Use of irradiated autologous bone in joint sparing endoprosthetic femoral replacement tumor surgery

Background: Joint preservation is usually attempted in cases of bone tumors, though insufficient bone following tumour resection may prevent fixation of conventional joint sparing prosthesis. To preserve the hip joint in skeletally immature patients, we have combined autologous proximal femoral irradiation and intercalary re-implantation with custom made distal femoral replacements. Materials and Methods: A retrospective cohort study of four patients (aged 4-12 years); in whom irradiated autologous bone was combined with an extendable distal femoral endoprostheses was performed. There were three cases of osteosarcoma and one case of Ewings sarcoma. Results: At a mean follow-up of 70.5 months (range 26-185 months), all four patients were alive without evidence of local recurrence. There was no evidence of metastatic disease in three patients while one patient showed chest metastatic disease at presentation. In all cases, the irradiated segment of bone united with the proximal femur and demonstrated bone ongrowth at the prosthetic collar. There were no cases of loosening or peri-prosthetic fracture. One implant was revised after 14 years following fracture of the extending component of the endoprosthesis. Conclusions: We report encouraging results utilizing irradiated autologous proximal femoral bone combined with distal femoral replacement in skeletally immature patients

The Glacial Geomorphology of the Loch Lomond (Younger Dryas) Stadial in Britain: a review

This paper systematically reviews the glacial geomorphological evidence of the Loch Lomond Stadial (LLS; Younger Dryas) glaciation in Britain (12.9–11.7 ka). The geomorphology of sub-regions within Scotland, England and Wales is assessed, providing the most comprehensive synthesis of this evidence to date. The contrasting nature of the evidence at the local scale is reviewed and conceptual themes common to multiple sub-regions are examined. Advancements in glaciological theory, mapping technologies, numerical modelling and dating have been applied unevenly to localities across Britain, inhibiting a holistic understanding of the extent and dynamics of the LLS glaciation at a regional scale. The quantity and quality of evidence is highly uneven, leading to uncertainties regarding the extent of glaciation and inhibiting detailed analysis of ice dynamics and chronology. Robust dates are relatively scarce, making it difficult to confidently identify the limits of LLS glaciers and assess their synchroneity. Numerical models have allowed the glacier–climate relationships of the LLS to be assessed but have, thus far, been unable to incorporate local conditions which influenced glaciation. Recommendations for future research are made that will allow refined reconstructions of the LLS in Britain and contribute to a more comprehensive understanding of glacier–climate interactions during the Younger Dryas