Giant cell tumor of bones: management by different surgical techniques

To evaluate the clinical outcome of different surgical techniques used in the treatment of giant cell tumor of long bones and their effect on the rate of local recurrence. Thirty-seven patients with giant cell tumor of the long bones have been treated between July 1994 and July 2003. All patients were evaluated by clinical examination, plain X-ray, computerized axial tomography and magnetic resonance imaging. Biopsy was taken in all cases to confirm the diagnosis and to define the histological grade of the tumor. Thirty- one patients were treated primarily by curettage and six were treated primarily by wide excision. Selection of the surgical technique was based on site and size of the lesion, soft tissue involvement [intra- or extra-compartmental], tumor grade [histological and radiological] and if recurrent or not. Patients were followed-up for a minimum of two years. The mean age of our patients at presentation was 29.3 years [ranged from 19 to 52 years] and at last follow up visit 32.1 years [range 24 to 55 years]. Seventeen patients were males and twenty were females, [male to female ratio was [1:1.2]. According to the classification of Campanacci et al [3 patients were grade I, 24 patients were grade II and 10 were grade III]. There were no mortalities among our cases. Local recurrence occurred in 9 out of 31 patients treated by curettage. The main primary treatment of giant cell tumor is surgery. The use of local adjuvant therapy as part of treatment of giant cell tumor helps in decreasing the rate of recurrence. Curettage must he extensive to be effective and requires a large cortical window. Wide excision is used in extremely large lesions with cortical bone breakthrough and extension into soft tissue, when the joint could not be preserved and in cases where resection results in no significant morbidity

Carpal tunnel release VIA mini-open wrist crease incision: procedure and results of four years clinical experience

To evaluate prospectively the safety and effectiveness of a mini-open technique for carpal tunnel release using a 1-1.5 centimeter wrist skin crease incision. Clinical experience with the technique consists of 98 patients and 124 hands over a period of four years, from October 1999 - October 2003. All cases were done as outpatient under local anesthesia Details of the technique, patient satisfaction and Outcomes are presented. The mean duration of the operation was 12 minutes. The technique was highly satisfactory cosmetically for all patients especially who previously experienced the open standard palmar incision in the other hand. Ninety-four percent of the patients were completely satisfied with the procedure regarding their symptoms. Five cases developed minor superficial wound infection No major nerve or vascular injury had occurred. Postoperative outcome measures and patient satisfactions [pain, return to normal activities and work, scar and pillar tenderness] were comparable with published series of endoscopic carpal tunnel release. This technique is simple, safe, cosmetically satisfactory and cost effective. It can be used by experienced hand surgeons especially in countries where endoscopic release is expensive and not widely available