植长度4～14cm。骨膜原位严密缝合，仅2例肱骨用克氏针单针固定，术后石膏外固定。结果 术后6例随访时间18～78个月。骨膜下游离移植腓骨全部达骨性愈合。骨肿瘤病灶无复发，切除腓骨处腓骨又重新长出。踝关节功能正常。结论 骨膜下游离腓骨移植是治疗儿童良性骨肿瘤，骨支架重建的较好方法。     

儿童陈旧性孟氏骨折的手术治疗

目的:通过研究火器伤所致骨折患者的治疗及预后情况,探讨如何选择合理方法对其进行及时有效的治疗。方法:对25例火器伤所致骨折患者的治疗及预后情况进行回顾性总结分析,其中男18例,女7例;平均年龄36.2岁。骨折的部位为股骨骨折9例,胫骨骨折7例,肱骨骨折2例,骨盆骨折2例,锁骨骨折1例,椎体骨折1例,尺、桡骨骨折1例,髋关节骨折1例与膝关节损伤1例。骨折类型为未移位1例,移位2例,粉碎性10例,粉碎且移位6例,骨缺损6例。19例接受了骨科手术治疗,其他6例接受了清创治疗。10例采用外固定架固定,7例行内固定,4例行管形石膏固定,2例骨盆与髋臼骨折采用牵引治疗,2例锁骨骨折应用锁骨带治疗。结果:25例患者获得了平均4.2年的随访,18例骨折Ⅰ期愈合,6例需后期手术促进骨折愈合,1例截肢。有5例需要后期手术覆盖创面。大的并发症包括2例骨不连,4例延迟愈合,3例周围神经功能受损。结论:骨折固定方法的选择与骨移植是治疗火器伤所致的骨折与骨缺损的一项很有效的方法。     

Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures

OBJECTIVE: To summarize the complications and early clinical results of 123 distal femur fractures treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). DESIGN: Retrospective analysis of prospectively enrolled patients. SETTING: Two academic level I trauma centers. SUBJECTS AND PARTICIPANTS: One hundred nineteen consecutive patients with 123 distal femur fractures (OTA type 33 and distal type 32 fractures) treated by 3 surgeons. One hundred three fractures (68 closed fractures and 35 open fractures) in 99 patients were followed up at least until union (mean follow-up = 14 months, range: 3-50 months). INTERVENTION: Surgical reduction and fixation of distal femur fractures. MAIN OUTCOME MEASUREMENTS: Perioperative complications, radiographic union, infection rate, loss of fixation, alignment, and range of motion. RESULTS: Ninety-six (93%) of 103 fractures healed without bone grafting. All fractures eventually healed with secondary procedures, including bone grafting (1 of 68 closed fractures and 6 of 35 open fractures). There were 5 losses of proximal fixation, 2 nonunions, and 3 acute infections. No cases of varus collapse or screw loosening in the distal femoral fragment were observed. Malreductions of the femoral fracture were seen in 6 fractures (6%). The mean range of knee motion was 1 degrees to 109 degrees . CONCLUSIONS: Treatment of distal femur fractures with the LISS is associated with high union rates without autogenous bone grafting (93%), a low incidence of infection (3%), and maintenance of distal femoral fixation (100%). No loss of fixation in the distal femoral condyles was observed despite the treatment of 30 patients older than 65 years. The LISS is an acceptable surgical option for treatment of distal femoral fractures.     

火器伤骨折的治疗评价

目的:探讨有限剥离骨膜对老年人股骨干骨折的疗效和安全性。方法:应用钢板固定治疗老年人股骨干骨折45例,男32例,女13例;年龄58~81岁,平均(69.5±7.1)岁。分别采用常规骨膜剥离方法或有限(微创术式)骨膜剥离后,行复位和钢板固定。其中有限骨膜剥离(A组)27例,按Anderson分型:Ⅰ型15例,Ⅱ型8例,Ⅲ型4例。常规骨膜剥离18例(B组),Ⅰ型8例,Ⅱ型5例,Ⅲ型5例。分别对两组骨痂形成状况、骨折愈合时间及并发症进行比较。结果:术后随访10~24个月,平均18个月,有限骨膜剥离方法骨痂形成状况、骨折愈合时间与常规骨膜剥离方法相比差异有统计学意义(P<0.05),A组优于B组;骨折延迟愈合、非感染性骨不连及骨折畸形愈合等并发症的发生差异亦有统计学意义(P<0.01),B组并发症发生率高于A组。结论:有限骨膜剥离钢板固定治疗老年人股骨干骨折是一种安全、有效的方法。与常规骨膜剥离方法相比,有限骨膜剥离具有骨折愈合时间短、并发症少等优点。     

Operative management of periprosthetic femur fractures in the elderly using biological fracture reduction and fixation techniques

Treatment of periprosthetic femur fractures often requires deviation from standard fixation techniques due to the presence of associated arthroplasty components, however, the use of adjuvant bone grafts and bone graft substitutes remain controversial. 59 patients (average age, 74 years) with either a periprosthetic femoral shaft about an arthroplasty stem (n=29) or supracondylar fracture above a total knee arthroplasty (n=30) were treated with biological open-reduction internal-fixation techniques without the use of bone grafts or bone-graft substitutes. All except one patient healed after the index procedure. Three patients had progressive malalignment associated with failed screw fixation but all healed without further surgical intervention. 49 out of the 59 patients returned to their baseline level of function. These results indicate that use of adjuvant bone graft materials may not be routinely necessary when treating periprosthetic femur fractures using lateral plates and biological reduction and fixation techniques.     

Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment

We retrospectively analysed 90 patients who underwent "en bloc" resection and modular endoprosthesis reconstruction in the lower limbs between 1987-2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.     

The results of treatment of supracondylar fracture above total knee arthroplasty

This study analyzes the results of treatment of 22 patients with 24 supracondylar femur fractures above a total knee arthroplasty. Ten knees were treated by closed methods utilizing traction and then a cast, 10 knees with immediate open reduction and internal fixation, 2 knees with a custom total knee integrated with a distal femoral allograft, 1 knee with external fixation, and 1 knee with primary arthrodesis. Nine fractures treated by closed means and 5 fractures treated by open reduction and internal fixation healed primarily. Two of the 5 surgical failures healed after replating and bone graft. The 3 failures of surgical therapy were salvaged utilizing custom total knee arthroplasty, 2 of which required integration with a distal femoral allograft. One knee treated with external fixation developed a deep infection necessitating implant removal and arthrodesis. Twelve of the 14 femoral fractures that united primarily healed with the femoral component in varus with respect to the long axis of the anatomic femur. Nine of these 12 implants developed progressive radiolucent lines at the tibial component. Three of these knees have required implant revision due to progressive loosening of the tibial and/or femoral components. The results of this evaluation indicate that fractures above a well-fixed total knee arthroplasty are difficult to manage. If anatomical alignment cannot be achieved by simple closed techniques, then primary open reduction and internal fixation should be considered. However, because of the complexity of the problem, the surgeon should be prepared to perform a primary arthrodesis or revision using custom components with or without a distal femoral allograft.     

Curettage of benign bone tumors and tumor like lesions: A retrospective analysis

Background:

Curettage is one of the most common treatment options for benign lytic bone tumors and tumor like lesions. The resultant defect is usually filled. We report our outcome curettage of benign bone tumors and tumor like lesions without filling the cavity.

Materials and Methods:

We retrospectively studied 42 patients (28 males and 14 females) with benign bone tumors who had undergone curettage without grafting or filling of the defect by any other bone graft substitute. The age of the patients ranged from 14 to 66 years. The most common histological diagnosis was that of giant cell tumor followed by simple bone cyst, aneurysamal bone cyst, enchondroma, fibrous dysplasia, chondromyxoid fibroma, and chondroblastoma and giant cell reparative granuloma. Of the 15 giant cell tumors, 4 were radiographic grade 1 lesions, 8 were grade 2 and 3 grade 3. The mean maximum diameter of the cysts was 5.1 (range 1.1-9 cm) cm and the mean volume of the lesions was 34.89 cm³ (range 0.94-194.52 cm³). The plain radiographs of the part before and after curettage were reviewed to establish the size of the initial defect and the rate of reconstitution, filling and remodeling of the bone defect. Patients were reviewed every 3 monthly for a minimum period of 2 years.

Results:

Most of the bone defects completely reconstituted to a normal appearance while the rest filled partially. Two patients had preoperative and three had postoperative fractures. All the fractures healed uneventfully. Local recurrence occurred in three patients with giant cell tumor who were then reoperated. All other patients had unrestricted activities of daily living after surgery. The rate of bone reconstitution, risk of subsequent fracture or the incidence of complications was related to the size of the cyst/tumor at diagnosis. The benign cystic bone lesions with volume greater than approximately 70 cm³ were found to have higher incidence of complications.

Conclusion:

This study demonstrates the natural healing ability of bone without filling with bone grafts or bone graft substitutes. In selected sizes and locations of the benign lytic tumors and tumor like lesions extended curettage alone can be sufficient.     

Infected tibial nonunion: Good results after open cancellous bone grafting in 37 cases

We treated 37 infected tibial shaft nonunions by debridement followed by open autogenous cancellous bone grafting in a 2-stage procedure. Additional surgery was done in 21 fractures including second debridement before bone grafting and/or a second limited bone grafting and/or a split-thickness skin grafting. All fractures healed after an average of 11 (8-16) months. During 2 years follow-up there were no recurrences of the infection. Two cases of early refracture occurred, both healed following new bone grafting.     

Operative Versorgung von pathologischen Humerus- und Femurfrakturen

The life expectancy of patients with malignant tumours and the incidence of osseous metastases have increased over the last decades. Operations for skeletal metastases of the extremities represent the most frequent surgery in orthopaedic oncology. The purpose of this study was to evaluate and compare the different operative treatment options for patients with pathologic fractures of the humerus and femur in terms of complications, postoperative recovery, and survival. From 2000 to 2005, 109 patients were surgically treated for pathologic fractures of the humerus (n=19) or femur (n=90). The study group consisted of 60 women and 43 men, with a mean age of 67 years (13–88). Breast carcinoma (36%) was the most common primary tumour, followed by kidney (17%) and bronchial (16%) carcinoma. Of all patients, 75 (73%) had numerous skeletal metastases, and 38 (37%) had visceral metastases. Wide or marginal resection was performed in seven fractures of the humerus and 14 fractures of the femur; intralesional resection was done in seven humeral and 73 femoral fractures; and stabilisation alone was done in five fractures of the humerus and three fractures of the femur. The median survival time for all patients was 6 months (0–102). The survival rate at 1 year was 25% (25% for both humeral and femoral fractures), 15% at 2 years (17% for humeral and 15% for femoral fractures), and 8% at 3 years (16% for humeral and 7% for femoral fractures). The overall complication rate was 11%, and revision surgeries were performed in seven patients (6.4%). The majority of patients (n=65; 60%), especially those with fractures close to the articular joint, were successfully treated with endoprosthetic replacement. Patients with fractures stabilised by intramedullary nails had shorter operating times, a shorter hospital stay, and fewer complications than patients treated with plating systems. Therefore, we recommend intralesional resection of the metastasis and stabilisation with intramedullary devices, supported by bone cement, as the treatment of choice for pathologic fractures of the diaphysis and metaphysis of the humerus and femur. Wide resection should be reserved for selected cases, such as solitary bone metastasis of kidney carcinoma.     

Treatment of Vancouver B3 periprosthetic femur fractures with a fluted tapered stem

Periprosthetic femur fractures around a hip arthroplasty associated with a loose stem and severely deficient or comminuted bone typically have been treated with substitution for the proximal femur using an allograft prosthetic composite or a tumor prosthesis. Eight patients (mean age, 68 years; range, 34-80 years) with Vancouver Type B3 femur fractures were treated with revision using a long modular fluted tapered uncemented stem with retention of the proximal femur. Access to the failed prosthesis and joint was gained through the fracture or osteotomy and soft tissue attachments to the fracture fragments were maintained. One patient died within 1 week. The remaining patients were followed up 1 to 2 years (mean, 1.5 years). At final followup, all patients had stable implants and all acute fractures were healed. Marked reconstitution of proximal femoral bone stock was observed consistently. All surviving patients were ambulatory and none had more than mild pain. The preliminary results of this method show a high rate of stable implant fixation and fracture healing with preservation and reconstitution of the host femur.     

聚乙烯、钛合金板固定治疗股骨远段粉碎性骨折

目的探讨治疗股骨远段(包括股骨髁间、髁上)粉碎性骨折难题的新方法.方法手术治疗,骨折复位后用钛合金钢板、聚乙烯板组合固定.有骨缺损者加植骨,3～5周后开始膝关节功能锻炼.结果骨折均获愈合,平均愈合时间为7个月.1例开放骨折感染后治愈.末发生膝内、外翻等其他并发症,功能满意.结论两块板组合固定骨折呈中心型固定模式,较符合股骨负重的生物力学原理.双板固定后,可将碎骨块或植入的骨块呈挡板样保护作用,防止移位、离散.增加了内固定强度,抗弯屈、抗扭转应力较单侧钢板好.可以早期锻炼,促进骨折愈合和功能恢复.操作方便,减少了双钢板应力遮挡的副作用.     

Stress fractures of the tibia in elderly women]

Five women with stress fractures of the tibia with concomitant osteoarthritis of the knee were treated at the Department of Orthopaedics and Traumatology of the Lublin University of Medical Sciences between 1996 and 2001. The patients' age ranged from 57 to 78 years. Three fractures were located in the proximal part of the tibial shaft and 2 in the distal part of the tibial shaft. Two patients were unable to ambulate and 3 walked with crutches. In 2 cases the fracture healed after immobilisation in a walking cast for a period of 5 and 6 months respectively. Two cases with a concomitant varus or valgus deformity were treated surgically. In a 72-year-old woman the fracture healed 10 months after stabilisation with a locked intramedullary nail. In a 78-year-old woman the fracture healed 7 months after surgical correction of the tibial axis without internal fixation and a simultaneously performed Charnley knee arthrodesis. Immobilisation was achieved by a long plaster cast. A knee endoprosthesis was implanted in this patient a year after the first procedure because of advanced osteoarthrosis. A 72-years-old patient could not be treated because of poor general condition and advanced degenerative changes in both knee joints. All treated patients were pain free and ambulation parameters improved.     

Early management of pathological fractures in children

The management of pathological fractures in children remains controversial. The indications for surgical treatment are unclear and the need for histological diagnosis before or after definitive treatment is not clearly defined. We reviewed retrospectively the records of all patients under the age of 16 years who presented over the past 7 years with a fracture as the first manifestation of bone pathology. There were 23 patients (16 boys and 7 girls) of an average age of 12 years and 2 months (range 4.1-15.8 years). There were nine cases of fracture through a simple bone cyst, five cases of fibrous dysplasia, two giant cell tumours, three aneurysmal bone cysts, one chondroblastoma, and three cases of Ewings sarcoma. After review of our cases we propose a simple algorithm for the safe early management and assessment of paediatric pathological fractures. We recommend that primary fixation of pathological fractures should be avoided until histological diagnosis is obtained. Most lesions should eventually be biopsied. However, if radiographic appearances are reassuringly benign, biopsy can be delayed until conservative fracture management is completed. Definitive treatment of benign lesions with protective intra medullary nailing or curettage and grafting can follow frozen section under the same anaesthetic.     

Surgical treatment of giant cell tumours of the thoracic and lumbar spine: report of nine patients

Giant cell tumours involving vertebral bodies are still difficult to treat, though results are gradually improving. The object of this study was to assess the results of "complete excision", both of previously untreated giant cell tumours and of recurrences, and to consider the possible effects of any tumour contamination during operation. Nine consecutive patients with giant cell tumours of the thoracic and lumbar spine were treated surgically between 1986 and 1995. Four of these patients were referred with recurrent tumours. All operations aimed at complete resection of the tumour, where possible an en-bloc approach was used. The spines were reconstructed with autografts and instrumentation. All patients were regularly reviewed as part of an on-going study. Following the five operations for previously untreated tumours ("primary" operations), there were no local recurrences, but one patient died of pulmonary metastases. One of the four patients operated upon for a recurrence developed a further recurrence, which was excised 2 1/2 years ago. It would seem that giant cell tumours of the thoracic and lumbar spine, including recurrences, should be treated by complete excision. The en-bloc approach is the safest technique. Where an intralesional component is unavoidable, total removal of the (pseudo)capsule should be ensured by preliminary extralesional dissection. Any tumour spill should be meticulously removed. The use of frozen sections to check resection margins is advisable.     

Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty

OBJECTIVE: New locked plate devices offer theoretical advantages for the treatment of supracondylar femur fractures associated with a total knee arthroplasty (TKA). These devices also can be inserted with relative ease by using minimally invasive techniques, provide a fixed angle construct, and improve fixation in osteoporotic bone. The purpose of this study was to evaluate the results and complications of treating periprosthetic supracondylar femur fractures above a TKA with a locked plate designed for the distal femur. DESIGN: Prospective, consecutive case series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-two consecutive adult patients with 24 (2 bilateral) supracondylar femur fractures (OTA 33A) above a well-fixed non-stemmed TKA were treated with the Locking Condylar Plate. One patient who died before fracture healing and 1 who was lost to follow-up were excluded from analysis. All remaining patients (5 males, 15 females, average age, 73 (range, 50-95) years) were available for follow-up at an average of 15 (range, 6-45) months. According to the OTA classification, there were three 33A1, eight 33A2, and eleven 33A3 fractures. All fractures were closed. Indirect reduction methods without bone graft were used in all cases. RESULTS: Nineteen of 22 fractures healed after the index procedure (86%). All 3 patients with healing complications were insulin-dependent patients with diabetes who also were obese (body mass index >30). Two developed infected nonunions and 1 an aseptic nonunion. Postoperative alignment was satisfactory (within 5 degrees ) for 20 of 22 fractures. Fracture of screws in the proximal fragment occurred in 4 patients. In 3 of these cases, there was progressive coronal plane deformity. There was no change in alignment in any other patient. Fifteen of 17 patients who healed returned to their baseline ambulatory status, with 5 requiring additional ambulatory support compared with baseline. CONCLUSIONS: Fixation of periprosthetic supracondylar femur fractures with a locking plate provided satisfactory results in nondiabetic patients. Diabetic patients seem to be at high risk for healing complications and infection.