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Bifocal compression-distraction osteogenesis is a safe, reliable, and largely successful method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Further nonoperative or operative treatment can correct most complications.

Preoperative delay, problems of tuberosity fixation, and position of the tuberosities were parameters influencing the clinical outcome. Lateralization of the tuberosities results in better scores, whereas their distal transfer can be related to a poorer outcome.

The results of treatment of congenital pseudarthrosis of the tibia (CPT) are frequently unsatisfactory because of the need for multiple operations for recalcitrant nonunion, residual deformities, and limb-length discrepancies (LLD). Although the etiology of CPT is basically unknown, recent reports suggest the periosteum is the primary site for the pathologic processes in CPT. We hypothesized complete excision of the diseased periosteum and the application of a combined approach including free periosteal grafting, bone grafting, and intramedullary (IM) nailing of both the tibia and fibula combined with Ilizarov fixation would improve union rates and reduce refracture rates. We retrospectively reviewed 20 patients at two centers. The minimum followup was 2 years (mean, 4.3 years; range, 2-10

Twenty-two patients with primary tumors of the sacrum were surgically treated between 1983 and 1997. Seventeen male and 5 female patients were followed up for a mean of 53.6 months (range 12-203 months). The histopathologic diagnoses were giant cell tumor (GCT) in 7 patients, chordoma in 4 patients, aneurysmal bone tumor in 3 patients, chondrosarcoma in 2 patients, osteoblastoma in 2 patients, synovial sarcoma in 2 patients, Ewing's sarcoma in 1 patient, and simple bone cyst in 1 patient. Currettage and thermo- or chemocauterization was applied to 8 patients, a subtotal sacrectomy was done in 11 patients, and total sacrectomy and lumbopelvic stabilization was done in 3 patients. The surgical margins were wide in all patients with GCT. The surgical margins were wide in 3 patients and wide contaminated in 1 patient with chordoma. The 2 patients with chondrosarcoma had high sacral lesions and were managed with total sacrectomy and lumbopelvic fixation. The surgical margin was wide in 1 patient and wide contaminated in the other, who relapsed locally and systemically in the 30th postoperative month. Three patients with aggressive aneurysmal bone cyst and 1 patient with simple bone cyst were managed by curettage and thorough debridement. One patient with low sacral Ewing sarcoma was managed by subtotal sacrectomy with wide margins. The two osteoblastomas were localized to the posterior elements of the sacrum. None of the patients relapsed. Most of the tumors of the sacrum are benign aggressive lesions or low grade malignancies. Intralesional resections in the form of curettage, with the addition of chemo- or thermocauterization, provide a complete cure for benign lesions. In contrast, wide resections are necessary for complete disease control in radio- and chemoresistant malignancies. Nerve root dissection should be performed in order to achieve wide margins.

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This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation.

No abstract