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INTRODUCTION: Absorbable materials have been used as fixation devices in orthopaedic surgery. However, their use for treating isolated ulnar diaphyseal fractures in adults has not yet been studied. The aim of this study was to assess whether Inion OTPS™ absorbable implants consisting of L-lactide, D, L-lactide, and trimethylene carbonate provide adequate fixation for the healing of isolated ulnar diaphyseal fractures, their complication rate, and the patients' clinical functional outcome. MATERIALS AND METHODS: Three consecutive patients (all women; mean age, 45 years, and range 38-55 years) with isolated, unstable ulnar fractures were enrolled and treated operatively using Inion OTPS™ absorbable plates and screws. Discontinuation of the study was decided because of the early failure of all implants. The patients were assessed clinically (DASH Score and grip strength) and radiographically at 6 weeks, 3 months, 6 months, and 9 months. The incidence of late foreign body reactions was evaluated for 10 years follow-up period. RESULTS: Implant failure was noticed radiographically in the early post-operative period in all three patients. Subsequently, one patient was treated operatively using metallic devices, and the other two with prolonged splinting. All fractures healed uneventfully in variable time frames. No foreign body reactions were noticed during and beyond the degradation period, other than a small painless mass in one case. CONCLUSION: The results of the current study suggest that the Inion OTPS™ plating system is not appropriate for the fixation of isolated unstable ulnar diaphyseal fractures. It seems that these specific implants cannot withstand the internal mechanical forces of this anatomical area despite the protective splinting.

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Lipoma arborescens is a chronic, slow-growing, intra-articular lesion of benign nature, which is characterized by villous proliferation of the synovium, with replacement of the subsynovial connective tissue by mature fat cells. It usually involves the suprapatellar pouch of the knee joint. It is not a neoplasm but is rather considered a nonspecific reactive response to chronic synovial irritation, due to either mechanical or inflammatory insults. We report three cases of lipoma arborescens affecting the knee, the first in a young male without previous history of arthritis or trauma, the second in a 58-year-old male associated with osteoarthritis, and the final in a 44-year-old male diagnosed with psoriatic arthritis, which cover the entire pathologic spectrum of this unusual entity. We highlight the clinical findings and imaging features, by emphasizing especially the role of MRI, in the differential diagnosis of other, more complex intra-articular masses.

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BACKGROUND: Interspinous distraction devices (IPDD) are indicated as stand-alone devices for the treatment of spinal stenosis. The purpose of this study is to evaluate the results of patients undergoing surgery for spinal stenosis with a combination of unilateral microdecompression and interspinous distraction device insertion. METHODS: This is a prospective clinical and radiological study of minimum 2 years follow-up. Twenty-two patients (average age 64.5 years) with low-back pain and unilateral sciatica underwent decompressive surgery for lumbar spinal stenosis. Visual Analogue Scale, Oswestry Disability Index and walking capacity plus radiologic measurements of posterior disc height of the involved level and lumbar lordosis Cobb angle were documented both preoperatively and postoperatively. One-sided posterior subarticular and foraminal decompression was conducted followed by dynamic stabilization of the diseased level with an IPDD (X-STOP). RESULTS: The average follow-up time was 27.4 months. Visual Analogue Scale and Oswestry Disability Index improved statistically significantly (p < 0.001) in the last follow-up exam. Also, the walking distance increased in all patients but two. Posterior intervertebral disc height of the diseased level widened average 1.8 mm in the postoperative radiograph compared to the preoperative. No major complication, including implant failure or spinous process breakage, has been observed. CONCLUSIONS: The described surgical technique using unilateral microdecompression and IPDD insertion is a clinically effective and radiologically viable treatment method for symptoms of spinal stenosis resistant to non-operative treatment.

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Pigmented villonodular synovitis is a reactive condition characterised by exuberant proliferation of synovial villi and nodules. It may be localised or diffuse and can cause severe articular damage. This report is of 2 patients with pigmented villonodular synovitis of the shoulder causing extensive arthritic changes. Both patients underwent shoulder hemiarthroplasty and total synovectomy and achieved satisfactory painless range of motion, with no signs of local recurrence or loosening of the prosthesis after 4 to 5 years of follow-up.

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BACKGROUND CONTEXT: Primary epitheliod hemangioendotheliomas of the lumbar spine are extremely rare tumors with an unpredictable clinical course. PURPOSE: To present a case of primary lumbar epithelioid hemangioendothelioma and its treatment protocol. STUDY DESIGN/SETTING: A tertiary Spinal Unit. PATIENT SAMPLE: A previously healthy adult with persisting low back pain and neurologic deficit. METHODS: The diagnosis was confirmed by core needle biopsy. The patient was treated with preoperative embolization followed by staged surgery which included wide tumor resection and spinal fixation, using a cage system and a titanium plate anteriorly and a transpedicular fixation system posteriorly. RESULTS: Three years postoperatively the patient remains free of symptoms with no evidence of recurrence. CONCLUSIONS: The treatment of these unpredictable tumors should be dictated by adherence to general oncologic principles.

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