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1/6. Intermediate grade osteosarcoma and chondrosarcoma arising in an osteochondroma. A case report of a patient with hereditary multiple exostoses.

    A 40 year old man with hereditary multiple exostoses (HME), affecting predominantly his left proximal tibia, distal femur, and proximal femur, underwent resection of an osteochondroma near the trochanter major of his left proximal femur because of malignant transformation of the cartilaginous cap towards secondary peripheral chondrosarcoma. The patient had a history of a papillary thyroid carcinoma four years previously. At examination of the resected specimen, a third malignant tumour, an intermediate grade osteosarcoma (grade II/IV), was found in the osseous stalk of the osteochondroma. Although no mutations were found in the EXT1 and EXT2 genes, the genes involved in HME, or in exons 5-8 of the p53 gene, the development of three malignancies before the age of 40 suggests that this patient is genetically prone to malignant transformation.
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2/6. Tibial osteochondroma causing foot pain mimicking tarsal tunnel syndrome: a case report.

    Nerve entrapment syndromes of the lower extremity are relatively rare in patients with multiple hereditary osteochondromatosis. A case of tarsal tunnel like symptoms in a 52-year-old woman with a distal tibial osteochondroma is presented. This case emphasizes that the possibility of nerve compression needs to be considered in a patient with multiple hereditary osteochondromatosis and that tibial osteochondromas can be a cause of tarsal tunnel-like symptoms.
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keywords = tibia
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3/6. Metaphyseal acroscyphodysplasia.

    Based on two independent personal cases and a pair of sibs from the literature, we delineate a new category of bone dysplasia with cup-shaped large metaphyses, for which the name metaphyseal acroscyphodysplasia is suggested. The main clinical features are severe growth retardation, micromelia predominating in the lower limbs, knee flexion, and severe brachydactyly. The radiological aspect of the knees is very specific: the lower femoral and upper tibial epiphyses embed themselves in their metaphyses, which are severely cup-shaped. Premature central epiphyso-metaphyseal fusion and gross deformation, or even coalescence, of the femoral condyles may occur. The femoral diaphyses are very short and broad, and there is progressive coxa valga. Bowed and/or short stubby tibiae with cone-shaped metaphyses, and varus deformity of the tibio-astragalian joint are other features. Slight deformations of the long bones occur in the upper limb. Severe brachydactyly, brachymesophalangy, phalangeal and metacarpal cone-shaped epiphyses and irregular, bent and shortened diaphyses are the main signs of hand involvement. Psychomotor retardation is present in 3/4. Autosomal recessive inheritance is likely.
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keywords = tibia
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4/6. The treatment of ankle valgus by surface epiphysiodesis.

    Progressive ankle valgus in childhood requiring surgical correction is usually because of paralytic disease or conditions that produce a short distal fibula such as multiple exostoses or both. Surface epiphysiodesis of the distal medial tibial physis was used to correct valgus deformity in ten ankles in seven patients. This procedure has been found to be a simple and effective method of treatment. Measurement of the degree of valgus and calculation of the remaining growth of the distal tibial physis are recommended to determine whether this procedure will be effective. It is most often indicated in the presence of moderate valgus in children aged 11 to 14 years.
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ranking = 2
keywords = tibia
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5/6. osteosarcoma arising from a multiple exostoses lesion: case report.

    A case of osteosarcoma arising from a multiple exostoses lesion is presented. Poorly differentiated osteosarcoma occurred in a twelve-year-old girl's proximal tibia where an exostosis was confirmed from radiographs. We treated this patient with preoperative chemotherapy, thigh amputation and postoperative chemotherapy, but she died of multiple pulmonary metastases seven months after surgery. The osteosarcoma, complicated by multiple exostoses, had a very poor prognosis because it was resistant to various anticancer agents.
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keywords = tibia
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6/6. Mechanical induction of osteogenesis: the importance of pin rigidity.

    Eight dogs, divided into two groups of four by varying pin rigidity, underwent 15% left tibial lengthening by the Ilizarov method. In group I, "tensioned" 1.6-mm wires maintained a rigidity approaching that of 4.0-mm pins. In group II, the wires, maintained at half the tension, averaged 45% of the rigidity measured in group I. All dogs in group I filled the experimental gap with de novo osteogenesis, whereas all of the dogs in group II prematurely bridged the gap, arresting the process of osteogenesis. From these experimental results, clinical trials have been started using commercially available external fixation devices utilizing pins with equivalent rigidity.
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keywords = tibia
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