The objective of this study was to determine the efficacy of the PRECICE 2^® nail in the treatment of lower limb length discrepancy in patients with a history of bone tumors. This study reports on outcomes, complications, and the safety of the PRECICE 2 limb lengthening nail in a cohort of pediatric patients with limb length discrepancy after surgery for bone tumors. Seventeen patients were treated with intramedullary magnetic nails. The average patient age at the time of surgery was 19 (range 11–32). The PRECICE 2 nail was used on 14 femurs (6 retrograde and 8 anterograde) and 3 tibias. The average consolidation time was 141 days (range 50–360) with a mean CI of 31 ± 12 days/cm. The ASAMI bone score showed 14 (82%) excellent results, 1 (6%) good result, and 2 (12%) poor results. The ASAMI functional score showed 13 (84.6%) excellent results, 3 (11.5%) good results, and 1 (3.8%) fair result. Patients treated with chemotherapy for bone cancer did not show any increase in distraction time or consolidation time. A total of 3 (17%) problems, 1 obstacle (5.5%), and 1 complication (5.5%) were encountered in our case series. The PRECICE 2 nail allows for effective and accurate lengthening preserving the range of motion in patients treated for bone tumors.

Background: Bone tumors are not a frequent occurrence and bone infarct-associated sarcomas are even rarer. The prognosis of patients experiencing this disease is poor and treatment for them remains a challenge. Nevertheless, hardly any analyses in literature report on secondary osteosarcoma (SO) on bone infarct and most of the data available do not provide sufficient details. We evaluated whether this condition could be further characterized and if prognosis could be influenced by the chemotherapy (ChT) treatment. We sought to determine: (1) the main features of this rare disease; (2) the overall survival (OS) rate; (3) the OS rate associated to ChT treatment; and (4) the correspondence between our results and published data in terms of survival. Methods: We retrospectively reviewed patients admitted at the Rizzoli Orthopedic Institute of Bologna between 1992 and 2018 (1,465 total cases of osteosarcoma). We identified a list of 11 cases of SO on bone infarct (cohort 1). We conferred about the epidemiology, surgical and ChT treatment, and surveillance of infarct-associated osteosarcoma showing the correlation to data present in literature, corresponding to 14 case reports published within 1962–2018 (cohort 2). Results: (1) Cohort 1 was made of 11 patients: six females and five males, median age was 55 years. Nine (81%) were grade 4 and two (19%) were grade 3. Tumor predominantly arose on distal femur (64%). Most of patients had localized osteosarcoma at the diagnosis (81%); resection surgery was the elective treatment (73%) followed by amputation (18%). Of 11 patients, seven received also ChT (64%). (2) Five-year OS was 62% (95% confidence interval [CI]: 28–84). Median OS was 74 months (95% CI: 12-not reached). The cumulative incidence of cancer-related deaths (CICRD) was 37.7% (95% CI: 11.4–64.5) at 120 months. (3) In the group treated with only surgery, OS was 50% at 5 years. For patients treated with any form of ChT, OS was 71% at 5 years (p = 0.4773) and hazard ratio (HR) 0.56. The CICRD was 29% (at 2 years of follow-up. Instead, it was of 50% for patients treated only with surgery. (4) Median survival was 74 months and 12 months for cohort 1 and cohort 2, respectively (p = 0.0247). Data analysis showed a decreased HR for cohort 1 compared to cohort 2 (HR 0.315). Results confirmed also stratifying for age and ChT administration (HR 0.333). Conclusions: Based on this work, our opinion is that the treatment of SO patients with ChT combined to surgery improves patients’ survival.

Background: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. Materials and methods: This paper presents the results of a retrospective analysis of 33 patients with resection of the entire acetabulum and reconstruction with an allograft-prosthetic composite for the period 1999 to 2010. Patients were divided in two groups, based on type of resection. In Group 1. patients had resections under anterosuperior iliac spine allowing the highest bone-allograft surface contact in reconstruction, while in Group 2 patients had resections over it. Results: Mechanical survival of the implant and Musculoskeletal Tumor Society functional score were calculated. Impact of age and artificial ligament were investigated as well. Patients in Group 1 had 38% mechanical failure rate of the implant while patients in Group 2 had 88%. Average functional score was higher in Group 1 compared with patients in Group 2. An artificial ligament was shown to have non-significant impact on survival of the reconstruction in Group 1, while significantly improving survival of reconstruction in Group 2. Conclusion: Bone-allograft contact matters: resection under anterosuperior iliac spine allows better mechanical survival and offers better reconstruction functional scores.

Osteopetrosis is an uncommon skeletal disorder characterized by generalized sclerosis of bones due to defective osteoclast function. A wide variation in clinical severity of the disease has been observed. Radiographic features and genetic testing are usually used to diagnose the condition. In the present study, we present a case of an extremely rare, atypical and genetically-undetermined form of Osteopetrosis. This patient had some clinical and radiological features of craniometaphyseal dysplasia along with atypical radiological signs of osteopetrosis.

Introduction. Perioperative visual loss (POVL) is a rare and unpredictable complication of non-ocular surgical procedures. Case report. Here we report a case of visual loss after a routine orthopedic procedure. After a surgical procedure of total hip arthroplasty, sudden visual loss was referred by the patient and anterior ischemic neuropathy was diagnosed. Despite treatment, the patient has not regained his sight after more than a year.Discussion. Multiple studies have tried to identify pre-existing conditions or intra-operative factors that may contribute to ischemic optic neuropathy. Age, sex, intraoperative anemia, and acute blood loss seems to predispose patients to POVL, even if no cut-off values have been defined. Preoperative anemia and peripheral vascular disease may be risk factors for this condition. Prone position and prolonged operative time are intraoperative risk factors. However, the development of POVL remains unpredictable and a multi-factorial etiology seems to be the most plausible explanation. Conclusions. POVL is a rare and unpredictable complication that can occur in patients of all ages, even in routine uncomplicated orthopedic procedures. Pathogenesis and etiology are still to be defined and no preventive or treatment guidelines had been established.

Objectives. Knee dislocation is an uncommon injury. This study aims to describe the treatment of a postero-lateral knee dislocation. Case presentation. We report on a 71-year-old man, who accessed the emergency department for direct-rotational trauma to his left knee. X-rays showed a postero-lateral knee dislocation associated with multiple traction fractures. Results. Under fluoroscopy a closed reduction was performed in the operating room by flexing the knee to 120°, internal rotation of the lower extremity and valgus stress at the distal thigh. Due to the instability, a knee-spanning external fixation at 30° of flexion was performed. Post-operatively the patient fell, causing disassemblation of the external fixator and recurrence of medial knee dislocation. Only a partial re-alignment was obtained with a second closed reduction and spanning. The knee was later reconstructed with hinged knee prosthesis and the deformity was corrected. Conclusions. This case report is the third instance of closed reduction for a postero-lateral knee dislocation. Furthermore, this case report highlights possible complications of the treatment of this rare injury and how definitive treatment must be tailored to the patient’s age, function, clinical conditions, radiological findings and joint stability.