IntroductionCarcinomatous degeneration is a rare and late complication developing decades after the diagnosis of chronic osteomyelitis.ObjectivesTo present the results from a retrospective study of six cases of squamous cell carcinoma arising from chronic osteomyelitis.MethodsSix cases of chronic osteomyelitis related to cutaneous squamous cell carcinoma were identified. The cause and characteristics of the osteomyelitis were analyzed, as well as time up to malignancy, the suspicion signs for malignancy, the localization and histological type of the cancer, and the type and result of the treatment.ResultsThe mean time between osteomyelitis onset and the diagnosis of malignant degeneration was 49.17 years (range: 32–65). The carcinoma resulted from tibia osteomyelitis in five cases and from femur osteomyelitis in one. The pathological examination indicated cutaneous squamous cell carcinoma in all cases. All the patients were staged as N0M0, except for one, whose lomboaortic lymph nodes were affected. The treatment consisted of amputation proximal to the tumor in all patients. No patient presented signs of local recurrence and only one had carcinoma metastasis.ConclusionEarly diagnosis and proximal amputation are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis.

ObjectiveTo present a retrospective study of 16 patients submitted to hip disarticulation.MethodsDuring the period of 16 years, 16 patients who underwent hip disarticulation were identified. All of them were studied based on clinical records regarding the gender, age at surgery, disarticulation cause, postoperative complications, mortality rates and functional status after hip disarticulation.ResultsHip disarticulation was performed electively in most cases and urgently in only three cases. The indications had the following origins: infection (n = 6), tumor (n = 6), trauma (n = 3), and ischemia (n = 2). The mean post-surgery survival was 200.5 days. The survival rates were 6875% after six months, 5625% after one year, and 50% after three years. The mortality rates were higher in disarticulations with traumatic (66.7%) and tumoral (60%) causes. Regarding the eight patients who survived, half of them ambulate with crutches and without prosthesis, 25% walk with limb prosthesis, and 25% are bedridden. Complications and mortality were higher in the cases of urgent surgery, and in those with traumatic and tumoral causes.ConclusionHip disarticulation is a major ablative surgery with obvious implications for limb functionality, as well as high rates of complications and mortality. However, when performed at the correct time and with proper indication, this procedure can be life-saving and can ensure the return to the home environment with a certain degree of quality of life.

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The authors have reviewed 75 cases of infected Pseudarthrosis treated over the last five years (1989-1993) in the Septic Osteo Articular Pathology Unit (UP.S.O.A.) in the Orthopaedic Service of the Coimbra University Hospitals (H. U. C.).The primary objective was to cure infection, and the method of treatment was based on external fixation, applied at a distance from the focus. Once infection was resolved and as long as there was bone contact, the external fixators were removed and a plaster cast was applied (two months), followed by nailing.Where there was no bone contact, external fixation was maintained. Corticotomy was performed at a distance and transportation effected until consolidation was obtained. If this did not take place, treatment was with plaster cast followed by nailing.Of the cases treated, 65 were male and the average age was 32.5 years. Infection was cured in 73 patients. Twleve patients continued treatment for aseptic pseudarthrosis.