Severe bone loss in distal femur has traditionally been managed with bulk cementing, bone graft, metal augments, trabecular metal cones, and mega prosthesis. The authors present an alternative method using a stacked configuration of two tantalum cones to manage severe distal femoral bone loss. This study aims to evaluate the mid-term outcomes and possible complications in patients treated with this novel technique. We retrospectively analyzed the prospectively maintained records of 16 knees (in 16 patients) presenting with severe distal femoral bone deficiency due to septic loosening (5), giant cell tumor (GCT; 4), periprosthetic fracture (3), aseptic loosening (3), and distal femoral comminuted fracture with severe osteoarthritis (1). A standard medial parapatellar approach was taken in all our cases followed by preparation of distal femoral bone defect and use of two bridging tantalum trabecular metal cones to fill the defect, followed by implantation of rotating hinge knee prosthesis. At an average follow-up of 57 months (4.75 years), the average Knee Society Score was 74.56 (64-87) and the mean range of motion was 97.8 (70-120) degrees. Radiologically, all 16 knees showed good osteointegration with no evidence of progressive radiolucency or loosening. Complications included two patients with superficial infection (healed with antibiotics), and one with recurrence of GCT requiring tumor megaprosthesis reconstruction. The authors concluded that the stacked configuration of cones provides additional coverage and stability with good osteointegration and found it to be particularly useful in distal femoral GCTs and fracture situations. They recommend the use of stacked cones in selected cases of severe distal femoral deficiency.

Актуальность. Перелом диафиза бедра один из наиболее распространенных переломов, встречающихся в дет-ском возрасте. Как правило, дети в возрастной группе 6-14 лет лечатся с помощью скелетного вытяжения, ин-трамедуллярного остеосинтеза либо аппаратами внешней фиксации. Мы провели клинические исследования, в которых использовали только TENS (титановая эластичная стержневая система) при лечении переломом диафиза бедренной кости у детей. Методы. В данное исследование вошли 45 случаев переломов диафиза бедренной кости. Мы использовали следующие критерии: а) возраст 6-14 лет; б) свежие переломы диафиза бедра; c) поперечные, короткие косые, минимальные множественные переломы. Результаты. Клинические результаты были оценены по шкале критериев Flynn: отличные результаты были достигнуты у 40 пациентов (88,89 %), удовлетворительные -у 5 пациентов (11,12 %); плохих результатов не отмечалось. Рентгенологическая оценка сращения переломов проводилась по шкале Antony. У 9 пациентов в области введения TENS возник бурсит. Из этих 9 пациентов у троих зафиксирована инфекция мягких тка-ней. Полная нагрузка на нижнюю конечность была разрешена в среднем через 8,7 недели (7-12 недель). Выводы. TENS очень эффективны при лечении переломов диафиза бедренной кости в возрасте 6-14 лет. Пре-имуществами данного метода являются раннее сращение перелома, иммобилизация лишь у немногих пациен-тов, минимальные осложнения.Ключевые слова: детские переломы, бедренная кость, TENS, критерии Flynn. Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures. Results. The clinical results were evaluated using Flynn's criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks). TENS FOR THE SURGICAL MANAGEMENT OF FEMORAL SHAFT FRACTURES IN 6-14 YEARS AGE GROUP CHILDREN

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Percutaneous interventions of the coronary and peripheral vessels have historically been performed using a femoral artery approach. There has been increasing recognition of postprocedural bleeding complications and its impact on short-and long-term mortality. Because of its now recognized safety, the transradial approach has recently emerged as a preferred method compared to the transfemoral approach. The limitations associated with the distance from the puncture site to the lesion location are being addressed as new tools are developed for the endovascular treatment of peripheral arterial disease. In this review, we discuss the many facets of the transradial approach to lower extremity endovascular interventions, highlighting its safety and efficacy. Approaches to special populations including individuals with prior surgical bypass, Leriche's syndrome, and those committed to chronic anticoagulation are also reviewed.