Replacement of an extensive chest wall defect in combination with the elimination of postoperative ventral hernia after combined treatment of breast cancer complicated by osteomyelitis of the sternum and ribs

Plastic replacement of osteochondral defect of the chest wall after surgical treatment of osteomyelitis of the sternum and ribs is a complex and topical issue in surgery. Often, an extensive post-resected defect of the sternum and ribs is combined with instability of the frame of the chest wall and thoracoabdominal hernia, which leads to physiological and socio-psychological maladaptation of the patient. The case of successful replacement of an extensive chest wall defect in combination with a ventral hernia in a patient after combined treatment of breast cancer complicated by osteomyelitis of the sternum and ribs is presented. TiNi- reinforcing rib prostheses and TiNi-mesh were used to create the frame of the chest wall and hernioplasty. 5-year follow-up did not reveal a recurrence of osteomyelitis and ventral hernia, implant displacement and instability of the frame of the chest wall. The method of reconstruction of an extensive thoracoabdominal defect using bioadaptive implants from TiNi is safe and effective in patients at the final stage of surgical treatment of osteomyelitis of the chest wall including in combination with ventral hernia. Thanks to the developed technology, an excellent functional result was achieved.

Avoiding Above-the-Knee Amputation with a Free Tibiofibular–Talocalcaneal Fillet Flap and Free Latissimus Dorsi Flap

Despite the advances achieved in reconstructive surgery, amputation is still the only option after some severe traumas. Preservation of the knee joint is considered a significant functional advantage. We present the case of a 39-year-old man with a comminuted Gustilo type IIIC open tibia fracture with massive bone loss. To achieve a well-fashioned amputation stump and preserve the knee joint, a free osteocutaneous fillet flap was performed, including the distal tibia and fibula, talus, and calcaneus bones. As a result, a sensate and long amputation stump covered with thick skin from the sole of the foot provided a stable coverage with an excellent functional result and adjustment to prosthesis.

Our results in the treatment of tarsal dislocations

Introduction/Objective. Tarsal dislocations are rare injuries. Usually, they are caused by high-energy trauma. Depending on the type of dislocation, surgical treatment or closed reduction is used. In this study, 13 patients are presented with the aim to analyze the type of feet dislocations, their treatment, and outcome. Methods. Tarsal dislocation cases treated in the University Hospital in Foca were analyzed during the period 2009?2016. All the cases were clinically and radiographically examined and monitored on control examinations at least three years. The mobility of joints was measured and pain existence was estimated by visual analogue scale. Results. All 13 patients with tarsal dislocation were male. Four patients were treated surgically (two patients with tarsometatarsal and one with cuboid and navicular dislocation) and other patients had non-surgical treatment. In 10 patients, an excellent functional result has been achieved and in two patients with tarsometatarsal dislocation a good functional result. In one patient with cuboidal dislocation satisfactory functional result has been achieved. Conclusion. Out of the 13 reviewed patients with tarsal dislocations, functional results were rated as excellent in 10 dislocations, good in two, and satisfactory in one. Diagnosis and treatment of foot dislocations are demanding, but a favorable functional outcome can be expected with an adequate treatment of these injuries.

Functional outcome of surgical treatment of adults with extremity osteosarcoma after megaprosthetic reconstruction—single-center experience

Background Osteosarcoma is the most common primary malignant bone tumor in adults and is usually located in the long bones. Standard treatment consists of perioperative chemotherapy and radical surgical resection. Limb-sparing surgery using a variety of reconstructive techniques remains the gold standard. Methods In our study, we retrospectively analyzed 90 adult patients operated at our institution between 2000 and 2017 for extremity osteosarcoma that underwent limb-sparing reconstruction with the megaprosthesis. Sixty-one patients underwent resection and reconstruction of the distal femur, 9 patients—proximal femur, 7 patients—proximal tibia, 5 patients—total femoral resection and reconstruction, 5 patients—proximal humeral resection, and 3 patients—other types of resection with endoprosthetic reconstruction. The median follow-up time was 41 months, median overall survival was 86 months (3–225 months), and progression-free survival was 81 months (1–86 months). Functional assessment was made on 48 out of 56 living patients, after endoprosthetic reconstruction. The assessment was made according to MSTS functional scale. Results In 14 cases (15%), the endoprosthesis had to be explanted, or amputation was performed for local recurrence or septic complication. Due to a mechanical failure of the implant, we had to perform a revision in 5 patients (5%). Eighteen out of 74 patients with endoprosthesis died of the disease. The median MSTS score was 84% (53–100%), and the best result of 85% was achieved in patients after distal femoral resection with endoprosthetic reconstruction. Conclusion Careful planning of the treatment of patients with extremity osteosarcoma that is performed at the referral centers gives the possibility of long-term survival with a good and excellent functional result.

Bilateral Radial Agenesis in a Cat Treated with Bilateral Ulnocarpal Arthrodesis

Objective This article describes corrective antebrachiocarpal re-alignment and arthrodesis for bilateral radial hemimelia (radial agenesis) in an 8-month-old domestic short-haired cat. Methods Bilateral forelimb deformity of ulnocarpal varus with complete luxation and rotation of the antebrachiocarpal joint spaces, and joint contracture, was observed. Several carpal bones and metacarpal bones I and II and their associated phalanges were absent. Abnormal ambulation and weight bearing on the dorsolateral part of the manus were present. The deformities were treated by bilateral distal ulnar ostectomy and ulnocarpal arthrodesis using a 2.0-mm locking compression plate applied with hybrid fixation and allograft. Results Successful deformity correction was obtained with subsequent fusion of the antebrachiocarpal joints. No complications were observed. At long-term follow-up (4.75 years), there was good-to-excellent functional result, with approximately 15° internal rotation of the right forelimb manus and shortened stride with slight circumduction and lameness. All implants remained stable and continued bone remodelling was present. The cat was assessed to have good-to-excellent short- and long-term functional results with excellent owner satisfaction. Clinical Significance Treatment of radial agenesis in the cat has previously been limited to conservative management or limb amputation. While there are several reports of corrective limb-sparing procedures used to treat dogs, this is the first report of a cat with successful salvage corrective surgery.

First experiences with the Fitmore® hip stem: Early results of the 16-month monitoring

Background/Aim. Fitmore? hip stem belongs to the group of short stem prostheses with the metaphysar stabilization, with its shape and form that protects the bone mass in the greater trochanter region and the distal part of the femur. The aim of this paper was to present the early postoperative results in patients with implanted Fitmore? hip stem and point out some of the advantages. Methods. A series of 10 patients with implanted Fitmore? hip stem, was included in this study. The average age of the patients was 54.5 (48?65) years. There were 5 women and 5 men. The total monitoring time was 16 months. To rate the condition of the hip joint we used The Western Ontario and Mc Master Universities Arthritis Index (WOMAC) score. We also monitored the degree of hip pain, hip flexion, heterotopic ossification and indentation in the stem of the prosthesis. Results. After 12 months of monitoring 9 (90%) of the patients had no pain in the thigh region, and only 1 (10%) experienced mild pain. The hip flexion rose from the average 89? to postoperative 114?. WOMAC score rose as well, from 49 to 94 average points. Indentation in the stem was registered 3 months after the operation in 2 (20%) of the patients ? in one of the patients the indentation was 3 mm and in the other patient 5 mm. After the 16-month monitoring, the results were excellent. The monitoring period was short though it should be continued and the results should be presented after 5 and then after 10 years. Conclusion. Early results of the implantation Fitmore stem showed good bone ingrowth with excellent functional result.

ESTIMATION OF THE EFFECTIVENESS OF SURGICAL TREATMENT OF PATIENTS WITH OLD RUPTURE OF HEEL TENDON WITH SHORT PLASTER SPLINT IMMOBILIZATION

Heel tendon injuries is the most common trauma of tendomuscular apparatus. Old ruptures of heel tendon occur in 58 % of cases in humans. The aim of the research was to estimate the effectiveness of treatment of the patients with old ruptures of heel tendon with Myerson type III defects who had tendon reconstruction on Chernavsky and short plaster splint immobilization of lower extremity for 4 weeks. We operated 10 patients using reconstruction on Chernavsky in our clinic from 2012 to 2014 (average age – 47,6 ± 12,0 years, 8 males and 2 females). All patients had old ruptures of heel tendon. Average time from the moment of trauma till the operation was 112,6 ± 80,4 days. Diastasis between the ends of tendon was 5,8 ± 0,7 cm that corresponds to Myerson type III. Average term of staying at hospital was 10 ± 2 days. We didn’t register any complications in postoperative period. Term of plaster immobilization of the operated extremity was 4 weeks. AOFAS score was 34,2 ± 6,8 points at the control examination in 1,5 months that corresponds to bad functional result. We registered good functional results (88,6 ± 3,5 points) in 3 months. In 6 months, functional results were 95,9 ± 1,6 points. In 12 months after the operation average score was 97,9 ± 2,1 points that corresponds to excellent functional result. Using heel tendon reconstruction on Chernavsky at the Myerson type III defects in combination with short plaster immobilization and early activization of patients allows to decrease term of rehabilitation of patients after the operation.

Saving a Child’s Elbow Joint: A Novel Reconstruction for a Tumour of the Distal Humerus

Reconstruction after wide resection of a malignant bone tumor can be obtained using several techniques such as the use of prostheses, allograft, autograft, or combined procedure. We describe a 12-year-old girl with parosteal osteosarcoma of the distal right humerus treated by en bloc resection, intraoperative extracorporeal irradiation, and implantation. We inserted a nonvascularised fibular autograft through the middle of irradiated graft to obtain a greater stability. We have not recorded any complication associated with this technique such as nonunion, pathological fracture, infection, and bone necrosis and we obtained an excellent functional result. 10 years after surgery, the patient had no recurrence. Extracorporeal irradiation and reimplantation is a valid and inexpensive technique for the treatment of bone tumors when there is reasonable residual bone stock. With this procedure we have a precise fit being the patient’s own bone. In this way we avoid all the problems related to the adaptation of the shape and size.

Operative treatment of metacarpal and phalangeal fractures with Kirschner wire fixation: A review

Although hand fractures are most common fractures treated in orthopedic practice, many practicians treat them as trivial injuries. Improperly managed they can cause consequences and impair hand function. Metacarpal and phalangeal fractures are classified based on geometry, anatomic localization and wound presence and treatment depend on mechanism of injury. Many of them can be treated nonoperatively with reposition and immobilization, but in some cases osteosynthesis is a method of choice. Surgeon can choose various range of fixation material, and choice depends on fracture type and surgeons affinity. Kirschner wire fixation is one of the most frequently used operative procedure for hand fracture treatment. It provides good stability, early mobilization and excellent functional result.