1/77. Ewing's sarcoma recurrence vs radiation necrosis in dynamic contrast-enhanced MR imaging: a case report.PURPOSE: We report a case of Ewing's sarcoma in the right distal femur in a 6-year-old male to demonstrate how dynamic contrast-enhanced magnetic resonance imaging (DEMRI) findings predicted histopathology. MATERIALS AND methods: DEMRI was performed at presentation and during and after completion of chemotherapy and radiation therapy. Histopathologic studies were done at presentation, at 77 weeks (20 weeks after a pathological fracture), and from the en bloc resection at 104 weeks. RESULTS: DEMRI predicted the early tumor response, absence of tumor recurrence, presence of necrosis and lack of fracture healing, confirmed by histopathology. CONCLUSION: DEMRI is a clinically useful tool in managing Ewing's sarcoma.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/77. Extraskeletal myxoid chondrosarcoma with multiple skeletal metastases.Pulmonary metastases are not unusual in extraskeletal myxoid chondrosarcoma; however, only two patients have been reported with multiple bony metastases. We report here one patient with extraskeletal myxoid chondrosarcoma associated with lung and multiple bony metastases. After chemotherapy, the primary lesion was resected, but lung and multiple bony metastases were found 20 months later. The bony metastases were in the right femur, right humerus, and at multiple vertebral levels. Because of a pathologic fracture of the right femur, the metastases in the right femur and right humerus were surgically stabilized. After chemotherapy, the lung metastases were resected, and those in the vertebral bodies were treated with radiotherapy.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
3/77. Metastatic disease of the femur. Surgical management.Treatment of actual or impending pathologic fractures of the femur provides the senior author with some of the most rewarding surgical interventions of his practice. The patients' survival outlook is not changed, but their quality of life is enhanced significantly. Most health care providers usually provide the metastatic cancer patient only temporary symptomatic relief, at best, and often at the expense of continued pain, suffering, or sickness, such as is seen with chemotherapy-associated morbidity. patients with metastatic bone disease are usually incredibly grateful for the restoration of function and diminution of their pain that results from the proper operation on metastatic bone disease. These patients typically are among the most appreciative patients and often express their gratitude when seen in follow-up in the clinic or office. Despite their metastatic disease state, their usual enthusiasm is uplifting to the surgeon and to the staff. To help a patient be pain-free and functional in the waning days of his or her life affords the patient, the physician, and the physician's staff with an emotionally rewarding experience and one that is well worth the time and effort required to care for these patients. By following the techniques outlined in this article, most patients with metastatic disease of the femur can be appropriately managed with excellent results.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
4/77. Allograft-allograft healing? Salvage of massive allografts after fracture.Two cases are presented in which an allograft was inserted to salvage a previous allograft bone reconstruction that had followed resection for osteosarcoma. In each instance an allograft-allograft junction was created and, with time, healed. In the first case, a fracture of a distal femoral osteoarticular allograft was salvaged by adding a second allograft and a total knee arthroplasty. This construct preserved the majority of the allograft and allowed rapid rehabilitation. In the second case, an allograft arthrodesis of the knee was salvaged after fracture by replacing the distal portion of the fractured allograft with a new allograft. Again, an allograft-allograft junction was created and healed within 6 months. Allograft fractures pose challenging reconstructive problems. In these two cases, the addition of more allograft facilitated continued limb salvage and function.- - - - - - - - - - ranking = 4keywords = fracture (Clic here for more details about this article) |
5/77. Cotton-induced pseudotumor of the femur.Twenty-five years prior to presentation a 41-year-old man had a femoral fracture stabilized with a 4.5 mm AO/ASIF steel plate. The femur healed uneventfully and the patient was asymptomatic for the following 20 years. He then noticed a slow-growing swelling of the left thigh associated with a degree of weakness. Radiographs of the femur 25 years after fracture stabilization showed a massive expansive osteolytic process surrounded by a rim of bone. magnetic resonance imaging (MRI) confirmed the presence of a large tumor. Since malignancy could not be excluded the patient underwent incisional biopsy. The histologic findings were nonspecific. Because of persistent symptoms the lesion was marginally excised. Intraoperatively a folded cotton sponge was found adjacent to the femur. Histopathologic investigation confirmed a foreign body reaction probably related to the retained cotton sponge. Reactive, foreign-body-induced change may mimic bone and or soft tissue malignancies.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
6/77. Pathological fracture complicating epidural local anaesthetic opioid infusion for cancer pain.Two cases of severe bone pains from metastatic cancer, without clinical or radiological evidence of fractures on admission, are presented. pain control and mobilization were achieved initially with local anaesthetic-opioid epidural infusion. Subsequent loss of analgesia prompted a re-examination, which revealed pathological fractures of the femur. Internal fixation of the fractures resulted in good control such that strong opioids were no longer required.- - - - - - - - - - ranking = 3.5keywords = fracture (Clic here for more details about this article) |
7/77. Metal-associated angiosarcoma of bone: report of two cases and review of the literature.Angiosarcoma is an extremely rare bone tumor. The authors report two cases of patients with angiosarcoma that developed adjacent to a stainless steel plate used for fixation of a femur fracture. In both patients, the interval between fracture treatment and the development of the neoplasm was more than 40 years. A review of the literature found 36 previously reported cases of malignancy arising adjacent to an orthopaedic implant. Despite any evidence directly linking these implants to the development of cancer, continued vigilance is warranted.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
8/77. Segmental resection for chondrosarcoma.Specific anatomical and pathological criteria for resectability of so-called central chondrosarcoma of the extremities were set forth and a method of treatment based on autoclaving the segment and surrounding it with massive amounts of fresh autogenous cancellous bone was used in eight patients. Follow-up ranged from 3.2 to 13.5 years. The advantages of the method are: ease of procurement of bone graft, absence of storage and measurement problems, and lack of need for rigid immobilization. No secondary procedures were required because of fracture, resorption, or infection.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
9/77. growth and remodelling of the autologous bone transplant used in a pediatric femoral reconstruction.The aim of the present work was to assess how growth and remodelling changed the morphology of the transplanted fibula used to reconstruct the proximal femur of a 5 year old child affected by a Ewing's sarcoma during the first 3 years of follow-up. The morphological evolution of the transplant was quantitatively assessed on diagnostic images. Special software was developed to perform three-dimensional measurements on computed tomography (CT) datasets, while state-of-the-art image processing software was used for conventional radiography. The measurements were then correlated with the loads expected to act on the hip during the various stages of the rehabilitation protocol. A simple cantilever beam model was used for a gross estimate of the risk of fracture of the transplant. The results of the analysis showed that there is no clear correlation between the morphological changes of the autograft and the hip loading conditions experienced. Apart from a drastic increase in the periosteal radius in the frontal plane, occurring in the first 10 months after the operation, the growth of the transplanted fibula seems well within the ranges of the normal fibular growth. The cantilever beam model suggested that, although the autograft is currently subjected to subcritical stresses. morphological evolution could increase the risk of fracture in the next few years if a normal level of loading were allowed.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/77. Isolated limb perfusion with melphalan for femoral metastases of breast cancer: case report.BACKGROUND AND OBJECTIVES: Complications of bone destruction occur in 10-29% of breast cancer patients with skeletal metastases. Palliative treatment consists of systemic chemotherapy, hormonal treatment, radiotherapy, and/or surgery in the case of (impending) fracture. A case is presented where isolated limb perfusion was applied for this indication. methods: A 43-year-old woman with extensive femoral metastases of breast cancer with impending fracture was treated with isolated limb perfusion (ILP) with melphalan. radiotherapy had resulted only in pain reduction, and intramedullary fixation was opted against because stable fixation was considered not feasible due to the location of the metastases. ILP with high-dose melphalan (10-20 times the amount that can be administered systemically) under normothermic (37-38 degrees C) conditions, resulted in partial remission and reossification. RESULTS: One year after ILP, until her death 2 years later, due to progressive metastases at other sites, the patient was able to bear weight again on her left leg. CONCLUSIONS: In selected patients with symptomatic large bone metastases from breast cancer, and no other treatment options, ILP with melphalan may be used for successful palliation.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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