Die Behandlung von primär malignen Knochentumoren erfolgt interdisziplinär und individuell angepasst an den Patienten. Heutzutage ist eine extremitätenerhaltende extraläsionale Tumorresektion meistens möglich und die anschließende Defektüberbrückung wird entweder über die Implantation von modularen Tumormegaprothesen oder über biologische Rekonstruktionsverfahren durchgeführt. Hierbei sind spezielle operationstypische und sekundäre Komplikationen zu beachten. Indikation und Erläuterung von verschiedenen biologische Rekonstruktionsverfahren und Aufzeigen der speziellen peri- und postoperativen Komplikationen. Es erfolgte eine adaptierte Literaturrecherche und das Einbringen von eigenen Therapieerfahrungen und Fallbeispielen zur Präsentation von biologischen Rekonstruktionen und deren Komplikationsmanagement. Bei biologischen Rekonstruktionen werden Autografts, Allografts oder eine Kombination aus Auto- und Allografts verwendet. Eine Stabilisierung erfolgt über Schrauben- und Plattenosteosynthesen. Zu den häufigsten sekundären Komplikationen gehören die Pseudarthrose, die Interponatfraktur, die Transplantatnekrose und sekundäre Fehlstellungen. In ausgewählten Fällen, insbesondere an der oberen Extremität und bei dia- oder metaphysärer Tumorlage, ist die biologische Rekonstruktion nach extraläsionaler Tumorresektion die chirurgische Therapie der Wahl. Die Rate an langfristigen Revisionseingriffen ist im Vergleich zu modularen Tumormegaprothesen deutlich geringer. Die Anwendung biologischer Rekonstruktionen und das Behandeln der spezifischen Komplikationen obliegt spezialisierten Zentren für muskuloskelettale Onkochirurgie oder Tumororthopädie.

The hypothesis of the present study was that degenerative fibro-ostosis (FO) of the ischial hamstring tendon insertion is a risk factor for heterotopic ossification (HO) following THA.

and vomiting for 4 weeks. There was no history of Introduction smoking but he was known to suffer from alcoholism. At clinical examination he showed a generalized musCholesterol crystals embolism (CCE), ‘an important cular atrophy. Temperature 36.8°C, blood pressure new diagnosis for the general physician’ [1], is not so 160/80 mmHg. Livid soles with a livedo reticularis and rare as previously considered, particularly in aged blue toes were particularly evident in the recumbent patients having erosive atherosclerosis and undergoing position. The peripheral pulses, including foot pulses, vascular surgery, invasive radiological studies, or were all preserved without murmurs. The left heel had receiving anticoagulation [2–9]. The frequency of CCE a very painful non-inflammatory dry ulceration. The in autopsy series varies between 1 and 17% [8] and the tendinous reflexes were all present with normal sensibildisease has emerged as a not infrequent cause of ity and pallaesthesia. A Doppler of the arteries of the subacute or chronic renal failure [10–12]. legs showed physiological pressures, and the transcutaRenal failure and cutaneous findings are the most neous oximetry at the back of the feet was normal. frequently observed clinical manifestations of the disLaboratory results included sedimentation rate ease [2–6 ]. Classically the clinical presentation may be 36 mm/h, CRP 47 mg/l, haemoglobin 115 g/l, haemnon-specific and can mimic other multisystemic diseases [13–15]. Thus the diagnosis of CCE is often atocrit 0.30, leukocytes 9.1 G/l with 7.5% eosinophils difficult. In a large series reported by Fine et al. (=682/ml ). The serum creatinine was 800 mmol/l, blood premortem diagnosis was made in only 30% of cases urea 30 mmol/l, fasting glucose 6.4 mmol/l, serum [2]. sodium 146 mmol/l, serum potassium 3.6 mmol/l, We report a case in which the diagnosis of CCE was ionized calcium 1.16 mmol/l, serum phosphate suspected at the time of beginning dialysis but in which 1.98 mmol/l, alkaline phosphatase 312 U/l, gamma-GT confirmation was made only when the patient 288 U/l, Hb1c 4.6%, total cholesterol 4.2 mmol/l, trideveloped an uncommon complication of the disease. glycerides 1.28 mmol/l, HDL cholesterol 1.10 mmol/l, and intact parathyroid hormone 86 pg/ml. The serum electrophoresis was normal. The 24-h urine collecCase tion contained 0.96 g of proteins (53% albumins) with no Bence Jones protein. Creatinine clearance was A 65-year-old white caucasian man was hospitalized 5 ml/min. Urinanalysis showed no erythrocytes or leuin the ophthalmology department of our general hoskocytes. The serologies for HBV, HCV and HIV were pital for operation on a cataract. The preoperation negative. The antinuclear factor, anti-ds DNA, antilaboratory examination showed that he had severe RNP, SSA, SSB, cANCA, pANCA, and anti-GBM renal failure. antibodies were also negative. An abdominal ultraThe patient had been treated for 3 years for dietsound showed atrophy of both kidneys and no dilatacontrolled diabetes and hypercholesterolaemia. He also tion of the urinary tract. There was no aortic aneurysm. had chronic renal insufficiency (serum creatinine An ophthalmoscopic examination of the eyes did not 150 mmol/l 3 years before) and hypertension treated show retinal embolism. A fluorescein angiography with a beta-blocker for 2 years. During the last 6 showed a diabetic proliferative retinopathy. A renal months he developed repeated very painful ulcerations biopsy was not performed because of the kidney of the toes, somewhat like chilblains. He was in poor atrophy and the patient refused a skin or muscle general state of health (weight loss of 10 kg in the biopsy. The diagnosis of cholesterol embolism was previous 9 months), complaining of asthenia, nausea, suspected but could not be confirmed at that time. Chronic haemodialysis was started because of the Correspondence and offprint requests to: Dr med. E. Descombes, uraemic syndrome. His general condition progressively Département de Médecine, Hôpital Cantonal, CH-1700 Fribourg, Switzerland. improved, but the patient continued to complain of