Painless Growing Swelling on the Palm of a 4-year-old Boy: Malignant Peripheral Nerve Sheath Tumor.

In this study, we present a 4-year-old male patient with a slowly growing painless mass in the palm of his left hand for 2 years. Although musculoskeletal tumors are rare, hand localized tumors are even rarer in pediatric patients. The fact that very few (less than one in ten) tumors are malignant and there are dozens of subtypes, each with different treatment management, shows the importance of the management of these lesions. Appropriate diagnosis and management of soft tissue masses, especially insidious malignant tumors, is vital. Due to the rarity of soft tissue tumors, adequate guidelines for their management are limited. The purpose of this report is to present an example of the approach to one of the soft tissue tumors.

The Role of Preoperative Embolization in the Management of Aneurysmal Bone Cyst: A Comparative Analysis.

Introduction: The aim of this study was to evaluate the role of preoperative embolization in the management of aneurysmal bone cysts. Methods: In this study, the data of a total of 19 patients, 11 females and 8 males, with a mean age of 19.6 (range 5-46 years), who were operated on in our hospital with the diagnosis of ABC between January 2015 and January 2021 were retrospectively analyzed. In the specified date range, there were 10 patients with a diagnosis of ABC who were operated on within 48 h after preoperative embolization. For statistical comparison, 9 patients who were operated on without embolization in the same date range were included as the control group. Results: The mean age of the study group was 16.7 (between 5 and 27 years), while the mean age of the control group was 22.6 (between 16 and 46 years). In the embolization group (group I), the mean intraoperative blood loss was 550 mL (100-1200 mL), the mean intraoperative blood transfusion was 270 mL (0-900 mL), and the mean surgical time was 85 min. In the non-embolization group (group II), the mean intraoperative blood loss was 1250 mL (600-2200 mL), the mean intraoperative blood transfusion was 450 mL (450-1800 mL), and the mean surgical time was 90 min. In comparison, a statistically significant difference was found between the embolization group and the non-embolization group in terms of blood loss and blood transfusion requirement (p = 0.011 and p = 0.017, respectively). The mean surgery time was slightly shorter in the embolized group, and there was no significant difference in surgical time between the two groups (p = 0.821). Conclusion: Evidence suggests that preoperative embolization of an aneurysmal bone cyst, performed 0-48 h before surgery, can result in a reduction in intraoperative blood loss and intraoperative blood transfusion volume.

Does the preoperative neutrophil-to-lymphocyte ratio have a prognostic value in aneurysmal bone cysts?

OBJECTIVES: The aim of this study was to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-tomonocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in aneurysmal bone cysts (ABCs). PATIENTS AND METHODS: Between February 2001 and August 2019, a total of 86 patients (44 males, 42 females; mean age: 21.5±15.2 years; range, 2 to 73 years) with a histologically confirmed diagnosis of ABCs who did not receive cancer treatment previously and had a minimum follow-up period of 24 months were retrospectively analyzed. Data including age, sex, side, tumor location, pre-treatment complete blood count analysis results, preferred surgical method, follow-up period, presence of recurrence, and date of recurrence were recorded. Preoperative NLR, LMR and PLR values were calculated in all patients. RESULTS: The mean follow-up was 56.7±13.5 (range, 24 to 179) months. Forty-one (47.7%) ABCs were located in the lower extremities, 36 (41.8%) in the upper extremities, and nine (10.4%) in the pelvic girdle. A statistically significant difference was detected in the NLR values according to recurrence status (p=0.023). The PLR and LMR values were not significant for area under the curve, while NLR values were significant for recurrence. The cut-off value was determined as 2.054. Those with an NLR of ≥2.054 were found to have a 4.561-fold higher risk of recurrence than those with an NLR of <2.054 (odds ratio [OR]=4.561). CONCLUSION: Our study results suggest that NLR, which is the pre-treatment inflammatory index, is a prognostic factor in patients with ABCs. Although NLR alone is not decisive in patients with elevated NLR, it can be used to evaluate the clinical prognosis and recommend an appropriate treatment strategy.

First case of medullary osteogenic sarcoma of the pelvis: 12-year follow-up of reconstruction with hemipelvis allograft after resection.

A 45-year-old male patient with low-grade central osteosarcoma (LGCO) in the periacetabular region underwent wide resection, fresh frozen hemipelvis allograft reconstruction, and total hip prosthesis. To the best of our knowledge, this case is the first example of low-grade osteogenic sarcoma in flat bones. Aseptic loosening of the acetabular cup was observed 44 months after the operation, and it was revised with a constrained acetabular cup. Recurrent subluxation due to constraint ring failure and cup malposition was observed at 89 months after the revision surgery. Revision operation was performed with cage + non-constrained cup. Twelve years after the first operation, he is in exceptionally functional and disease-free condition. He can walk unlimited distances without pain. Radiographs show complete union at the junction of the allograft and disease-free bone.

Outcomes of Planned Marginal and Wide Resection of Sarcomas Associated with Major Vascular Structures in Extremities.

Bone and soft tissue sarcomas of lower and upper extremities may sometimes be in close contact with neurovascular structures. In such cases, it is controversial that whether en bloc resection and vascular reconstruction to reach wider surgical margins or planned marginal resection with the help of adjuvant therapies should be preferred. This study aimed to determine surgical and oncological outcomes of planned marginal and wide resection of extremity sarcomas that are associated with major vascular structures in the extremities. The collected database of 54 patients treated by the same orthopedic and vascular surgeon for primary or locally recurrent soft and bone tissue sarcoma of extremities was retrospectively reviewed. Eligible subjects for this study were patients diagnosed with upper and lower extremity soft and bone tissue sarcomas that encased a maximum of 50% of the circumference of the major vascular structures, requiring limb-sparing resection. When microscopic positive (19 patients, 33.9%) and negative cases' (35 patients, 66.1%) surgical margins were compared, local recurrence, metastasis, amputation, and tumor type (soft/bone) parameters showed no statistically significant difference. When metastatic and non-metastatic patients were compared, it was shown that bone tumors metastasized more than soft tissue tumors (p = 0.001). However, there was no difference between metastasis and amputation, histopathology, grade, nerve involvement, surgical margins, or local recurrences. The mean survival was 1460.6 ± 137.4 days, and the 6-year mortality was 87.5%. Anesthetic and surgical complication rates may be higher since en bloc resection surgeries of large tumors with vascular reconstructions take a very long time. Therefore, we suggest marginal resection with sub-adventitial dissection in those locations and wide resection at other areas according to the surgeon's experiences about safe margin with the contribution of radiotherapy.

A rare lesion that mimics a bone tumor: Osseous hydatidosis.

OBJECTIVES: This study aims to evaluate the symptoms, skeletal manifestations, and management of patients with tumor-like osseous hydatidosis treated in our oncology clinic in the long term and to share our clinical experience with this extremely rare disease. PATIENTS AND METHODS: Between December 2010 and May 2019, a total of 11 patients (6 males, 5 females; mean age: 45.1±13 years; range, 22 to 70 years) who were treated with a bone hydatid cyst (HC) and followed were retrospectively analyzed. Epidemiological, clinical, diagnostic, and therapeutic data of the patients with long-term follow-up were collected. RESULTS: The mean follow-up was 63.2±23.9 (range, 24 to 101) months. The most common site of bone hydatidosis was the femur in four (36%) patients. The most common clinical presentation was pain in seven (63.6%) patients. Two (18.2%) patients had a pathological fracture of the femur. It was detected incidentally in two patients. Contact history was present in two patients (with dog), and two (18.2%) patients had concomitant extraosseous cystic echinococcosis in the liver. Complete blood count analysis was performed in all patients and eosinophilia was positive in three (27.3%) patients. As treatment, curettage cementation was performed in nine (81%) patients (internal fixation was also applied to five of them), while wide resection and prosthesis were applied to two (18.2%) patients. CONCLUSION: The diagnosis of osseous hydatidosis is difficult and the prognosis is often poor. This entity should be kept in mind for the differential diagnosis of the cystic or tumoral lesions of the bone.

Characterization of primary fibular bone tumors and post-surgical clinical and functional outcomes.

OBJECTIVES: In this study, we present the characterization of tumors located in the fibula, which is a rare site for tumors, and the clinical and functional results of patients with fibular tumors that we operated in our clinic. PATIENTS AND METHODS: Between February 2008 and December 2018, a total of 104 patients (58 males, 46 females; mean age: 26±18 years; range, 3 to 78 years) who were operated for tumor located in the fibula were retrospectively analyzed. Demographic data, histopathological diagnosis, tumor localization, surgical method and postoperative complications, metastases, follow-up time, and functional results of the patients were recorded. The fibula was divided into three groups as proximal, diaphysis and distal one-third. RESULTS: The mean follow-up was 56±25.3 (range, 24 to 108) months. Eighty (76.9%), seven (6.7%) and 17 (16.3%) patients were located proximal, diaphysis and distal to the fibula, respectively. The number of patients with malignant tumors located in the fibula was 26 (25%), the tumor was benign in 54 (51.9%) patients and 24 (23%) tumors were borderline. The most common tumor localized to the fibula was osteochondroma with 28 (26.9%) patients. The most common malignant tumors located in the fibula were Ewing sarcoma and osteosarcoma in 11 patients each. The most common surgical method was curettage in 44 (42.3%) patients. Distant organ metastases were present in 18 (17.3%) patients. The Musculoskeletal Tumor Society score of 17 patients who underwent resection of the proximal fibula were 87%. CONCLUSION: Fibula is a rare location for tumors and fibula tumors tend to be located more proximal. Tumors located in the fibula have good functional outcomes after surgery.

Clinical outcomes of tumors and tumor-like lesions located in the clavicle.

OBJECTIVES: The aim of this study was to examine the characterization of tumors and tumor-like lesions located in the clavicle and to present their clinical results. PATIENTS AND METHODS: Between January 2006 and December 2018, a total of 44 patients (25 males, 19 females; mean age: 36.2±21.8 years; range, 2 to 87 years) who were operated in our clinic for a clavicular lesion were included. Among 4,856 extremity tumors operated in our clinic between these years, 44 cases (0.9%) located in the clavicle were eligible. Demographic data, tumor types, location, surgical method, metastasis, survival analyzes and clinical results of these patients were reviewed retrospectively. According to the clavicle location, the patients were divided into groups according to their involvement in proximal, middle, lateral and more than one region. RESULTS: The most frequently involved site was the lateral edge of the clavicle, and the most common tumor was aneurysmal bone cyst. The most common malignant tumor was Ewing sarcoma and plasmacytoma (13.6%) and the most common surgical method in the clavicle was wide resection with 34.1%. Of the 38 primary clavicle tumors remaining after the metastatic lesions were removed, 21 (55%) were benign, while 17 (45%) were malignant. Aneurysmal bone cyst was most common in the group under 30 years of age, osteochondroma was most common in the 30-50 age group, and plasmacytoma was most common in those over 50 years of age. The mean musculoskeletal tumor society (MSTS) score of 15 patients (34.1%) who underwent clavicle resection was 79.4±6. CONCLUSION: We believe that a wide spectrum should be considered in the differential diagnosis of tumors located in the clavicle. Age is an important predictive factor for malignancy. We believe that resection should be applied without fear considering its effects on function and recurrence.

Does biopsy before excision have contribution to clinical results in patients with schwannoma? A single-center prospective observational study.

INTRODUCTION: This study aimed to investigate whether tru-cut biopsy before excision contributes to clinical outcomes in patients diagnosed with limb schwannoma.

Mid-term outcomes of hemipelvic allograft reconstruction after pelvic bone tumor resections.

OBJECTIVES: This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic allograft following a pelvic resection. PATIENTS AND METHODS: Between January 2009 and December 2016, a total of 19 patients (12 males, 7 females; mean age: 35.8±14.4 years; range, 10 to 53 years) who underwent reconstruction with fresh-frozen massive allograft after internal hemipelvectomy were retrospectively analyzed. Patients̓ age, sex, resection types, histopathology and grades, surgical margins, operative times, intraoperative blood loss, complications experienced during their treatment (infection, dislocation, implant failure, nonunion, local recurrence and metastasis), neoadjuvant and adjuvant therapies they received, and functional scores were revealed and analyzed in 10 years period. RESULTS: According to the Enneking and Dunham classification, two (10%) patients had type I resection only, six (32%) had type I-II, one (5%) had a type II resection, one (5%) had type II-III resection, three (16%) had type I-II-III resection, one (5%) had type I-IV resection, and five (26%) had type I-II-IV resection. The resection involved the acetabulum (type II) in all, but three patients. Several complications were seen in 12 patients, although seven patients had no complication. Pelvic resections had a high mortality rate in patients with malignant tumors and reconstruction with massive allograft had a high morbidity rate with susceptibility to many complications. Prolonged surgical time was found to be directly related to blood loss. Deep infection significantly worsened functional results. CONCLUSION: Despite the high complication rates seen in pelvic resections, massive pelvic allografts represent a valid option for reconstruction after resection of pelvic tumors, but due to the associated morbidity, patients should be carefully selected.

Are preoperative complete blood count parameters in peripheral nerve sheath tumors useful diagnostic tools?

OBJECTIVES: This study aims to evaluate the diagnostic value of complete blood count (CBC) parameters in patients with peripheral nerve sheath tumors (PNSTs). PATIENTS AND METHODS: A total of 181 patients (83 males, 98 females; median age: 44 years; range, 15 to 83 years) who underwent surgical treatment for PNSTs in our tertiary oncology center between January 2010 and December 2019 were retrospectively analyzed. Eighty-two patients were diagnosed with a neurofibroma, 79 with a schwannoma, and 20 with a malignant PNST (MPNST). The patient group was evaluated as malignant (n=20) and benign (n=161). Age- and sex-matched patients admitted to our outpatient clinic of orthopedic and traumatology with non-specific symptoms other than tumor, infection, fracture, and rheumatological or hematological diseases were included as the control group (n=165). Data including age, sex, definitive histopathological diagnosis, and pre-treatment CBC values were obtained from the hospital records. Pre-treatment CBC values such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated for both malignant and benign groups and control groups. Diagnostic values of NLR, PLR, and LMR between PNST groups were assessed using the receiver operating characteristic (ROC) curve analysis. RESULTS: Neurofibroma, schwannoma, and MNPST groups had significantly higher median NLR, compared to the control group (p<0.001), while the median LMR was significantly lower in these groups (p<0.05). However, the median PLR was higher only in the MPNST group, compared to the control group (p<0.001). Post-hoc analyses revealed that median NLR, PLR, and LMR ratios were similar in PNST groups, compared to the control group. In addition, the median NLR, PLR, and LMR ratios were similar between malignant and benign patient groups. The highest area under the curve (AUC) was found for NLR (AUC=0.756) and LMR (AUC=0.716) in the MPNST group. CONCLUSION: Our study results suggest that NLR, PLR, and LMR may have an added value in the early diagnosis of PNSTs and are valuable for differentiating patients from healthy individuals, although their value in differential diagnosis is still unclear.

Diagnostic and prognostic role of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and lymphocyte/monocyte ratio in patients with osteosarcoma.

OBJECTIVES: This study aims to evaluate the diagnostic and prognostic significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) values in patients with osteosarcoma. PATIENTS AND METHODS: A total of 172 patients (111 males, 61 females; mean age: 24.3±15.3 years; range, 7 to 82 years) diagnosed with osteosarcoma in our institution between January 2002 and December 2018 were retrospectively analyzed. A total of 165 healthy individuals (115 males, 50 females; mean age: 20.2±9.2 years; range, 10 to 65 years) who did not have infectious, rheumatological or hematological diseases or any pathological finding were assigned as the control group. The clinical, laboratory, and demographic findings of the patients were obtained from hospital records. Pre-treatment NLR, PLR, and LMR values were calculated in all patients. Diagnostic and prognostic values of pre-treatment NLR, PLR and LMR were assessed using receiver operating curve (ROC) analysis. The Kaplan-Meier method was used for survival analysis. RESULTS: For diagnostic approach, the highest significance in area under the curve (AUC) values was obtained for NLR (AUC=0.763). The AUC for PLR and LMR was statistically significant, while the statistical power was weak compared to NLR (AUC=0.681 and 0.603). The NLR, PLR, and LMR were found to be predictors of mortality. The cut-off value was found to be 3.28 for NLR, 128 for PLR, and 4.22 for LMR. The prognostic value of NLR for mortality was higher than (AUC=0.749) PLR (AUC=0.688) and LMR (AUC=0.609). The NLR, PLR, and LMR were associated with overall survival (OS). There was a significant difference in the median OS time among the NLR, PLR, and LMR values (log-rank test order p<0.001, p=0.001, and p=0.004, respectively). CONCLUSION: Based on our study results, pre-treatment NLR, PLR and MLR have diagnostic and prognostic values in osteosarcoma.

A Simple Bone Cyst of the Acromion: Case Report.

Simple bone cysts rarely occur in the scapula, and, to our knowledge, they have not been reported in the acromion. In the present report, we present the case of a 24-year-old female patient who was successfully treated by curettage and grafting using xenografting. No recurrence findings were observed during the follow-up six months postoperatively, the patient had recovered full range of motion, and she was able to perform all routine activities satisfactorily.

Diagnostic and prognostic role of mean platelet volume and mean platelet volume/platelet ratio in the most common soft tissue sarcomas.

OBJECTIVES: This study aims to investigate the diagnostic and prognostic role of mean platelet volume (MPV) and MPV/platelet (PLT) ratio in the most common soft tissue sarcomas. PATIENTS AND METHODS: We retrospectively investigated 131 patients (76 males, 55 females; mean age: 51.8±17.1; range, 18 to 87 years) with soft-tissue sarcomas between January 2011 and January 2019. Demographic features, MPV, PLT counts, mortality, and recurrence records of the patients were obtained from archives. A total of 165 healthy volunteers (101 males, 64 females; mean age 52.9±4.1; range, 18 to 60 years) who applied to the outpatient clinic in 2019 and had routine blood control without any additional disease formed the control group. RESULTS: A total of 55 patients were diagnosed with liposarcoma and 76 with pleomorphic sarcoma. Of the tumors, 77.1% were located in the lower limbs. Lesions were mostly localized on the thigh 48.8% (n=64). Recurrence occurred in 28.2% of the patients. A total of 25 (19.1%) patients were exitus. The mean follow-up period of the patients was 34.4±19.1 (range, 9 to 112) months. The mean PLT value of the patient group was significantly higher than the control group. The median MPV and MPV/PLT ratio were statistically significantly lower in the patient group than in the control group. The MPV and MPV/PLT ratio were not associated with mortality and recurrence. CONCLUSION: As a result, MPV and MPV/PLT ratio can be used as a diagnostic support parameter in soft tissue sarcomas, but have no prognostic value.

Prognostic significance of the preoperative neutrophil-to-lymphocyte ratio patients with giant cell tumor of bone.

OBJECTIVE: To evaluate the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in giant cell tumor of bone (GCT). METHODS: The patients with GCT were identified in the hospital records and pre-treatment complete blood count results were acquired retrospectively. Whether preoperative NLR lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) values had prognostic significance in predicting recurrence was evaluated by Receiver operating curve (ROC) analysis. Furthermore, the prognostic value of NLR was evaluated by Multivariable Cox Regression analysis. RESULTS: There were 96 patients with GCT. It was found that only NLR values had prognostic significance for predicting recurrence (AUC:0.647; 95% CI:0.533-0.762; P=0.021). The statistically significant cut-off value of NLR for predicting recurrence was ≥2.25. NLR was ≥2.25 in 51% (n = 49) of patients. Multivariable analysis showed that NLR ≥2.25 (HR=2.9, 95% CI:1.3-6.6; p=0.009) and lung metastasis (HR=7.9, 95% CI:2.2-28.2; p=0.001) were independent factors of recurrence. In patients with lung metastasis and patients with NLR ≥2.25, recurrence was observed in a sooner period (Log rank test; p=0.001; p=0.009, respectively). CONCLUSION: Our findings showed that NLR is a new and promising inflammation-based prognostic factor in GCT patients.

Are Daily Life Activities of Patients with Proximal Femoral Tumor Resection Prosthesis as Good as those of Patients Undergoing Total Hip Prosthesis for Non-Tumor Causes?

INTRODUCTION: The Barthel Index of Activities of Daily Life (ADL) is a scale used to evaluate performance in daily life activities and investigate the reason and resulting relationships in a comprehensive, non-biased manner. AIM: The aim of this study was to compare the daily life activities of patients who underwent proximal femoral tumor resection prosthesis assessed by the Barthel Index with the activities of daily living of patients with a total hip prosthesis performed for non-tumor reasons. MATERIALS AND METHODS: Twenty-eight patients were included in the study. Sixteen patients underwent hip prosthesis for reasons other than tumor (femur proximal avascular necrosis, coxarthrosis, etc.) and 12 underwent wide resection and femur proximal tumor resection prosthesis due to primary malignant bone tumor or metastasis in the proximal femur. The Barthel Index was used to evaluate their life quality at 3 months. RESULTS: A total of 28 patients (mean age 60.9±1.4 yrs, range 19.0-84.0, 17 female and 11 male patients) were included into the study. Mean ADL score was 84.5±20.6 (5-100.0). While only one patient was totally dependent in terms of daily life activities, 8 other patients were totally independent. When the patient groups were categorized by degree of dependency according to the ADL scores, it was found that dependency states of the two surgery groups were similar in distribution (p=0.212, p=0.703, and p=1.000 respectively). CONCLUSION: Functional recovering levels were good in the patients who underwent a surgery for proximal femoral tumor resection prosthesis; there was no significant difference when we compared the functional level after total hip prosthesis applied for non-tumor reasons.

The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis.

AIM: The aim of this study is to evaluate the risk of thromboembolic events and amount of postoperative blood loss and transfusion in patients who received preoperative tranexamic acid (TXA) administration in proximal femoral resection and endoprosthesis of proximal femur malignant lesion. METHODS: In this study, the data of 46 patients who underwent extensive resection and proximal femoral tumor prosthesis for proximal femoral bone malignancies were retrospectively reviewed. Patients were divided into two groups according to preoperative 15 mg/kg bolus intravenous administration of TXA. These patients were compared in terms of postoperative blood loss, postoperative bleeding, and transfusion requirements. RESULTS: There were 46 patients (18 female, 28 male) with a mean age of 60.7±14.7 (19-89) years. Fifteen patients (32.6%) were treated with iv TXA. In the TXA group (46.7%), there was a statistically significant decrease in the need for transfusion compared to the patient group (93.5%) without TXA (p=0.001). Postoperative 24th hour, 48th hour,and total drainage blood loss values were found to be significantly lower in the TXA group (p=0.047, p=0.015, and p=0.019, respectively). There was no thromboembolic event observed. CONCLUSION: Because of proximal femoral malignancy, extensive tumor resection and preoperative bolus 15 mg/kg TXA administration in proximal femoral prosthesis surgery significantly decreased the amount of postoperative bleeding and transfusion requirement without increasing the risk of thromboembolic event. LEVEL OF EVIDENCE: Level III - retrospective comparative study.

Talus localized osteochondromas: Treatment management and mid-term outcomes - Case series.

OBJECTIVES: This study aims to define the demographic and clinical findings of patients with talus localized osteochondroma, to present treatment management and mid-term results. PATIENTS AND METHODS: The study included 10 patients (4 males, 6 females; mean age 31.9+19.5 years; range, 11 to 70 years) with osteochondroma of the talus who were admitted to our center between January 2008 and December 2015. Clinical findings, treatment methods, and clinical outcomes were retrospectively evaluated. All patients were followed-up for at least two years. RESULTS: The most frequent localization was anterior of the talus (70%, n=7). The mean tumor size was 2.4±1.4 cm (range, 1-5 cm). When the relationship between tumor diameter and age was analyzed, no statistically significant correlation was detected (p=0.973). Besides, no statistically significant difference was found between the genders in terms of tumor diameters (p=0.584). The most common symptoms were pain, swelling, and restricted movements. The mean duration of postoperative follow-up was 48.1±27.7 months (range, 24-114 months). All patients underwent complete surgical excision. None of the patients developed recurrence or complication related to the treatment of osteochondroma. CONCLUSION: Talus localized osteochondromas are often symptomatic and more common in adults. Also, they are more common in females. The ideal treatment approach is resection of the tumor. When rigorous surgical excision is performed, recurrence rates are low with satisfactory outcomes.

Place of orthopedic surgery in gout.

OBJECTIVE: To evaluate the indications, surgical results, and complications related to tophaceous gout surgery in the orthopedics and traumatology clinic of our hospital. METHODS: A retrospective analysis of all patients who underwent surgery for topical gout in our orthopedics and traumatology clinic between January 2008 and December 2017 was carried out. Their history, physical examination, and radiological and laboratory tests were examined. Surgical indications, surgical results, and complications were analyzed. RESULTS: Total 18 lesions in 15 patients with gout tophi were operated (60% males). The most common lesion was in the elbow (6; 33%). All patients underwent total excision, and the mean mass size was 4.0 cm. Only one patient had a delayed wound healing. All other patients had no complications. CONCLUSION: The results of surgical procedures which were performed to confirm the diagnosis, to reduce mechanical problems due to tophaceous and to alleviate pain were excellent, and complication risk was acceptable. Comorbidities and sepsis were the predictors of surgical complications.

Malignant tumors of the shoulder girdle: Surgical and functional outcomes.

BACKGROUND: Large resection and reconstruction of the malignant tumors of the shoulder girdle are used to provide maximum protection of the soft tissues with sufficient surgical margin. However, these have their own difficulties. The goals of this study were to review demographic data of 187 patients diagnosed with the malignant tumors located around shoulder between 2001 and 2016 in our clinic, to evaluate the functional outcomes and surgical outcomes, and to classify the resection methods according to new classification systems. METHODS: There were 187 patients (108 male and 79 female) and the mean age at surgery was 47.9 (range 2-87). Fifty-one of these patients underwent biopsy only: 8 partial/total claviculectomy, 10 partial/total scapulectomy, 80 proximal humeral resection, 5 total humeral resection, 6 shoulder girdle resection, and 13 amputations. Eighty-six had prosthetic implants, five had fibula transpositions, and one had a massive homologous bone graft. Seventy-one of the 136 patients were followed for an average of 40.3 months. RESULTS: When the bone resections were evaluated, the best results were obtained while the rotator cuff function is preserved in glenoid preserving partial scapulectomy, partial/total claviculectomy, and proximal humerus intercalary resection. In total, scapulectomy and proximal/total humeral resection operations' results were moderate because of partial or total injury of the abductor mechanism. CONCLUSIONS: As a result, malignant tumors of the shoulder girdle and soft tissue can be treated with limb-sparing surgery procedures. Reconstructive procedures and reconstructive methods such as prosthetic replacement, auto-allograft, and soft tissue reconstructions should be specified in each case. These resection and reconstruction methods are reliable and applicable procedures for local tumor control, pain control, and functional outcomes. More rarely, amputation/disarticulation can be performed.