Reliability of Goldberg Scoring System in the Radiographic Evaluation of Bony Union after Bone Grafting

Background@#Evaluation of bony union after bone grafting is very important in orthopedic surgery. The aim of this study was to verify inter- and intraobserver reliability of the Goldberg scoring system for radiographic evaluation of bony union after bone grafting in various situations of animal models. @*Methods@#Twenty-seven male C57/BL6 mice, which lack the ability to synthesize galactose-alpha-1,3-galactose (GalT KO mice), and 9 C57/BL6 mice carrying a wild-type gene were used as animal models. We divided the mice into four groups. In group 1, syngenic bone grafting and intramedullary fixation were performed (9 wild type C57BL/6 mice). In group 2, allogenic bone grafting was performed (9 GalT KO mice). In group 3, an alpha-galactosidase-treated porcine xenograft was transplanted into the femur to reduce the antigenicity (9 GalT KO mice). In group 4, a non-treated porcine xenobone grafting was performed (9 GalT KO mice). The level of radiographic bony union (Goldberg method) was assessed by three orthopedic surgeons. Intra- and interobserver reliability for radiographic evaluation was assessed. @*Results@#In the Goldberg scoring system, most of the radiographic measurements showed substantial to almost perfect intraobserver reliability. The total score showed substantial intraobserver reliability. The kappa coefficient (κ) of the first examiner was 0.603, the κ of the second examiner was 0.790, and the κ of the third examiner was 0.758. The scoring system showed substantial interobserver reliability. The κ of the first session was 0.641 and the κ of the second session was 0.649. @*Conclusions@#The Goldberg scoring system is a reliable tool for radiographic evaluation of bony union after bone grafting.

Is It Radiculopathy or Referred Pain? Buttock Pain in Spinal Stenosis Patients

BACKGROUND: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. METHODS: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. RESULTS: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). CONCLUSIONS: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.

The Effectiveness of Ultrasound-Guided Selective Nerve Root Block for the Treatment of Radicular Pain in the Lower Cervical Spine: An Assessment of Sustainability and Side Effects / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the sustainability and adverse effects of ultrasound-guided selective nerve root block in patients who complained of radiculopathy due to lower cervical disc herniation. MATERIALS AND METHODS: Between February 2014 and February 2016, 39 out of 60 patients who visited Department of Orthopedic Surgery, Kosin University Gospel Hospital with a chief complaint of radiculopathy due to lower cervical disc herniation were treated with an ultrasound-guided selective nerve root block. To evaluate the efficacy and sustainability of this treatment, the degree of pain relief and functional improvement were evaluated before and 3 months after the procedure. Patients were categorized into two groups: The soft disc group and the hard disc group. The safety of the procedure was evaluated by examining the side effects occurring immediately after the procedure and the following day. RESULTS: Visual analogue scale and Neck Disability Index were improved from 6.00 to 3.02 and from 15.82 to 6.15, respectively (p < 0.05). There were 2 cases of headache and 2 cases of dizziness; however, they were resolved within 1 hour after the procedure. In 32 patients (82.1%), there was improvement in pain, which persisted for more than 3 months in 24 patients. Contrastinly, 7 patients (17.9%) showed no improvement and 6 patients (15.4%) experienced recurrence of pain or symptoms within 1 month after the procedure. In the soft disc group, there was a reduction in pain, from a score of 5.88 before the procedure to 2.64 twelve weeks after the procedure (p < 0.01). In the hard disc group, there was also a reduction in, from a score of 6.09 before the procedure to 3.22 at postoperative 12 weeks (p < 0.01). There was no significant difference between the two groups. CONCLUSION: In patients with cervical disc herniation, an ultrasound-guided selective nerve root block appears to be an effective treatment option for outpatients due to its low risk of serious complications.

Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) is an uncommon condition that can occur when the nerves, artery, or vein to the arm is compressed by one or more of the structures that make up the thoracic outlet. TOS was the first compression neuropathy of the upper extremity to be identified. The wide variability of patients' symptoms, which include vascular and neural signs, as well as diffuse symptoms, and the lack of a valid and reliable test to confirm the diagnosis of TOS makes it difficult to identify correctly patients with TOS. Rates of three to 80 cases per 1,000 patients have been reported, but more patients are likely to have TOS because it is underestimated. Additionally, the primary controversy regarding patients with TOS is related to symptoms such as paresthesia, numbness, and pain. No positive objective test exists to confirm an accurate diagnosis. If patients present with diffuse pain and numbness in the neck and upper extremity with more than 2 provocation tests, TOS could be considered. The purpose of this review is to provide an overview of the causes, classification, evaluation, and management of TOS.

Clinical Efficacy and Safety of Radiofrequency Ablation Therapy with Cement Augmentation for a Metastatic Spine Tumor

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical efficacy and safety of radiofrequency (RF) ablation therapy followed by a bone cement augmentation procedure in treating and managing pain among metastatic spine tumor patients. SUMMARY OF LITERATURE REVIEW: As a metastatic spine tumor is unresectable, this procedure was performed. Results showed an increase in the necrosis rate, and a decrease in local recurrence and secondary vertebral stability. MATERIALS AND METHODS: From March 2007 to April 2016, 26 patients who were treated with RF ablation with a bone cement augmentation procedure and the same number of patients treated with radiotherapy for metastatic spine lesions were included in this study. Pain relief and functional quality of life were evaluated using a visual analogue scale (VAS) and Roland Morris Questionnaire (RMQ). RESULTS: VAS scores preoperatively and at 1, 4, and 12 weeks follow-up were 7.45, 3.01, 3.78, and 2.97 in the procedure group, and 7.04, 6.65, 5.87, and 3.03 in the radiotherapy group. The procedure group had significantly better average outcomes than the radiotherapy group for pain relief at 4 weeks but showed no difference at 12 weeks. The RMQ score improved from 13.92 to 7.21 in the procedure group, and from 15.33 to 9.75 in the radiotherapy group. Two patients who had a metastatic tumor near the vertebral body posterior cortex showed cement leakage into the disc space, that is, intraforaminal and intracanal space; therefore, operations were performed (7.69% nerve injury). CONCLUSIONS: RF ablation therapy with cement augmentation in treatment of metastatic spine tumor shows effectiveness in early pain relief and brings immediate vertebral stability, helping patients return to normal life. However, it carries a risk of nerve injury due to cement leakage.

Prevalence and Clinical Characteristics of Neurogenic Thoracic Outlet Syndrome in Specific Industrial Field

PURPOSE: The aim of this study was to analyze the multiple factors as a cause of thoracic outlet syndrome (TOS) in specific industrial field which is a South Korea company manufacturing rolling stock, defense products and plant equipment. METHODS: We analyzed questionnaire survey of 30 patients diagnosed as TOS at outpatient department from January 2005 to October 2015 retrospectively. We reviewed clinical records and questionnaire about repetitive task related to microtrauma. Questionnaire was established to analyze the correlation between occupational history and TOS. Statistical test was done with multiple regression analysis. RESULTS: Incidence rate was 9%, all of 30 patients engaged in heavy workload with symptoms of pain in neck and shoulder. A multiple regression was run to predict arm visual analogue scale (VAS) score from age, force of work, time of work and career. The model of analysis for arm VAS was statistically significant, p<0.001, adjusted r²=0.489. Only force of work variable added was statistically significantly to the prediction, p<0.001. CONCLUSION: Prevalence of TOS in highly loaded industrial field is higher than typically known, appropriate diagnosis is important for early comeback to work. Aggressive diagnosis and treatment is important since non-operative treatment can have satisfying result for patient and help early comeback to work.

The Efficacy of Carpal Tunnel Release with Mini-Open Incision / 고신대학교의과대학학술지

OBJECTIVES: We evaluated the effects of carpal tunnel release with a mini-open incision by analyzing symptom improvement. METHODS: We retrospectively reviewed 64 carpal tunnel syndrome patients who underwent carpal tunnel release with mini-open incisions between January 2001 and December 2010. The 22 males and 42 females had a mean age of 49 years and a mean follow-up of 12 months. We analyzed postoperative symptoms using The Michigan Hand Outcome Questionnaire. RESULTS: Patients reported complete resolution of their symptoms, and some patients who had presented with residual symptoms improved gradually. No complications or scar hypersensitivity were observed. MHQ(Michigan Hand outcomes Questionnaire) scores improved significantly between preoperative and postoperative 6 months and 12 months. CONCLUSIONS: Carpal tunnel release with mini-open incision provides a clinically effective, reliable and safe procedure.

Ultrasonographic finding Paratesticular Embryonal Rhabdomyosarcoma: Case Reports

Rhabdomyosarcoma (RMS) may arise from anywhere in the body, and RMS has been recognized as one of the most frequent forms of childhood solid tumors, occurring with a frequency similar to that of Wilms' tumors and neuroblastomas. However, RMS arising in the paratesticular region is rare so that an ultrasound appearance of paratesticular RMS has rarely been reported. We report the US findings of paratesticular embryonal RMS in 15 and 19 year old males.

The Purport of Steroid Treatment in the Weakness Phase of Parsonage-Turner Syndrome / 대한정형외과학회잡지

This article presents six cases of Parsonage-Turner syndrome with corticosteroid therapy in the muscle weakness phase. Three cases did not receive injected steroids after the onset of muscle weakness, and were classified as Group 1. The other three cases received injected steroid from just after muscle weakness onset, and were classified as Group 2. This article has a small study group of six cases, but is the first case study about the efficacy of steroids in the muscle weakness phase, showing a better treatment result when steroids were injected during the muscle weakness period. We report these findings, together with a review of the literature.

The Signification of Anterolateral Thigh Free Flap for Reconstruction of Soft Tissue Defect in Malignant Soft Tissue Tumor of Lower Extremity

PURPOSE: The purpose of this study was to evaluate the clinical results of anterolateral thigh free flap on soft tissue defect following wide excision in malignant soft tissue tumor of lower extremities. METHODS: Between February 2005 to April 2010, we followed up 19 cases who were undergoing anterolateral thigh free flap because of soft tissue defect following wide excision of malignant soft tissue tumor in lower extremity, including 9 cases were heel, 5 cases in foot, 3 cases in ankle, 2 cases in knee and leg. We observed that of implanted area's color, peripheral circulation at 3, 5, 7 days after operation and evaluated operating time, amount of hemorrhage, implanted skin necrosis, additional operations, complications. And we also evaluated the oncologic results, including local recurrence, metastasis, and morbidity. RESULTS: Average operation time of wide excision and anterolateral thigh free flap was 7 hour 28 minutes. 18(94.7%) of total 19 cases showed successful engraftment, on the other hand, failure of engraftment due to complete necrosis of flap in 1 case. In 18 cases with successful engraftment, reoperation was performed in 4 cases. Among them, removal of hematoma and engraftment of flap after bleeding control was performed in 3 cases, because of insufficient circulation due to the hematoma. In the remaining 1 case, graft necrosis due to flap infection was checked, and grafted after combination of wound debridement and conservative treatment such as antibiotics therapy, also skin graft was performed at debrided skin defect area. Skin color change was mainly due to congestion with hematoma, flap was not observed global congestion or necrosis except 4 cases which shows partial necrosis on margin that treated with conservative therapy. CONCLUSIONS: Anterolateral thigh free flap could be recommended for reconstruction of soft tissue defect following wide excision of malignant soft tissue tumor in lower extremity.

Repetitive Microtrauma as a Cause of Thoracic Outlet Syndrome

PURPOSE: The aim of this study was to analyze the repetitive stress of neck and shoulder area as a cause of thoracic outlet syndrome which is relatively common but frequently underestimated. MATERIALS AND METHODS: We analyzed 110 patients (114 cases) diagnosed as thoracic outlet syndrome. We designed diagnostic criteria of thoracic outlet syndrome involving symptom, tenderness, Tinel's sign and provocation tests. We reviewed the clinical, radiologic records and questionnaire about repetitive job related microtrauma. The questionnaire was established to investigate the relation between work history and thoracic outlet syndrome based on Labor Standards by Ministry of Employment and Labor. RESULTS: Accumulated repetitive stress on the neck and shoulder associated with work as a presumed cause of thoracic outlet syndrome were found in 88 cases (77.2%). The most common stress related to the development of thoracic outlet syndrome was occupation that requires repetitive shoulder action (more than 2.5 times per a minute) and the most common duration they exposed to the labor per day was more than 4 hours a day. CONCLUSION: Repetitive microtrauma of neck and shoulder can be a cause of thoracic outlet syndrome. In patients with a history of work related microtrauma, accurate physical examination and clinical history are important for diagnosing thoracic outlet syndrome.

How to Overcome Complications of Allograft Transplantation? / 대한골관절종양학회지

PURPOSE: We evaluated the complications of allograft reconstruction after a bone tumor resection, and reviewed literatures to overcome such complications. MATERIALS AND METHODS: We retrospectively reviewed clinical records and radiographs of fifteen patients in whom reconstruction with allograft after bone tumor resection. RESULTS: Eight patients were men and seven were women with a mean age of 27.1 years (1-56 years) and a mean follow-up period of 89.5 months (33-165 months). All postoperative complications related to the allograft were recorded. Twenty patients (80.0%) obtained a radiologic bony union at a mean of 8.35 months (4-12 months). The mean Musculoskeletal Tumor Society score was 73.5% (46.6-93.0%). Nine patients (60.0%) experienced one event and 3 (20.0%) patients experienced multiple events during the follow-up period. Recorded events were infection (3), fracture (2), nonunion (2), limb length discrepancy (2) and varus deformity (2). The mean event free survival period was 60.8 months (6-144 months). The mean allograft survival period was 80.2 months and the 5 year survival rate of the allografts was 83.0%. CONCLUSION: In order to overcome complications, the combination of an allograft and vascularized fibular graft is highly recommended. In the near future, the tissue engineering technique, the application of the stem cell and PRP, could reduce the complication of allograft such as resorption and nonunion.

The Efficacy of Scalene Injection in Thoracic Outlet Syndrome

OBJECTIVE: To evaluate the efficacy of scalene injection in patients with thoracic outlet syndrome. METHODS: We selected 142 patients diagnosed with thoracic outlet syndrome between January 2005 and October 2009. We performed a series of scalene injection with conservative treatment in all cases. Patients rated their pain degrees using a visual analogue scale. We also evaluated the time to return to everyday life and work, and patients' functional capacity. RESULTS: There were no complications or instances of inadvertent somatic or sympathetic ganglionic blockade after scalene injection. Overall, 111 patients (76.5%) experienced improved symptoms after the first set of scalene injection and 128 patients (88.2%) improved after scalene injection followed by conservative treatment. Of the 68 patients who returned to work during the study period, 54 returned within 1 week, and 62 within 2 weeks. Of those who returned to work, 61 reported nearly full functional capacity. We found that scalene injection was more effective in cases of thoracic outlet syndrome related to trauma than in those related to work-related repetitive stress. CONCLUSION: In patients with thoracic outlet syndrome, scalene injection effectively reduces pain. We recommend scalene injection as an adjunct to conservative treatment.

The Significance of Sentinel Node Biopsy in Malignant Melanoma and Squamous Cell Carcinoma of Lower Extremities / 대한골관절종양학회지

PURPOSE: Sentinel lymph node (SLNB) is the first confronted lymph node from primary lesion of tumor through lymphatic drainage, which is important for determining early metastasis and setting guidelines for treatment. We reported significant of sentinel lymph node biopsy in malignant melanoma (MM) and squamous cell carcinoma (SCC) of lower extremities. MATERIALS AND METHODS: Twenty-five cases of surgically treatment and being possible for follow up more than 1 year among the patients who were diagnosed as MM and SCC in this institution from Sep. 2005 to Jan. 2009, and 10 cases of them were performed SLNB. Average age was 64 years old, and 15 cases of male and 10 cases of female were in this group. RESULTS: 3 years overall survival rate was 100% and 3 years disease-free survival rate was 76%. Metastasis occurred in total 6 patients, 4 cases of inguinal lymph nodes, 1 case of soft tissue around knee, 1 case of left achilles tendon. In 15 cases of not performing SLNB, overall survival rate was 93.3% and disease-free survival rate was 73.3%. In 10 cases of performing SLNB, overall survival rate was 100% and disease-free survival rate was 90%. And only 1 case showed positive finding in the biopsy, and none of the 10 cases showed metastasis in follow-up. CONCLUSION: SLNB leads simpler and less complications compared to prior elective lymph node dissection, and shows high degree of accuracy. Throughout the SLNB, setting guidelines for treatment by accurate staging is thought to be helpful for increasing the survival rate in the patient with MM and SCC.

Common Extensor Fasciotomy and Radial Nerve Decompression on Recurrent Lateral Epicondylitis

PURPOSE: This study was performed to evaluate the results after a combined surgical treatment of common extensor Fasciotomy & Radial nerve decompression in recurrent lateral epicondylitis patients. MATERIALS AND METHODS: We retrospectively reviewed the functional records of 6 cases of patients who were treated surgically from the February 2004 to June 2008. 2 cases had Radial tunnel syndrome, and The average duration from the time of diagnosis until operation was 23.5 months (7~38), the patients were given an average of 5.7 local steroid injections each, and they were followed up postoperatively for at least 1 year. We performed combined surgical treatment of common extensor Fasciotomy & Radial nerve decompression. The patients' pain intensity was evaluated by VAS score system before the operation, 6 months and 12 months after the operation. The objective assessment of the surgery was investigated according to the criteria by Roles and Maudsley. RESULTS: The grasping power of the lesion site was 11.7 before surgical treatment, 18.6 and 28.3 after 6 months and 12 months. The mean VAS score was 8.2 before surgical treatment, 4.2 and 1.3 after 6 months and 12 months, respectively. The mean Simple Elbow Test Score was 1.8 before operation, 7.0 and 10.3 after 6 and 12 months, respectively. In clinical evaluation by the Roles and Maudsley's Criteria, there were 3cases assessed as excellent and 3 cases assessed as good after 12 months of follow up. No recurrence was noted and all the patients returned to the occupational activity and the average duration was 4.5 months. CONCLUSIONS: The surgical treatment using common extensor fasciotomy and radial nerve decompression for recurrent lateral epicondylitis is considered to be one of the recommendable methods.

Thoracic Outlet Syndrome Caused by Automobile Accident

PURPOSE: Thoracic outlet syndrome (TOS) causes pain, paresthesia and muscle weakness in neck, upper back, and the upper limbs. The etiologic factor of TOS is associated with car accident. However, in many cases diagnosis of TOS is underdiagnosed and proper treatment was not performed, which consequently lead to chronic pain status. The authors report of cases diagnosed with TOS following car accidents in our hospital. MATERIALS AND METHODS: The retrograde study was conducted on 12 subjects who reported of neck pain and numbness following car accidents from January 2006 to June 2009. The study was conducted through telephone interviews and surveys to investigate the mechanism of the accidents, clinical manifestation, duration of the symptoms from diagnosis to treatment, treatment course and prognosis. RESULTS: Of the 12 subjects diagnosed with TOS, 9 of them were caused by whiplash injuries, and 3 of them were due to lateral side injuries. l0 of the subjects complained of cervical pain and upper limb paresthesia, 4 of the subjects had upper limb pain and 3 of them had only cervical pain as chief complaint. All of the subjects were underwent anterior scalene injections. A total of 8 subjects who were diagnosed with TOS within 4 weeks of the causal event showed symptom improvements while in the group of subjects who were diagnosed after 4 weeks after the injury, only 2 of the subjects showed recovery, 2 recovered for only a brief period of time after the scalene injection and showed chronic pain status. In the 2 cases initially diagnosed as cervical whiplash injury, the diagnosis of TOS was done in 3months and 6months after the accident respectively and the treaatment was delayed. CONCLUSIONS: There is high possibility of TOS after car accidents if cervical pain and numbness on the upper extremity are observed. Better clinical course and prognosis is expected in subjects who were diagnosed and treated within 4 weeks.

Reconstruction of Defect After Wide Excision of Malignant Soft Tissue Tumor of Limb Using Free Flap

PURPOSE: Evaluation of results of free flap as a method of reconstruction in soft tissue defect after wide excision of soft tissue tumor of extremity. Materials and METHODS: From 2000 through 2007, 11 patients received free flap surgery for soft tissue defect after wide excision operation for soft tissue tumor of limbs. Four cases were upper extremities and seven were lower extremities. Four subjects were diagnosed as squamous cell carcinoma, three as malignant melanoma, two as synovial sarcoma and one as malignant fibrous histiocytoma and alveolar soft part sarcoma. Donor sites of free flap varied with anterolateral thigh flaps in six cases, latissimus dorsi flaps in four, reverse forearm flap in one. By the method of doppler ultrasound, venous circulation was evaluated for the survival of each flap on the third, fifth and seventh day respectively after the operation. RESULTS: 10 of 11 free flaps were successfully survived. Necrosis of free flaps in 1 cases occurred in case of anterolateral thigh flap. CONCLUSION: Free flap can be a useful method for reconstruction of soft tissue defect after wide excision of soft tissue sarcoma of extremity.

Internal Fixation for Isolated Posterolateral Fracture of the Acromion: A Case Report

Isolated acromial fracture is not common and it frequently accompanies fractures to the coracoid process and glenoid bone and also injuries to the acromioclavicular joint. Furthermore, most of these combined acromial fractures have minimal displacement, which needs no additional treatment other than protection for a certain period of time. We have experienced a case of isolated fracture of the posterolateral angle of the acromion, which we reduced and fixated using K-wire and cannulated screws. We report on the technical aspects and clinical results of this reduction and fixation, along with a review of the literature.

Limb Allotransplantation In Rat Immunosuppressed with FK-506 / 대한정형외과학회잡지

PURPOSE: This study investigates the effectiveness of FK-506, a new immunosuppressive agent for in preventing the rejection of limb allo-transplants in rats. MATERIALS AND METHODS: Inbred strain Lewis (RT1l) were used as donors and Brown Norway (RT1n) as recipients for limb allotransplan-tation. The experimental animals were divided into four groups; group I: untreated allografts, group II: allografts receiving FK-506 1mg/kg/day for 5-12 days (n=6), group III: 2 mg/kg/day for 15 days (n=6), group IV: single dose of 10 mg/kg (n=3), immediately. Rejection signs, mean survival time of limbs and histologic analysis (by the muscle grading system of Buttemeyer et al.) were evaluated. RESULTS: The mean survival time in group I was 3.5 +/-1.04 days, in group II 7.17 +/-3.43 days, in group III 25.5 +/-12.01 days and in group IV 16.33 +/-8.08 days. FK-506 prolonged the survival time of limbs significantly in a dose-dependent manner. Histologic examination revealed that group II was grade II (n=2) and grade III (n=1); group III was grade I (n=2); and group IV was grade I (n=1) and grade II (n=1). CONCLUSION: These results demonstrate the unique effects of FK-506 upon preventing graft rejection and prolonging limb survival allo-grafts in rats.

Recycling Autograft with Extracorporeal Irradiation for Reconstruction in Malignent Bone and Soft Tissue Tumors / 대한정형외과학회잡지

PURPOSE: This report is comprehensive results of our clinical series in which we report theoretical advantages and indication of recycling autograft following extracorporeal irradiation in malignant bone and soft tissue tumors. MATERIALS AND METHODS: We have treated in 24 patients by en bloc resection, extracorporeal irradiation and reimplantation of irradiated bone from june 1994 to june 1999. All patients were evaluated radiologiccal union, functional results and complication. RESULTS: The radiologiccal union of junctional sites had appeared at 9.1 months postoperatively. The mean functional results was 73%, we used the criteria of Enneking et al.. There are 10 cases (47.6%) of complication, witch were nonunion, epiphyseal collapse, joint instability, infection, local recurrence and metal failure. CONCLUSION: The recycling autograft following extracorporeal irradiation is a useful method on minimal bony destruction, preserving joint function as osteoarticular autograft, using bone with soft tissue (ligament and tendon) attachment in periarticular tumor and biological spacer in immature skeletal age.