Intramedullary rod fixation of fibrous dysplasia without use of bisphosphonates.

PURPOSE: Controversy exists regarding approach to treatment of pediatric patients with fibrous dysplasia. METHODS: We retrospectively reviewed medical records of seven patients who were treated at our institution for fibrous dysplasia by intramedullary rod fixation without bisphosphonate supplementation. RESULTS: Seven patients with a total of ten fibrous dysplasia lesion sites surgically treated by intramedullary rod fixation were included. Of these ten lesion sites, eight demonstrated pathologic fracture at the time of fixation. Complete fracture healing was observed in all eight sites, with no incidence of recurrent pathologic fractures examined radiographically. There were no major infections or neurologic deficits, and lesions appeared to stabilize. CONCLUSIONS: In this series, intramedullary rod fixation proved to be successful in treatment of acute pathologic fracture and incompletely healed fibrous dysplasia lesions. We observed partial resolution of fibrous dysplasia lesions at all ten sites without significant long-term complications. Following treatment, there were no refractures. LEVEL OF EVIDENCE: Level IV, case series.

Effect of COX-2 inhibitors and non-steroidal anti-inflammatory drugs on a mouse fracture model.

A randomised, blinded, prospective animal study with 296 male C57BL/6N mice was performed to evaluate the biomechanical, biomolecular, biochemical, and histological impact of anti-inflammatory medications on fracture healing. A reproducible closed tibia fracture was created and stabilised with an intramedullary pin. Animals were randomised to placebo, ketorolac, ibuprofen, celecoxib, or rofecoxib treatment groups with biomechanical and biochemical testing at 4, 8, and 12 weeks. A second arm of the study was conducted in which animals were randomised to indomethacin or placebo treatment with biomechanical testing at 12 weeks. Histological and biomolecular studies were performed at 2 weeks on all groups in the first arm of the study. Biomechanical testing consisted of three-point bending evaluating maximum load, energy absorbed to maximum load, and stiffness. Safranin O-Fast Green stain was performed for histology. Biochemical quantifications of chondroitin and dermatan sulphate, hydroxyproline, total protein, and DNA content were performed. Osteocalcin and collagen types II and X were evaluated by in situ hybridisation. Some mechanical differences were seen between ketorolac and placebo at 4 weeks with respect to energy absorbed, but there were no differences in maximum load or stiffness seen between any treatment group and placebo at any time point. Indomethacin, celecoxib, rofecoxib, ibuprofen, and ketorolac did not significantly affect fracture healing in this young murine model.

The cytopathology of soft tissue mxyomas: ganglia, juxta-articular myxoid lesions, and intramuscular myxoma.

We studied the practicality of issuing a cytologic diagnosis of myxoma/juxta-articular myxoid lesion/ganglion (MJG) by reviewing all fine-needle aspiration (FNA) biopsy specimens of soft tissue masses in our files with diagnoses of myxoma, myxoid cyst, myxoid lesion, ganglion, or ganglion cyst. The control group was soft tissue aspirates with abundant myxoid stroma. Of 39 cases with a cytologic diagnosis of soft tissue MJG, 15 had subsequent tissue biopsy or complete resection of the mass; 24 had clinicoradiologic follow-up. All cases except 1 (fat necrosis) were diagnosed correctly as benign myxoid lesions. We grouped MJG aspirates into 3 subtypes based on clinicoradiologic features: soft tissue ganglion/ganglion cyst (12 cases), juxta-articular myxoid lesion (16 cases), and intramuscular myxoma (11 cases). MJG aspirates showed few, subtle cytopathologic differences among subtypes. They characteristically had a viscous, gelatinous quality when expressed from the needle onto the glass slide. The typical smear contained a film of paucicellular, often finely granular, myxoid stroma, that contained few cells, usually macrophages or bland spindle cells. Control group aspirates always contained cellular components that allowed distinction from MJGs. The cytopathologic diagnosis of MJG lesions is accurate; FNA biopsy can be used to subtype MJGs into 3 categories when clinicoradiologic features are known.

Fine-needle aspiration cytology of sclerosing perineurioma.

Sclerosing perineurioma is a recently described rare benign nerve sheath tumor. The cytopathology of this neoplasm has, to our knowledge, not previously been described. We report the fine needle aspiration cytopathology of sclerosing perineurioma, discuss potential pitfalls in cytologic interpretation, and compare the aspirate with the corresponding resection specimen.

Fluorescent tetracycline labeling as an aid to debridement of necrotic bone in the treatment of chronic osteomyelitis.

The authors have found that several months of preoperative tetracycline administration will label living bone so that it fluoresces under a blacklight during surgery. This allows intraoperative differentiation of viable bone from necrotic sequestra, which require removal in the treatment of chronic bone infection.

Foot tumors: diagnosis and treatment.

Several large clinical series have demonstrated that benign and malignant tumors occur in the foot and ankle at a much higher rate than previously thought. Vigilance is warranted in investigating any foot mass, including those with an apparently indolent course. Although tumors in the foot tend to produce symptoms relatively early because of the foot's compact structure, many tumors are initially misdiagnosed. Given the comparatively small size of the anatomic compartments in the foot, tumors often present outside the original compartment, making timely diagnosis essential. Major treatment errors can be avoided if physicians consider the potential for malignancy when evaluating all foot masses. A high index of suspicion, an organized approach to diagnosis, and evaluation of and adherence to the basic principles of treatment of musculoskeletal neoplasms increase the likelihood of acceptable results.