Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary A. Traoré et al. 391 nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.

Traumatic dislocation of the hip is quite rare and accounts for 2%-5% of all dislocations. We report on a case of a bilateral posterior hip dislocation associated with symmetric acetabular fracture and two cases of infracotyloid dislocation. The report included 2 men and one woman. The mean age of patients was 33 years. All dislocations followed a road traffic accident. Non-operative closed reduction was achieved within 19 hours of admission. The average follow-up time was 15 months. The hips were stable, mobile, and painless; and there was no radiographic sign of avascular necrosis of the femoral head.

Infection after hip prostheses is a potentially devastating complication, and a serious medical and surgical challenge, especially when associated with Paprosky type III femoral bone loosening. Treatment is difficult and options are limited. We report on a 2-stage revision of 15 patients undergoing femur reconstruction with massive allografts. Materials and methods: This was a prospective study which included 15 patients (10 men and 5 women) with infected hip prosthesis, associated with Paprosky type III femoral proximal massive bone loss. The median age of patients was 64 years with a preoperative functional status score of 6. The average number of procedures to the same hip after the first arthroplasty was 6. All patients benefited from a 2-step surgery with massive allografts and locking prosthesis. The average follow-up time was 36 months. Results: Infection was monomicrobial in 14 cases; and was polymicrobial in 4 cases. Methicillin-resistant Staphylococcus epidermidis was the main bacteria (n = 10). The average C-reactive protein level before the second procedure was 2.3 ± 3.4. It was normalized in 8 cases. We recorded 13 cases of primary consolidation without another surgery, 3 cases of relapse, 2 traumatic dislocations and 2 fractures of the allograft. Conclusion: Hip prosthesis infection is a potentially catastrophic complication with significant negative ramifications for both the patient and the healthcare system. Massive allografts use in Paprosky III femoral defect remains very attractive for bone stock restoration and hip function improvement.

Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated fragment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.