We evaluated the functional and radiologic outcomes after stabilization of distal femoral fractures using the distal femoral nail and a less invasive stabilization system to determine if the new implants are superior to other implants (especially the condylar blade plate) regarding the rates of axial deviation, nonunion, and infection and if one of these new implants (Less Invasive Stabilization System, or distal femoral nail) is superior to the other. Two groups, each with 16 patients, were documented prospectively and the results were compared. To record the findings objectively, the LysholmGillquist score was used. A conversion procedure was done in two patients in the plate group and one patient of the nail group. At the 1-year followup mobility of the knee was on average 110°in the plate group and 103°in the nail group. The Lysholm-Gillquist score did not show any significant differences between the groups. There were clinically relevant varus or outer rotation deviations in three patients in the plate group and two patients in the nail group. The two minimally invasive implants used were good in terms of technique and outcome for treatment of distal femoral fractures and did not differ significantly for epidemiology, fracture type, conversion procedures, infection rate, malalignments, and subjective and objective findings at the 1-year followup. They were also superior to the condylar plate in terms of infection and axial malalignments.

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1075etastatic cancer is the most common malignant disease of the skeletal system. Many of the affected patients are receiving palliative care. The first goals should be the alleviation of pain and the prevention of complications such as pathologic fractures, which is especially important in patients with spinal metastasis to avoid instability and neurologic dysfunction. The standard treatments include radiation therapy, surgery, chemotherapy, hormone therapy, and, recently, therapy using systemic radiopharmaceuticals and biphosphonates; radiotherapy remains the treatment of choice. However, the long-term results of these treatments are not fully satisfying; an effective, minimally invasive local therapy that can be performed at a single outpatient setting would be beneficial [1].We are aware of only four patients whose spinal metastases have been treated with a combination of radiofrequency heat ablation and vertebroplasty [2]. To our knowledge, ours is the first report on the successful use of combined radiofrequency heat ablation and vertebroplasty in a single session. The aim of performing radiofrequency heat ablation before vertebroplasty in this patient was to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus and thereby minimize procedure-related complications. The purpose of vertebroplasty was to then stabilize the vertebra. Subject and MethodsAn 80-year-old man with suspected renal cell carcinoma and lower back pain was referred to our institutuion. Initial contrast-enhanced multidetector CT (Somatom Volume Zoom; Siemens, Erlangen, Germany) revealed a left renal cell carcinoma and a solitary osteolytic metastasis measuring 3 × 2 cm in the L3 vertebral body (Fig. 1A). Tumor nephrectomy was carried out, but the patient refused the standard treatment options for the vertebral metastasis. Because of the anterior location of the metastasis and the intact posterior cortex of the vertebral body, the decision was made to treat the tumor with percutaneous radiofrequency heat ablation in combination with vertebroplasty. The patient gave written informed consent.We administered general endotracheal anesthesia and placed the patient in a prone position on the CT table. A team of anesthesiologists, trauma surgeons, and radiologists were present in the CT room during the entire procedure. The whole procedure was performed under fluoroscopic and CT guidance. Before radiofrequency heat ablation, a biopsy was taken from the lesion. A small skin incision was made at the puncture site, and an 11-gauge bone marrow biopsy needle (OptiMed, Ettlingen, Germany) was inserted via a transpedicular approach into the tumor. Histopathologic examination confirmed a vertebral metastasis of the renal cell carcinoma. A 16-gauge LeVeen needle electrode (RadioTherapeutics, Sunnyvale, CA) was deployed through the inserted cannula into the central part of the lesion (Fig. 1B). After unsheathing the electrode tines, which opened to a diameter of 2.5 cm in the metastasis, we connected the needle with a rad...

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The purpose of this study was to evaluate the effects of partial and full weightbearing after cementless total hip arthroplasty over a two year follow-up period. Fifty-nine women and 41 men (average age 61 years) received an uncemented Spotorno stem and were randomised into a full and a partial weightbearing group. No significant difference was found between the groups with regard to the Merle d' Aubigne hip score, VAS pain level, shaft migration or radiographic signs of bony ingrowth. All femoral components seemed radiologically well-fixed and showed bone ingrowth at 24 months. Provided that solid initial fixation is obtained full weightbearing immediately after cementless total hip arthroplasty using a hydroxyapatite-coated Spotorno-type femoral shaft component can be recommended.