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Rupture of the patellar tendon is a rare injury requiring acute repair to reestablish knee extensor continuity and to allow early motion. Different pathomechanisms have been postulated, and multiple techniques for repair have been described in the literature. Firstly, the current study reviews the epidemiology, pathomechanism, and risk factors. Secondly, we compare the outcome of two augmentation techniques after end-to-end sutures: reinforcement with either a wire cerclage or a PDS cord. In the first part of the study, the medical records of 66 patients with 68 ruptures were reviewed. For the second part, 33 patients were included who had no prior injury to the extensor mechanism of the knee and had suffered an indirect, low-velocity injury followed by immediate repair. Twenty-seven patients with 29 ruptures of the patellar tendon returned for follow-up. Follow-up averaged 8.1 years (range 1-16 years). In the follow-up group, 22 ruptures had augmentation with a wire cerclage (group A), and 7 ruptures had augmentation with a 2-mm PDS cord (group B). Follow-up evaluation consisted of a subjective questionnaire, a physical and radiographic examination, the Hospital for Special Surgery Knee Score, and the Insall-Salvati ratio. Nineteen patients underwent Cybex isokinetic strength testing of the quadriceps. Indirect, low-velocity injuries occurred most often in the 30-40 year age group, whereas complex knee traumas or knee luxations were more evenly distributed. In 10 of 46 patients with an indirect, low-velocity injury, there was a history of prior injury and illness to the extensor mechanism of the knee, compared with 1 of 22 patients with a high-velocity complex knee trauma. In the follow-up group, no patient sustained a rerupture. Two of 22 patients had an extension lag in group A compared with no extension lag in group B. Average flexion in group A was 130 degrees (SD 29 degrees) compared with 137 degrees (SD 12 degrees ) in group B. The average Hospital for Special Surgery Knee Score was 92 (SD 17) in group A and 96 (SD 12) in group B. Three patients were dissatisfied. All had radiographic signs of retropatellar osteoarthritis. In contrast, 9 of 26 patients who were satisfied with their result had radiographic signs of retropatellar osteoarthritis. A postoperative difference in the Insall-Salvati ratio did not correlate with the development of osteoarthritis. Both augmentation techniques are reliable and demostrate good intermediate to long-term results. The outcome did not show significant differences. To avoid reoperation for removal of the cerclage wire, a PDS cord can be used. The infection rate seems to be higher in the PDS group. A larger prospective study group is necessary to determine whether this phenomenon can be reproduced.

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Compared with bone fractures caused by trauma, pathologic fractures due to diseased bone are rare events. A pathologic fracture is one that occurs without adequate trauma and is caused by a benign or malignant bone lesion. Diagnosis of the basic disease is important for the subsequent therapy. In cases of benign bone lesions the aim of treatment is total osseus healing with complete restoration of function. In malignant pathologic fractures surgery is an essential part of the overall oncologic treatment design. In most cases it is combined with adjuvant therapy. Various surgical procedures are available for fractures at different sites and depending on whether the operation is performed with curative or palliative intent. In cases of progressive neoplastic disease stabilization is necessary to attenuate pain and to maintain mobility. Between 1983 and 1993 we treated 131 patients with 143 pathologic fractures. Conservative therapy was possible in 10 cases, while 133 fractures had to be treated surgically. Most fractures were caused by skeletal metastasis (61), solitary bone cysts (19), osteoporosis (17) and plasmocytoma (16). The most frequent localizations of pathologic fractures were humerus and femur. The favoured methods of surgical stabilization were endoprosthesis and reinforced osteosynthesis. Most fractures appeared in adolescent patients up to the age of 19 and in adults between the 5th and the 7th decade, and 57.3% of the fractures were caused by a primary or secondary malignant tumour lesion. Surgical treatment was performed in all but 1 case of malignant pathologic fractures. Of 74 patients, with malignant bone lesions 6 (8.1%), are still alive. For 68 patients who died after stabilization, the average survival time was 11.6 months; individual survival time depended on the kind of the tumour present. In 55 patients with fractures in the area of benign bone lesions complete healing was achieved, in 9 cases with conservative therapy. The rate of recurrence for solitary bone cysts treated by curettage or segment resection was 23.5%. Compared with the recurrence rates published by other authors this is a very good result.

The case of an 18-year-old girl is described who 1 year after surgical stabilisation of a spine injury developed a multifocal desmoid tumor in the scar region and another at a distance away from the scar in the area of the left scapula. After nononcological resection of both tumors subsequent diagnosis with magnetic resonance imagins (MRI) showed a questionable recurrence only in the scar; positron emission tomography failed to elucidate the local situation. Because a radical re-resection would mean mutilation, and local radiation may damage the spinal cord, a 'wait-and-see' strategy was chosen for further follow-up.

Two-hundred fifty implantations of a cemented femoral stem made of titanium alloy in 239 patients were followed for 9.7 years (range 8.7-10.3 years). Eighty-nine patients with 93 hips have died and two could not be located. Five hips have been revised, two for infection, one for aseptic loosening and two during revision of the cup. Three stems showed radiological loosening but have not been revised. The average hip score was 85. The results are encouraging and comparable to other cemented femoral stems.Résumé 250 implantations d'une tige fémorale cimentée en alliage de titane chez 239 malades ont été suivies pendant 9.7 années (8.7-10.3 années). 89 malades avec 93 prothèses sont morts et deux sont perdus de vue. Cinq hanches ont été révisées, deux pour infection, une pour descellement aseptique et deux pour une révision de la cupule acétabulaire. Trois tiges ont présentés un descellement radiologique mais n'ont pas été reprises. Le score moyen était de 85. Les résultats sont encourageant set comparables à ceux des autres tiges fémorales cimentées.