The Authors analysed two cases of catastrophic failures of Total Hip Prostheses due to the disruption of the PE inlay and the Ti-alloy metal back of the acetabular components. In the cases reported the PE inlay (4 mm in thickness) was coupled with a 32 mm in diameter Alumina ball heads. At time of revision the alumina ball heads showed many black marks due to the contacts with the Ti-alloy metal back. The sockets showed severe damages, concentrated in the superolateral zone. The PE inlays were disrupted. Almost a third of the metal back is missing. A large metallosis was also visible in the membrane at the interface between implant and bone. Histologic sections showed a large amount of metallic debris in a pseudovillous membrane. At higher magnification oligonuclear cells in a rich in vessels stroma were in contact with metal particles. PE debris with the characteristic birifrangent aspect to the polarised light microscope was contained into polynuclear giant cells. SEM showed that the size of 25% of particles was less than 1 μm, while the size of 53% of wear debris is in the range from 1 to 5 mm. EDAX confirmed that these particles consisted of Ti alloy. The Authors analysed the possible roles of different factors in the etiology of this cup failures and concluded that in both the cases analysed the initiator of the failure was the size selection of the prosthesis, and in particular the PE thickness, followed by the positioning of the acetabular component. The deformation of the PE inlay leads to rupture of the inlay itself, followed by the direct contact between the Alumina ball head and the titanium alloy cup, causing the disruption of the Ti-alloy metal back, with massive release of wear debris in the surrounding tissues.

Aim: Unstable lateral fractures of the proximal femur (type A2 and A3 of AO classiþcation) present a controversial problem for surgical treatment, due to the difþculty to achieve an adequate mechanically stable bone-device system, so to allow an early weight-bearing. To improve the stability of bone-device complex, a trochanteric stabilizing plate (TSP) has been introduced. The properties of TSP is to avoid shaft medialization in the postoperative. The aim of our study was report results of surgical treatment of unstable trochanteric fractures using a dynamic hip screws in association with TSP. Methods: From January 2000 to March 2002, 51 patients affected by this kind of fractures (type A2 of the AO classiþcation 37 cases and type A3 14 cases) were treated with the association of dynamic hip screw and trochanteric stabilizing plate. Results: The average time that patients spent in the hospital was 7.8 days for the group A2,2, 8.5 days for the group A2,3, 9.9 days for A3,1 and 10.3 days for A3,2. The average healing time was 6 weeks for A2 fractures and 7.2 weeks for the A3. According to the HSS at 6 months for the group A2,2 the average score was 85,5 for the group A2,3 was 81,7 for the group A3,1 was 74,4 and for the group A3,2 was 70,1. The main postoperative complications were 3 superþcial infection of surgical wound, 3 deep vein trombosis and 1 pulmonary embolism. Conclusions: Our series show that this device, although it interferes with trochanteric structures, is a real aid for the dynamic hip screw system in the treatment of unstable lateral fractures of proximal femur due to the possibility of stabilizing the great trochanter and the lateral cortex in order to avoid the medialization forces of the femoral shaft.

Aims: Primary non-Hodgkin lymphoma of bone account for 5% of extra nodal lymphomas. The Authors report their experience referring to the results obtained with a multidisciplinary approach.

Materials: 18 cases of lymphoma of bone were included. Medium age was 63 yrs. All cases have been classified according to the REAL classification system. Patients have been staged with: total body CT scan, bone marrow aspirate, bone marrow biopsy, LDH serum level, skeletal survey and MRI of the skeletal segments involved. We treated 10 cases with solitary localization and 8 with multiple ones. Three patients presented with a pathologic fracture at diagnosis.

Chemotherapy protocols were:

MACOP-B < 60 yrs.

VNCOP-B > 60 yrs.

Seven patients received the PROMACE-CYTABOM protocol.

13 patients received EBRT (40 Gy). Ten patients received a surgical treatment: internal fixation in 7 cases and of spine stabilization in 3 cases

Results: At a medium follow-up of 40 months overall survival was 34,6 months and 14,5 months respectively for solitary or multiple localizations. Surgical treatment has been useful in improving performance status and in some cases to obtain a better control of the disease.

Discussion: In our experience bone lymphomas have always a high grade histology. Chemotherapy constitutes the treatment of choice. Surgical treatment have to be considered as a support treatment. Prognosis is worse in multiple localizations

Aims: The aim of our study was to assess results of treatment of trochanteric fractures using a speciþc algorythm Methods: From January 2000 to March 2002, 215 patients affected by fractures of trochanteric region were treated. 130 were female and 85 male, the average age was 72,5 (5–96). Author used an algorythm based on the analysis of stability of the bone-device system considering three groups: GROUP 1: stable fractures (A1 and A2.1 according to AO classiþcation) in which dynamic hip screw was employed, GROUP 2: unstable fractures (A2.2, A2.3, A3.1) in which dynamic hip screw and trochanteric stabilizing plate were employed, GROUP 3:unstable fractures (A3.2 and A3.3) in which intramedullary nailing was performed. Results: The average healing time was 6 weeks for GROUP 1 and GROUP 2 and 7,2 weeks for GROUP 3. According to the HHS at 12 months the average score for GROUP 1 was 83,1, with 72% of excellent results, 20% good, 4% fair and 4% poor; for GROUP 2 the average score was 79,7 with 56% of excellent results, 25% good, 10% fair and 9% poor; for GROUP 3 the average score was 77,2 with 40% of excellent results, 29% good, 18% fair and 13% poor. In GROUP 2 we observed 2 cases of limb shortening more then 2 cm and 9 cases of pain due to trochanteric plate. In 2 cases of cut-out of the lag screw cemented endoprosthesis was required. In GROUP 3 we observed 5 cases of limb shortening more then 2 cm and 4 cases of persistent trochanteric pain. Conclusions: Following this algorythm a low rate of complication were observed specially in GROUP 2.

Aim: The differential diagnosis between chondroma and grade I chondrosarcoma still represents a challenge. There are always cases in which a perfect diagnosis can’t be done for sure. This cases are defined in literature with different synonyms such as: borderline chondrosarcoma, grade 0 chondrosarcoma, atypical enchondroma or in situ chondrosarcoma. Enchondroma are benign lesions that do not require a surgical treatment. Low grade chondrosarcoma is a malignant tumour that can recur and also if in a low percentage of cases can metastasize. Methods: The Authors reviewed 22 cases of chondrosarcoma of the limbs for clinical, radiographycal and histological features. Results: Pain was present in 80% of cases of low grade chondrosarcoma, while was absent in enchondroma. Radiographic analysis was not significative. Bone scan was often positive in low grade chondrosarcoma as in enchondroma. Histology demonstrated a permeative pattern in chondrosarcoma with infiltration of the bone trabeculae. Conclusions: Only the complete evaluation of the patient resulted in a correct diagnosis. Follow-up of patients confirmed our findings

An increased long-term survival of patients with malignant tumours also increases the possibility of the development of skeletal metastases and pathological fractures. The management of bone metastases includes the removal of gross disease and the administration of local adjuvants. We have investigated the possibility of adding antiblastic drugs to acrylic cement.

Cylinders of acrylic cement were manufactured containing three different antiblastic drugs, methotrexate, cisplatin and doxorubicin.

We performed in vitro analysis on MCF-7 human breast cancer cells in order to evaluate the biological effect of the mixtures and surface analysis of the acrylic cement-cisplatin cylinders using energy-dispersive x-ray analysis (EDAX). All drugs were released in an active form from the cement. Each drug had a different effect on cell viability. Doxorubicin had the greatest effect on breast cancer cells. Surface analysis showed that antiblastic drugs were present in the form of granules.

These results confirm the potential of antiblastic-loaded cement as a possible adjuvant in the local treatment of bone metastases.

Further studies should be undertaken to determine whether the release of antiblastic drugs from cement is elution or if they are only released from the surface.