Midterm results of treatment with a retrograde nail for supracondylar periprosthetic fractures of the femur following total knee arthroplasty

OBJECTIVES: Although the short-term results of supracondylar periprosthetic fractures treated with retrograde nailing have been satisfactory, there is always a concern about the long-term survival of the prosthesis. The aim of the study was to evaluate fracture healing and knee functional outcome with a follow-up time of at least 2 years in periprosthetic fractures of the knee treated with a supracondylar nail. DESIGN: Cohort study. PATIENTS: There were 9 patients with 10 periprosthetic fractures. In 1 patient, the fracture occurred intraoperatively. In the others, the time between the total knee arthroplasty and the periprosthetic fracture ranged between 2 weeks and 7 years (average time: 2.78 years). The mean follow-up was 34.5 months (25-52 months). MAIN OUTCOME MEASUREMENTS: The Western Ontario and McMaster Universities index was used to evaluate the functional result postoperatively using the paired t test as the statistical test. Fracture union was assessed with plain x-rays. RESULTS: All the fractures united within 3 months. One fracture united in extreme valgus (35 degrees) and was revised to a stemmed total knee replacement. There were no infections and no prosthesis loosening. The paired t test before the fracture and after the operation demonstrated no statistically significant differences; however, there was a trend toward lower functional score postoperatively. CONCLUSIONS: It appears that retrograde nailing is a reliable technique to treat periprosthetic supracondylar fractures. It provides adequate stability until fracture union. The morbidity of the operation is minimal, and the complication rate is low. The midterm results in our study showed that none of the prostheses required revision. In our opinion, it is the treatment of choice for a periprosthetic fracture when the prosthesis is stable.     

Diagnose septischer Hüftprothesenlockerung via LeukoScan

Diagnosis of septic loosening of hip endoprosthesis with antigranulocyte scintigraphy (AGS) was analysed. Twenty-one hip prostheses were studied using laboratory tests and, in cases of elevated values, three-phase bone scan (BS) and AGS. Elective SPECT/CT scans were performed. Histologic and microbiologic exams verified the diagnosis.The AGS analysis revealed sensitivity, specificity and accuracy of value 1, while positive and negative predictive values were also 1. BS showed sensitivity of 1 and specificity of 0.33. In three cases, SPECT/CT scans corroborated the AGS interpretation. This diagnostic algorithm proved effective in the detection of septic loosening of hip prostheses. AGS can be avoided without risk of infection being overlooked.     

Does graded reaming affect the composition of reaming products in intramedullary nailing of long bones?

Reaming products taken during intramedullary nailing were examined to identify possible differences in their composition depending on the reaming percentage. Reaming products were taken from 39 fresh closed tibial and femoral diaphyseal fractures in patients with an average age of 29 years. According to histology, reaming products mainly consisted of bone trabeculae, viable or nonviable, and bone marrow stroma. A statistically significant reverse correlation exists between viable bone mass percentage and reaming progress. Reaming 1 mm less than the minimum canal diameter provides a higher viable bone mass percentage, which might be an important factor in the bone healing process.     

Distal tibial fractures and non-unions treated with shortened intramedullary nail

We reviewed 18 patients, 14 with acute fractures and four with non-union of the distal tibia, treated between 1990 and 2001 with a shortened, reamed intramedullary nail. The mean follow-up was 38 (8–144) months. The fractures united at an average of 16 (12–18) weeks and the non-unions at 20 (12–30) weeks. Two patients required nail dynamization. No limb shortening nor material failures were seen. All patients returned to normal daily activities. Although technically demanding, intramedullary nailing for distal tibial fractures and non-unions with a shortened nail represents a safe and reliable method.

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Résumé Nous avons revus 18 malades, 14 avec une fracture récente et quatre avec une pseudarthrose tibial distale, traité entre 1990 et 2001 avec un clou intramédullaire court placé après alésage. Le suivi moyen était de 38 mois (8–144) . Les fractures ont consolidé à une moyenne de 16 (12–18) semaines et les pseudarthroses à 20 (12–30) semaines. Deux malades ont nécessité une dynamisation du clou. Il n'y a pas eu de raccourcissement de membre ni d'ennuis de matériel. Tous les malades ont retrouvé des activités journalières normales. Bien que difficile techniquement, l'enclouage intramédullaire distal avec un clou court représente une méthode sûre et fiable.

     

Radiotherapy-Resistant Solitary Bone Plasmacytoma of the Clavicle

Abstract Solitary bone plasmacytoma of the clavicle is an extremely rare tumor, with an incidence of approximately 0.05% among the primary tumors of the skeleton, defying a challenging diagnostic and therapeutic problem. The absence of particular clinical signs and laboratory tests and the abated sensitivity of modern imagination to differentiate the benign or malignant characteristics of an osteolytic lesion of the distal clavicle impeded a definite diagnosis, which can usually be obtained only after an open biopsy of the lesion. The presented case is distinctive, as it refers to a plasmacytoma of the distal end of the clavicle, which expressed unexplained resistance to both the administrated radiotherapy and chemotherapy. The therapeutic quandary finally resolved after the surgical resection of the entire lesion, leaving the patient free of plasma cell disease 37 months after the initial diagnosis.     

Estrogen receptor (α and β) but not androgen receptor expression is correlated with recurrence,progression and survival in post prostatectomy T3N0M0 locally advanced prostate cancer in an urban Greek population

The objective of this study was to evaluate the expression of estrogen receptors (ER(α) and ER(β)) and androgen receptors (ARs) as prognostic factors for biochemical recurrence, disease progression and survival in patients with pT3N0M0 prostate cancer (PCa) in an urban Greek population. A total of 100 consecutive patients with pT3N0M0 PCa treated with radical prostatectomy participated in the study. The mean age and follow-up were 64.2 and 6 years, respectively. The HSCORE was used for semi-quantitative analysis of the immunoreactivity of the receptors. The prognostic value of the ER(α) and ER(β) and AR was assessed in terms of recurrence, progression, and survival. AR expression was not associated with any of the above parameters; however, both ERs correlated with the prognosis. A univariate Cox regression analysis showed that ER(α) positive staining was significantly associated with a greater hazard for all outcomes. Increased ER(β) staining was significantly associated with a lower hazard for all outcomes in the univariate analysis. When both ER HSCORES were used for the analysis, it was found that patients with high ER(α) or low ER(β) HSCORES compared with patients with negatively stained ER(α) and >1.7 hSCORE ER(β) had 6.03, 10.93, and 10.53 times greater hazard for biochemical disease recurrence, progression of disease and death, respectively. Multiple Cox proportional hazard analyses showed that the age, preoperative prostate specific antigen, Gleason score and ERs were independent predictors of all outcomes. ER expression is an important prognosticator after radical prostatectomy in patients with pT3N0M0 PCa. By contrast, AR expression has limited prognostic value.     

Relationship between haemagglutination-inhibiting antibody titres and clinical protection against influenza: development and application of a bayesian random-effects model

Background  

Antibodies directed against haemagglutinin, measured by the haemagglutination inhibition (HI) assay are essential to protective immunity against influenza infection. An HI titre of 1:40 is generally accepted to correspond to a 50% reduction in the risk of contracting influenza in a susceptible population, but limited attempts have been made to further quantify the association between HI titre and protective efficacy.