External fixator and/or combined treatment are effective and reliable methods to treat infected nonunion of the distal tibia. Every patient should be evaluated according to their infection level and bony defects for reconstruction.

While usual complications related to the external fixators, such as pin-track infections and mobilization difficulties were not encountered, the development of additional complications such as dysfunction of the distraction mechanism should be monitored with the use of motorized intramedullary nails in limb lengthening.

Undifferentiated pleomorphic sarcoma (UPS) of the skin is a rare soft tissue sarcoma subtype with a high risk of metastasis and local recurrence. Ultraviolet exposure plays a prominent role in its etiology. Herein, we present two rare cases of UPS of the skin with an occurrence in non-ultraviolet exposed locations and discuss the need of wide resection and the identification of the depth of the tumor. Due to the resection of the skin, resulting defect was undertaken with skin grafting. One case was extending to the fascia and, after the resection, vacuum-assisted closure therapy was used for the formation of granulation tissue. No recurrence was seen after three and four years for either cases. In conclusion, UPS is a rare, aggressive malignant tumor with a high local recurrence and metastasis rate. Suspicion of malignancy in a plaque-like or nodular lesion in the skin is crucial, and local recurrence and metastasis risk is significantly correlated to the success of wide excision.

This study aims to present our results for limb sal- vage in Gustilo IIIC open fractures of the femur and tibia. 92 patients with Gustilo IIIC fractures operated in our clinic between January 2000 and March 2016 were retrospectively evaluated. Demographic data, ischemia time, method of arterial repair, means of primary and secondary fixation, time to amputation, complications, and final VAS scores were recorded. The difference between the primary amputation rates of tibia and femur fractures was not statisti- cally significant (18% vs 21%, p>0.05). The difference between the secondary amputation rates of tibia and femur fractures was not significant (16% vs 27%, p>0.05). All secondary amputations were done within the first month during the initial hospital stay. Overall limb salvage rate was 69% for Gustilo IIIC fractures of the femur and 58% for Gustilo IIIC fractures of the tibia. The overall limb salvage rate was not signifi- cantly different between the two groups (p>0.05). At the final follow-up, patients in the limb salvage group had average VAS scores of 4.3 (femur) and 4.7 (tibia). The decision between amputation versus limb salvage remains a difficult decision that should be jointly made by the treating physicians and the patient.

No abstract