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Aneurysmal bone cysts (ABC) are rare and they represent 1- 1.4 % of all primary bone tumors. ABC of cuboid bone are extremely rare, especially in children. Very few cases have been reported in the literature since 1967. We present a case of pathological fracture of cuboid bone due to an aneurysmal cyst in a 10-year-old girl. Surgery was performed, which included open biopsy with aspiration and intralesional curettage . Bone defect was then filled in by fully synthetic cancellous bone graft substitute consisting of pure β-tricalcium phosphate. Aneurysmal cyst of cuboid bone with pathological fracture could be successfully treated with pure β-tricalcium phosphate as a bone graft substitute. This procedure is safe with excellent outcome.Follow up to nearly four years did not show any recurrence.

Metastases in the proximal femur and in the femoral diaphysis are usually treated with either cephalomedullary or intramedullary nailing. The benefit of curettage and augmentation of the nail with methyl methacrylate remains controversial. The authors retrospectively studied the outcomes with cephalomedullary and intramedullary nailing without curettage and methyl-methacrylate augmentation for lytic metastases of the proximal/diaphyseal femur. Twenty-one complete (11) or impending (10) pathological fractures in 19 consecutive patients were treated between January 2006 and August 2013. There were 11 women and 8 men. Their mean age was 62 years (range, 38 to 87). All patients received adjuvant chemotherapy or radiotherapy.The average postsurgical survival was 9.7 months (range 1-36 months). A single deep infection was debrided. Seventeen out of 19 patients were ambulatory, with or without a walking aid. No implant failure was noted. In other words, patients succumbed to the disease prior to hardware failure. Femoral nail insertion without curettage and cement augmentation provided satisfactory stabilization of proximal and diaphyseal femur fractures, impending or complete, even when there was massive bone destruction.

This retrospective study analyzed 276 cases of giant cell tumour of bone in the appendicular skeleton of patients first diagnosed and treated at the Orthopaedic Department of the West China Hospital in Sichuan University between 1988 and 2007. Fifty-eight percent of the tumours involved the knee region. The most common primary treatment was curettage (162 patients) combined with adjuvant local therapy. The effects of bone cement (PMMA), high-speed burring, electro- cauterization, liquid nitrogen, and phenol on the recurrence rate were also analyzed. The differences in local recurrence rates were analyzed between giant-cell tumours confined to bone (Campanacci grades I and II) and giant-cell tumours with extraosseous extension (Campanacci grade III) treated with intralesional curettage. The recurrence rate of patients who received the first treatment at our institution was 11.2%. Recurrence was observed in 31 cases and multiple recurrences were observed in 5 cases. Treatment included intralesional curettage (173%), marginal excision (143%), wide excision (1.9%), or radical resection (0%). Metastases, which mainly involved the lung, occurred in 6 cases (2.2%). There was a significantly lower recurrence rate (p = 0.004) following intralesional curettage combined with high-speed burring (n = 102) as compared with intralesional curettage without high-speed burring (n = 60). Although the efficacy of liquid nitrogen and electrocauterization did not reach significance, they seem to have a similar effect to high-speed burring. Therefore, we recommend high-speed burring as a necessary adjuvant therapy. The combination of all adjuvants (burring, liquid nitrogen, and electro-cauterization) is recommended as a standard treatment. Cement filling of the cavity after curettage was not widely used in this series, but its merits have been reported in several studies; we therefore recommend that cement filling should be added to the adjuvants to be used after burring, liquid nitrogen and/or electrocauterization.

Metastatic lesions often occur in the trochanteric region of the femur with a risk for pathologic fractures, requiring aggressive surgical treatment. We present two cases of mechanical failure of the Titanium Gamma 3 Nail 180 used for treatment of impending pertrochanteric pathologic fractures. Metallurgic and low power optical examination findings are presented. Treatment with intramedullary nailing devices has proven its efficacy. However in cases of delayed union or non-union, a fatigue fracture due to dynamic overload should be expected sooner of later. If there is no evidence of healing within six months postoperatively a hardware exchange or another therapeutic option should be considered.

Periarticular bone metastasis may be treated with endoprosthetic reconstruction. The extensive surgery required may not, however, be appropriate for all patients. Our aim was to establish whether locking plates provide good functional outcomes and a durable construct when used in the management of metastatic disease. Prospective data collection was performed. Twenty one patients underwent surgery for periarticular metastatic tumours. The median duration of followup for surviving patients is one year. There have been no cases of implant failure and no requirement for revision surgery. Pain relief was excellent or good in the majority of patients. Patients who had sustained a fracture prior to fixation had restoration of their WHO performance status. All patients had a dramatic improvement in their MSTS scores. The median pre-operative score was 15% (0%-37%) improving to a median score of 80% (75%-96%) post operatively. Locking plates were found to provide reliable fixation and excellent functional restoration in selected patients suffering from periarticular metastatic bone disease.

A patient who presented with a displaced subcapital fracture of the proximal femur in her third trimester of pregnancy is reported. Following delivery of the baby with an emergency caesarean section, the fracture was immediately reduced and fixed using cannulated screws. The outcome of her fracture management for this rare condition is discussed. Only seven cases have been reported in the literature and we review the possibility that this condition may be a systemic rather than a purely localised problem as previously believed.

Renal osteodystrophy and post renal transplantation bone disease are increasingly common causes of pathological fracture. The authors present the first case of a pathological hangman's fracture in a patient after successful renal transplantation. An anterior instrumented C2-C4 fusion was performed.

The results in a series of 42 patients with 48 impending or complete pathological femur fractures stabilised with the Long Gamma nail (Howmedica-Osteonics, Rutherford, NJ,USA) are presented. Twenty two impending and 26 completed pathological femoral fractures treated between 1995 and 1999 were retrospectively analysed. The mean age of the patients was 65.7 yrs (range: 40 to 88). All patients were treated with an 11-mm diameter Long Gamma Nail, inserted through a 5-cm incision proximal to the greater trochanter using the antegrade reaming technique. The mean surgical time was 98 minutes (range: 65 to 225). Reliable stability was achieved in all cases and pain relief was excellent. Complications included 2 superficial and 1 deep wound infections, 4 chest infections, 2 urinary tract infections, and 2 deaths in the recovery. Implant failure occurred in one patient and needed revision to a long stemmed total hip prosthesis. The Long Gamma nail offers the advantage of a technically less demanding percutaneous insertion through the tip of the greater trochanter, secure proximal femoral fixation and the ability to allow immediate or early weight-bearing ambulation. Because of these advantages, we recommend the use of the Long Gamma nail for stabilisation of pathologic and impending pathologic fractures of the femur.

The use of elastic intramedullary nails for the treatment of diaphyseal fractures of the humerus has been associated with few complications. We report a fracture of an elastic Marchetti-Vicenzi nail used to treat a pathological fracture of the humerus. The failure of the intramedullary nail followed low-energy trauma and was presumably the end result of metal fatigue, as the original fracture had only healed after 13 months.

Pathologic fractures of the tibia due to a metastasis are rare. The treatment of an established fracture is sometimes conservative, but more often surgical. The purpose of the surgical procedure is to improve the quality of life and the ambulatory status, to relieve pain and to facilitate activities of daily living and nursing care. Four cases of operatively managed metastatic fractures of the tibia are presented with emphasis on the surgical technique. The scarce literature on metastatic tibial fractures in reviewed. The operative technique to be used does not only depend on the location of the tumor but also on the primary tumor, the response to adjuvant therapy and the life expectancy. For metastatic shaft fractures an intramedullary nail, sometimes augmented with bone cement, is preferred. For distal or proximal fractures a compound osteosynthesis with plates and screws offers a good solution. In the epiphyseal and metaphyseal region of the tibia an amputation or a tumor prosthesis is the procedure of choice.

The authors describe an original reconstruction technique following resection for a chondrosarcoma of the femur. Although fatigue failure of the implant occurred four years later, they still think that this surgical procedure may be considered as a good treatment option in patients with a limited life expectancy.

The authors report 10 cases of Seidel locked intramedullary nailing of the humeral shaft for borderline indications (5 delayed unions, 2 complex nonunions, 2 reconstructions for tumor and a panmetastatic humerus). All delayed unions went to union in spite of unscrewing of the expanding screw in 2 cases. In cases of segmental reconstruction, union never occurred due to unlocking of the distal bolt by bone incompetence. Diaphyseal straightening was obtained, but not rotational stability. These elderly patients, in whom the osteoporotic bone is inadequate for plate osteosynthesis, were pleased with the result in comparison with their preoperative status. For pathological fracture, a painfree status is obtained. No subacromial impingement was observed.

The records of 44 patients who underwent internal fixation for metastatic fractures between 1970 and 1989 were studied. Excluded were pathologic fractures involving the spine, pelvis, ribs and clavicles. None of the patients was still alive at the time of the study.

Radiotherapy and chemotherapy will result in an increase in the number of pathological fractures that occur, principally as a consequence of metastatic disease. Especially at the level of the femur, these lesions are painful and are apt to make the patient invalid. Aggressive surgery is often the only possible treatment for such patients, who in many cases may live on for several weeks, months or years. Contra-indications, however are: a survival expectancy of less than 4 weeks, a poor general condition that is an obstacle to a safe operation, or complete mental deterioration. If possible, internal fixation should be performed prophylactically before the real fracture occurs. From January 1980 to December 1990, 65 patients (53 women and 12 men) with 77 pathological fractures of the femur were operated on in the department of traumatology and emergency surgery of the Leuven University Hospital. The average age was 65 years. Metastatic spread from breast cancer was by far the most frequent pathology (75%). Sixty fractures out of the 77 (78%) occurred at the level of the proximal end of the femur in 29 cases (38%) the fracture was in the subtrochanteric region. In 6 cases a "prophylactic" osteosynthesis was performed because of an impending fracture. Endoprosthetic surgery was performed in 36 cases (47%). In 41 cases we performed osteosynthesis: 34 times a compound double-plate fixation, 5 times a gamma nail, 2 times an interlocking nail. Fourty-six patients (71%) obtained very reasonable functional results: they were able to walk again independently or with the help of sticks and crutches.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper reviews the current literature on metastatic lesions most likely to result in a pathologic fracture of a long bone. Prophylactic surgery is recommended in the following situations: Persisting or increasing local pain despite the completion of radiation therapy; permeative involvement; a solitary well-defined lytic lesion greater than 2.5 cm; a solitary well-defined lytic lesion circumferentially involving more than 50% of the cortex; metastatic involvement of the proximal femur associated with a fracture of the lesser trochanter.

Osteosynthesis was performed in 36 pathologic fractures, and in 21 metastases prophylactic internal fixation was carried out. The principles of the operative technique consist of a rigid osteosynthesis with removal of metastatic tissue and filling up of the bone defect with allograft or methylmethacrylate. The indications and benefits of prophylactic internal fixation are discussed.