The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy. These have largely been single institutional studies with limited numbers. The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.</p><p><b>METHODS</b>A retrospective review of the data was conducted. Ninety-five cases of nonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.</p><p><b>RESULTS</b>In the fracture group, the LSS rate was 62.1%, and the rate of amputation was 37.9%. In the nonfracture group, the LSS rate was 74.7%, and the amputation was 25.3%. In patients with a pathologic fracture, the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%, respectively. In this group, the 5-year survival in the LSS group was 66% as against. 46.8% in the amputation group.</p><p><b>CONCLUSIONS</b>Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.</p>

Spontaneous Bone Regeneration in Surgically Induced Bone Defects in Young Rabbits / 대한정형외과학회잡지

PURPOSE: To evaluate and compare the spontaneous regeneration repair process in femoral bone defects in 6-week-old rabbits and to compare the healing time periods between different rabbit groups. MATERIALS AND METHODS: Bone defects were created at the femur mid-shaft and an external fixator was applied in 50 rabbits. The periosteum was resected in 10 rabbits (defect size: 15%, 25%) and left untouched in the remaining rabbits. Forty rabbits were divided into four groups according to the percentage of bone defects (15%, 20%, 25%, 30%). Radiographs were taken weekly to evaluate the bone regeneration and union. The bone union time was measured between the osteotomy and the cortico-medullary differentiation by examining radiographs. The healing index was defined as the union time (week) per amount (cm) of bone defect. Eight rabbits, 2 from each groups with the bone defects, were investigated by histopathologic examination. RESULTS: The mean union time was approximately 7.0 to 7.3 weeks. The healing index in groups that had a large percentage of bone defects was less than in groups that had a small percentage of bone defects. The periosteum-resected group did not show bone regeneration. Histopathologic examinations showed intramembranous and atypical endochondral ossifications along the periosteum and typical endochondral ossification at the center of the bone defects. CONCLUSION: Spontaneous bone regeneration may be used in children to fill the bone defect instead of performing an internal bone transport. Spontaneous bone regeneration is useful in cases of mid-shaft bone defects or when the remaining bone fragments are large enough for an external fixation application.