79,693 research outputs found
Humeral fracture between a total elbow and total shoulder arthroplasty
No full textThis article presents a case of a 71-year-old woman with a humeral fracture between a cementless reverse total shoulder arthroplasty and a cemented total elbow arthroplasty and discusses our treatment plan. Surgical treatment was performed after the patient was informed of possible complications and the benefits of surgery including: early, complete restoration of arm anatomy, greater functional improvement of the adjacent joints, and increased risk of nonunion with nonoperative treatment. The fracture was comminuted and extended proximally around the shoulder prosthesis. Through the posterior approach, the radial nerve was identified and protected. Both prostheses were found firmly fixed to bone. The fracture around the shoulder prosthesis was reduced first using a strut allograft and reduction clamps. Next, arm alignment restoration and distal humerus reduction were performed. The construct was neutralized with a 3.5-mm locking plate spanning the whole length of the humerus. The locking plate was positioned posterolaterally and the strut medially in a 90° to 90° configuration secured with wires and cables. A hinged elbow brace was applied for 6 weeks postoperatively. Active range of motion exercises of the wrist and hand and passive motion of the elbow and shoulder were started at 4 to 5 days postoperatively. At 2 weeks postoperatively, passive motion of the elbow and shoulder progressed to strengthening exercises. Thereafter, the patient underwent several weeks of physical therapy to restore motion, strength, and function of the upper extremity with instructions not to overload the arm and avoid heavy work and sports for as long as 1 year. At 10 months postoperatively, radiographs of the arm showed a stable construct; the patient had resumed full activities of daily living
How should musculoskeletal biopsies be performed?
No full textBiopsy refers to tissue sampling for histological examination, diagnosis, classification, and grading of a tumor. The goal of biopsy is to obtain a diagnostic tissue sample without complications, tumor spread, and compromise of future treatments.1,2 As a rule, all lesions should be biopsied as if they were malignant,2,3 and all soft tissue masses 3 cm or larger in diameter or growing lesions should be biopsied.2,4 Biopsy for musculoskeletal tumors can be closed (percutaneous) or open (incisional or excisional). Closed biopsy can be performed with a fine needle (fine-needle aspiration biopsy) or a core needle, and can be imaging guided or not. This editorial discusses the techniques, principles, and errors of biopsies for musculoskeletal tumors from radiologists’ and orthopedic surgeons’ perspectives
Current treatment considerations for osteosarcoma metastatic at presentation
No full textApproximately one-fourth of osteosarcoma patients have metastases at presentation. The best treatment options for these patients include chemotherapy, surgery, and radiotherapy; however, the optimal scheme has not yet been defined. Standard chemotherapy for osteosarcoma metastatic at presentation is based on high-dose methotrexate, doxorubicin, and cisplatin (the MAP regimen), with the possible addition of ifosfamide. Surgical treatment continues to be fundamental; complete surgical resection of all sites of disease (primary and metastatic) remains essential for survival. In patients whose tumors do not respond to neoadjuvant chemotherapy, early surgical resection of the primary tumor with limb-salvage surgery or amputation and multiple metastasectomies, if feasible, after the completion of adjuvant chemotherapy is a reasonable option, as the reduction of the tumor volume could probably increase the effect of chemotherapy. Advanced radiotherapy techniques, such as carbon ion radiotherapy and stereotactic radiosurgery, and molecular targeted chemotherapy with drugs such as pazopanib or apatinib have improved the dismal prognosis, especially for patients who are medically inoperable or who refuse surgery. Given that the presence of metastatic disease at diagnosis of a patient with osteosarcoma is a poor prognostic factor, a multidisciplinary approach by surgeons, medical oncologists, and radiotherapists is important
Clinical out come in central conventional chondrosarcoma of bone. Analysis of 296 cases
No full textClinical out come in central conventional chondrosarcoma of bone. Analysis of 296 case
Giant cell tumor of the capitate
No full textGiant cell tumors are primary bone tumors most often observed in the metaepiphyses of long bones; location in the hand, especially the carpal bones, is rare. We report a patient with recurrent giant cell tumor of the capitate and discuss treatment and prognosis in this rare site
Limb lengthening for deformities in Ollier’s disease: a systematic review
No full textBackground: The management of limb deformity, shortening, and bone defects in treatment of Ollier’s disease is a major challenge. This study aims to summarize and compare the different surgical treatments, and to evaluate the outcome and possible prognostic factors of leg lengthening in these patients. Materials and methods: A systematic review of the literature from 1993 to 2017 was performed. Nineteen articles were found including a total of 121 patients with limb deformities because of Ollier’s disease. The mean patients’ age at the time of first surgery was 12 years. A total of 272 segments were surgically treated (14 segments in the upper limbs) with variable techniques including osteotomies and external fixation, intramedullary nails, as well as epiphysiodesis and lengthening over nail. We studied the bone healing index (BHI), distraction index (DI), distraction time, gained length, total treatment time, and complications. Results: Available implants and techniques allowed correction of patients’ deformities (lengthening and correction of angular defects) in most cases. External fixators, circular or monolateral frames were the most commonly used technique. The Ilizarov external fixator was the most commonly used frame (196 segments). The BHI was significantly better when the external fixation was combined with intramedullary nails. Epiphysiodesis was most likely to be more associated with the past than to the present. Joint stiffness, infection, early consolidation, pathological fracture, deformity recurrence, delayed union, non-union, neurapraxia, and overlengthening were the reported complications with an overall rate of 27.9%. Conclusions: There is no consensus for the optimal surgical technique and implants for correction of limbs deformities in patients with Ollier’s disease. External fixators most commonly circular are the most commonly used implants; however, complications do occur
Therapeutic approaches for bone sarcomas
No full textBone sarcomas include a wide variety of primary, non-epithelial, malignant neoplasms originating from bone cells or their precursors. By definition, they have a potential for metastasis. Some bone sarcomas are purely osteolytic, while others produce a calcified matrix (e.g. osteosarcoma), a cartilaginous matrix (e.g. chondrosarcoma), or a mixed osteolytic/osteoblastic matrix. The three main bone sarcomas include osteosarcoma, Ewing sarcoma and chondrosarcoma. Most bone sarcomas occur in children and young adults and develop in the extremities, especially the distal femur, or the pelvis. The most common symptoms are pain and an enlarging mass. The location, depth and size of an enlarging mass can be determined on physical examination. The presence of persistent non-mechanical pain in any bone lasting more than a few weeks should cause concern and lead to further immediate investigation. A palpable mass will only be present if the tumor has progressed through the cortex and distended the periosteum. Radiographs are important in any patient with prolonged bone pain. Conventional radiographs in two planes should always be the first investigation; a bone sarcoma will almost always be obvious in radiographs. Magnetic resonance imaging is the primary imaging method for evaluating bone lesions, their exact location, and their proximity to neurovascular structures. General staging including bone scintigraphy, chest radiographs and CT should be carried out to assess the extent of distant disease. The majority of patients with bone sarcomas require a multidisciplinary approach that includes orthopedic, medical and radiation oncologists, plastic surgeons, pathologists, and radiologists with expertise in bone tumors. Surgery is the primary therapeutic approach. The role of chemotherapy and radiation therapy is individualized. For some bone sarcomas, such as osteosarcoma and Ewing sarcoma, there is a preference to treat the patient with chemotherapy at the beginning of the course, prior to surgical treatment, aiming to treat the potential micrometastatic disease, reduce the soft tissue mass about the bone tumor and/or mature the mass, allowing for easier resection
Post radiation sarcoma: a single institution experience on 52 cases
No full textPost radiation sarcoma: a single institution experience on 52 case
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