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The purpose of this case study of severe metallosis is to draw the attention of orthopedic surgeons to extremely serious results of this kind in the event of the fracture of the ceramic ball in a total hip prosthesis. Eleven months after implantation of a KJF hip prosthesis with an aluminum oxide ceramic ball in combination with a polyethylene acetabular cup, fracture of the ceramic ball was observed. After examining the polyethylene cup during the revision operation, the operating orthopedic surgeon merely replaced the fractured ceramic ball with a metal ball head made of stainless steel. Twenty-five months after this procedure, radiography revealed massive wear of the steel ball head with resulting severe metallosis of the surrounding tissues. All prosthetic components therefore had to be removed. Careful examination of the removed prosthetic components clearly showed that sharp-edged ceramic particles originating from the fractured ceramic ball had become embedded in the bearing surface of the polyethylene cup. These tiny ceramic fragments, ranging from 0.05 to 2 mm, were too small to be seen by the operating surgeon's unaided eye. It is these extremely hard ceramic fragments that were responsible for the massive wear of the steel ball head, the hardness of which is approximately ten times less than that of aluminum oxide ceramic. The fracture of the ceramic ball further resulted in damage to the metal taper of the stemmed femoral component. In cases of this kind it is consequently absolutely essential to remove both the polyethylene cup and the ball head, and--if necessary--the femoral component as well.

The Gamma Nail is the latest advance in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures. Its design is based on Küntscher's Y-nail and locking intramedullary (IM) nails. This paper reports the results from the first-ever series of 121 patients operated between 1988 and 1990. They were followed until bone union was achieved. The mean patient age was 75 years. Most patients were in poor general health and had unstable fractures. Anatomical preoperative reduction was achieved in 72% of cases. Fixation was good in 66% of cases and acceptable in 27% of cases. Intra-operative complications consisted of nine fractures without consequences. Of the treated patients, 83.4% resumed weight-bearing during the first week. There was one case of deep infection that resolved with treatment. The mortality rate was 12.3% at three months. We noted 7 alunions in varus, 3 in valgus, 2 in external rotation and 1 in internal rotation. There were no cases of non-union. In six cases, the screw had cut out of the femoral head. The drawbacks associated with surgical treatment methods for trochanteric fractures also apply to the Gamma nail. Nevertheless, one of its primary advantages is the possibility of using a closed procedure. When compared to Ender nailing, knee pain is absent and weight-bearing can be achieved in all patients, no matter the fracture type.

We present the case of a 22-year-old woman with an aneurysmal cyst of the right proximal radius, treated by resection and a free bone graft (microvascular fibular transfer), without recurrence after 4 years. Over a 4 month period, there was a rapidly expanding and lytic lesion found in the radius. There were symptoms of elbow and wrist pain and early radially innervated muscle weakness. Radiological examination showed a localized tumour of the proximal radius, type 2, grade C, according to the classification of Campanacci. Biopsy led to the diagnosis of an aneurysmal bone cyst. Complete tumour resection was followed by a free vascularized fibular bone graft, resulting in good functional improvement, without local recurrence. Aneurysmal bone cysts are a rare condition, and the location in the radius has not previously been described. Vascularized bone grafts are mechanically and biologically superior in this type of case.