In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.

Cone hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilisation.

The purpose of this study was to compare primarily open versus primarily closed surgical treatment of Gartland type III extension supracondylar fractures in children. Also the outcomes of different pinning techniques in open surgery were evaluated retrospectively. Eighty displaced type III extension supracondylar fractures treated consecutively at two different centres were included. The treatment protocol of one institute was primarily closed reduction and percutaneous cross-pinning (n=43). The treatment protocol of the other institute was primarily open reduction and internal fixation (n=37) with two lateral parallel pins (n=11), cross pins (n=11) and two lateral and one medial pin (n=15) according to the stability and configuration of the fracture. According to Flynn's criteria the outcomes of the open and closed reduction groups were not statistically significant (P>0.05). Although the outcomes of closed reduction showed no superiority over open reduction, it should be the first choice of treatment due to its low morbidity and short hospital stay.

Although CE angle of Wiberg, which is an important radiographic indicator, has an adequate level of reliability and reproducibility it may not reflect the true lateral femoral head coverage in some cases.

Althought obtaining proper tip-apex distance is important to prevent cutout complication in these fractures, if the fracture is not reduced in varus position and helical blade is inserted in the proper quadrant, possibility of cut-out complication is very low even in the patients with high tip-apex distance.

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ObjectiveClosed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to configuration of pin fixation, many factors have been attributed to loss of reduction (LOR). The aim of the present study was to review potential factors that contribute to loss of reduction in the closed management of type III pediatric supracondylar fractures.MethodsTreatment of 87 patients with type III supracondylar fractures was reviewed to determine factors associated with loss of reduction; 48 patients were treated with lateral pinning and 39 with crossed-pinning after closed reduction. Outcome parameters included radiographic maintenance of postoperative reduction.ResultsLateral or crossed-pin configuration, pin spread at fracture site, pin-spread ratio (PSR), and direction of coronal displacement of the fracture were not associated with LOR. A significant difference (p = 0.01) was found between LOR rates of patients with medial wall communication and LOR.ConclusionMedial wall communication is a contributing factor to LOR in the management of type III supracondylar fractures. Cross-pinning should be preferred when medial wall communication is present, to provide more stable fixation.Level of evidenceLevel IV, Therapeutic study.