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PubMed1976

Surgical exposure of the lesser trochanter and the medial proximal part of the femur.

An exposure of the medial proximal femur between the femoral artery and vein medially and the femoral nerve laterally is described. As far as the authors know, this exposure has not been described in the literature before. In their opinion it is to be preferred to the exposures already published when lesions of the medial proximal part of the femur are to be treated. Moreover, the exposure can be extended distally as described by Henry (1970).

Child, Preschool↗
PubMedDate not supplied

Osteosarcoma in blood relatives.

Osteosarcoma is an uncommon tumor. Family occurrence of osteosarcoma is even rarer. Four cases of osteosarcoma in two siblings and in a father and son treated at our Institute with surgery and chemotherapy are reported. These patients had no other tumors in their family history, and had negative p53 mutations in exons 5-9 by SSCP analysis. RB, CDK4, MDM2, c-myc, c-fos, and p53 gene expression, which are the major genes involved in osteosarcoma susceptibility, were studied. Our results revealed an inactive form of p53 sporadically seen in the samples, a total loss of Rb protein expression, an increased expression of Cdk4, MDM2, c-fos, and c-myc proteins which literature currently reports being the principal alterations found in osteosarcoma. These findings confirm that specific genetic alterations occur in osteosarcoma pathogenesis.

Adolescent↗
PubMed1999

Gastrocnemius muscle transfer in limb-sparing surgery for bone tumors around the knee.

Limb-sparing surgery for bony tumors around the knee, resulting in large segmental defects, involves its replacement with an endoprosthesis. The viability of the overlying skin flaps is of utmost importance. Their healing without breakdown is essential or else leads to prosthesis exposure, infection and perhaps prosthesis removal. In this situation, gastrocnemius muscle transfer is a robust vascular option, not only providing soft padding to cover the endoprosthesis, but also supporting the vascularity of the skin flaps. Out of 16 such muscle transfers done, 15 survived completely with good wound healing. One patient developed a severe infection of the wound associated with skin flap breakdown and necrosis of part of the muscle flap. There was 1 case of wound haematoma which was treated successfully.

Arthroplasty, Replacement, Knee↗
PubMed1999

Biopsy of musculoskeletal tumors. Current concepts.

Biopsy is a key step in the diagnosis of bone and soft tissue tumors. An inadequately performed biopsy may fail to allow proper diagnosis, have a negative impact on survival, and ultimately necessitate an amputation to accomplish adequate margins of resection. Poorly performed biopsy remains a common finding in patients with musculoskeletal tumors who are referred to orthopaedic oncology centers. The principles by which an adequate and safe biopsy of musculoskeletal tumors should be planned and performed are reviewed, and the surgical approach to different anatomic locations is emphasized.

Biopsy↗
PubMedDate not supplied

The natural limb is best: joint preservation and reconstruction by distraction osteogenesis for high-grade juxta-articular osteosarcomas.

This paper introduces an innovative technique of highly conservative limb-saving surgery for juxta-articular osteosarcoma. This technique consists of marginal tumour excision, joint preservation and reconstruction by distraction osteogenesis. Ten patients, with a mean age of 19.5 years and high-grade osteosarcoma, underwent this procedure. The distal femur and proximal tibia were affected in five patients each. After effective pre-operative chemotherapy, the tumour was excised with preservation of the epiphysis, the articular surface and the maximun amount of healthy soft tissue. This was followed by application of an external fixator. Bone transport was performed for seven patients and shortening-distraction for three. The limb function was rated excellent in seven patients, good in one and fair in two. At the final follow-up, three patients were dead after a mean of 25.3 months while seven patients remained free of disease with a mean follow-up of 55.4 months. Joint preservation and biological reconstruction through distraction osteogenesis can produce excellent and long-lasting functional results.

Bone Neoplasms↗
PubMed1992

Metastatic bone disease of the pelvis and femur.

Metastatic bone disease involving the pelvis and femur is a common clinical occurrence. A pathologic fracture in this region is a catastrophic event that results in significant pain and loss of function. Recent advances in surgical management of pathologic fractures, resulting in secure fracture stability or stable joint replacement, have allowed these patients to resume their pre-fracture level of activity and ambulation. The surgeon must be familiar with the various devices available, because the choice of surgical procedure depends on the location of the tumor. In selected patients with extensive destruction, methylmethacrylate can be used to enhance the security of fixation and stability. Moreover, a more aggressive approach to prophylactic fixation before a catastrophic fracture develops has distinct advantages.

Bone Neoplasms↗
PubMed1979

Sarcoma in Paget's disease (11 cases).

Eleven cases of sarcoma in Paget's disease of bone are presented, together with an extensive review of the literature. These neoplasms are rare but not exceptional, and mostly affect male subjects in the seventh decade of life. The sites most frequently affected are the pelvis, femur and humerus. In 30 per cent of cases these neoplasms are multifocal. Radiographically the lesions are nearly always osteolytic. The radiographic diagnosis may, however, be quite difficult, especially in the presence of the severe (but benign) osteolyic lesions that sometimes occur in Paget's disease. Morphologically these tumours are mostly highly polymorphic sarcomas. The cases in this series were diagnosed histologically as osteosarcoma, grade 3 fibrosarcoma, and malignant fibrous histiocytoma; but there are no prognostic differences between the various histological types. The prognosis is very serious, only about 3 per cent of patients surviving for five years from the time of diagnosis. Therapy, unfortunately nearly always palliative, is based on amputation or disarticulation after sections biopsy in cases where the disease is localised to the limbs, and on radiotherapy in cases not amenable to surgery.

Adult↗