Comparative efficacy of intraoperative extracorporeal irradiated and alcohol-inactivated autograft reimplantation for the management of osteosarcomas-a multicentre retrospective study.

BACKGROUND: Biologic bone reconstruction in limb salvage surgery for the treatment of malignant bone tumours has always been controversial. The various inactivation methods, their convenience and stability, the curative effects elicited and associated costs all need to be considered. This study aimed to compare the clinical efficacy of intraoperative extracorporeal irradiated reimplantation with alcohol-inactivated autograft reimplantation for limb salvage surgery in patients with osteosarcoma. METHODS: We retrospectively analysed 28 patients with osteosarcoma, 14 patients treated with intraoperative cobalt 60 irradiation and reimplantation (group A), and 14 patients treated by alcohol-inactivated autograft reimplantation (group B). The postoperative complications and clinical efficacy of each treatment method were compared by statistical analysis. RESULTS: The local recurrence rate was 14.3% in each group. Complete bony union was achieved in 64.3% of patients in group A and 71.4% of patients in group B. The overall 5-year survival rate was 71.4% in group A and 78.6% in group B. The mean Musculoskeletal Tumor Society (MSTS) score was 25.33 ± 4.72 (range 15-30) in group A and 24.00 ± 5.85 (range 15-30) in group B, and the mean International Society of Limb Salvage (ISOLS) score was 25.79 ± 5.13 (range 20-36) in group A and 26.14 ± 5.33 (range 20-30) in group B. P < 0.05 was considered to indicate a significant difference. The results showed that the long-term clinical efficacy did not differ significantly between the two methods. CONCLUSIONS: In limb salvage surgery for osteosarcoma, intraoperative extracorporeal irradiation and alcohol-inactivated autograft reimplantation yielded equivalent outcomes. The alcohol-inactivated method may be a much more convenient and inexpensive way to reconstruct bone defects. Additional studies as well as more case studies are needed to fully evaluate the clinical efficacy and safety of this treatment method.

En bloc resection, intraoperative extracorporeal irradiation and re-implantation of involved bone for the treatment of limb malignancies.

Reconstruction of the defect following limb-sparing resection of malignant bone tumors is controversial and extremely challenging. Extracorporeal irradiation (ECI) and re-implantation have been used for limb salvage surgery for patients, with major advantages, including biological reconstruction, ready availability and preservation of bone stock, over replacement with a megaprosthesis. The purpose of the present study was to present our experience and details of all patients treated with this surgery. Between June 2005 and December 2014, we followed-up 23 patients with limb malignancies who were treated with en bloc excision followed by 50-Gy single dose ECI and re-implantation of involved bone segments. All cases were evaluated based on clinical and radiological examinations, complications and Musculoskeletal Tumor Society (MSTS) score. Mean follow-up period was 77.6 months (range, 17-116 months). A total of 17 patients (73.9%) demonstrated no evidence of disease, 5 (21.7%) patients succumbed to the disease and 1 (4.3%) patient was alive with the disease at the final follow-up. Local recurrence occurred in 3 patients (recurrence rate, 13.0%) in the bed outside of the irradiated graft, and 4 of the 5 patients that lost their lives did so due to associated metastatic disease. The mean value of the MSTS score was 78.8% (50-93.3%). The majority of patients demonstrated solid bony union; however, 3 patients had non-union (13.0%) and 1 had a delayed union (4.3%). Early or late complications occurred in 11 patients (47.8%). Although the complication rate (47.8%) and re-operation rate (39.1%) were high, ECI and re-implantation may be a useful and cheap technique following en bloc resection for limb salvage in appropriately selected patients.

Functional outcome of en bloc excision and custom prosthetic replacement for giant cell tumor of the distal radius.

BACKGROUND: Giant cell tumors (GCT) of the distal radius at Campanacci grade II/III are particularly challenging to treat. Wide excision is the management of choice, but this creates a defect at the distal end of radius. We treated 11 cases of GCT of the distal radius by en bloc excision and custom prosthetic replacement. The purpose of this study was to present our experience and assess the functional outcomes of all patients treated with this surgery. MATERIALS AND METHODS: Between 2005 and 2014, we followed up 11 patients with GCT of the distal radius who were treated with en bloc excision and custom prosthetic replacement. All cases were evaluated based on clinical and radiological examinations, passive range of motion (ROM) of the wrist joint, complications, and Musculoskeletal Tumor Society (MSTS) score. RESULTS: Mean follow-up period was 55.5 months (24-83 months); mean resected length of the radius was 7.9 cm. One patient had tumor recurrence in the soft tissues after 15 months (recurrence rate 9.09 %). No patient had fracture, recurrence in the bone, metastases, or immune rejection. No complications were seen, such as loosening, rupture, or dislocation of the custom prosthesis. One patient developed superficial infection at the operative site which resolved after a course of antibiotics for 4 weeks. One patient experienced pain, which could be endured without the need for analgesics. Average ROM was 40.9° of dorsiflexion, 30.0° of volar flexion, 46.4° of supination, and 38.2° of pronation. Mean grip strength was 71 % (42-86 %). Overall revised MSTS score averaged 80.3 % (63.3-93.3 %) with one being excellent, five good, and five satisfactory. CONCLUSION: En bloc excision and custom prosthetic replacement for a Campanacci grade II/III GCT of the distal radius results in reasonable functional outcome at intermediate follow-up evaluation. Although average ROM of the ipsilateral wrist is poorer than some studies with other techniques, this method can be considered a reasonable option.

Primary dedifferentiated liposarcoma of the femur presenting with malignant fibrous histiocytoma: A case report and review of the literature.

In the current report a case of a 26-year-old male with a primary dedifferentiated liposarcoma of the femur accompanied by malignant fibrous histiocytoma is presented. The patient complained of a dull intermittent pain, for three months, along the anterolateral aspect of the right knee and was referred to Southwest Hospital (Chongqing, China) in May 2013. All of the radiographic findings, including radiography, magnetic resonance image and emission computed tomography (CT) supported the diagnosis of a primary malignant bone tumor. CT-guided biopsy results demonstrated blood clots and a small quantity of heterogeneous cells. Thus, a limb-salvage procedure, involving a wide resection and total knee endoprosthesis replacement, was performed in May 2012. The final pathological diagnosis was of a primary dedifferentiated liposarcoma of the femur and the dedifferentiated tissue was identified as malignant fibrous histiocytoma. On review of the literature, it was identified that primary intraosseous liposarcoma are a rare and malignant tumor of the skeletal system, with only a small number of cases reported in the English literature since 1980. To the best of our knowledge, a case of dedifferentiated liposarcoma has not previously been reported.

[Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases multi-center statistic analysis].

OBJECTIVE: To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures. METHODS: According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched. RESULTS: Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90%). Acetabular variables: variabe 1 in 203 cases of simple displaced fracture (17.8%); variabe 2 in 516 cases of comminuted fracture(45.3%); variabe 3 in 421 cases of compression fracture (36.9%); 249 cases of pelvic ring lesions damage (21.8%), 75 cases femoral head fracture (6.6%); 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables (1.58%). Key part and curative effect elements of 1140 cases acetabular fracture: 507 cases of dome or posterior acetabular fracture (44.5%); 421 cases of compression fracture (36.9%); 249 cases of pelvic ring variables (21.8%); 75 cases of proximal humerus joint variables (6.6%); 486 cases of simple Aa/pl/2,Bapl/2 acetabular fracture (42.6% ). CONCLUSION: Compression fracture, especially defected compression fracture, takes important part in acetabular damage variables, and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables, and its percentage shows the key points and elements in clinical treatment: weight-bearing to dome accounts for 44.5%; compression to defects account for 36.9%, pelvic ring to float accounts for 21.8%; dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity, anatomic localization, difficulty index, alternative strategy, operative approach, effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.

Repair of large segmental bone defects using bone marrow stromal cells with demineralized bone matrix.

OBJECTIVE: The aim of the present study was to evaluate the effect of tissue-engineered constructs on repair of large segmental bone defects in goats. METHODS: Allogenic demineralized bone matrix (aDBM) was seeded with autologous marrow stromal cells (aMSC) for seven days to construct DBM-MSC grafts prior to implantation. 24 goats were randomly divided into three groups (eight in each). In each group, 3 cm diaphyseal femoral defects were created unilaterally, and subsequently filled with the DBM-MSC grafts, DBM alone and an untreated control, respectively. Radiological analysis and biomechanical evaluation were performed at 12 and 24 weeks after operation. RESULTS: Obvious increases in radiological scoring and biomechanical strength were found in the DBM-MSC group when compared to the DBM group. X-ray examination showed excellent bone healing in the DBM-MSC group, whereas only partial bone repair was seen in the DBM group, and no healing in untreated controls. Histologically, a tendency to bone regeneration and remodeling was far more obvious for the DBM-MSC group than the DBM only and untreated controls. CONCLUSION: Our results strongly suggest that transplantation of bone MSC within a DBM could have advantages for the bone repair of large segmental defects.

[Treatment of high-energy tibia plateau injury with half-ring external fixation combined with minimum internal fixation].

OBJECTIVE: To evaluate the effect of less invasive surgical treatment for high-energy tibia plateau injury with half-ring external fixation combined with minimum internal fixation. METHODS: From January, 2003 to May,2006, 16 cases of high-energy tibia plateau fracture were treated with half-ring external fixation combined with minimum internal fixation including 10 cases of type V and 6 cases of type VI according to Schatzker's classification. The average age of the patients was 42.4 years (range 25 to 50 years). RESULTS: All patients were followed for an average of 16 months (range 5 to 27 months). All the fractures healed after an average time of 3.5 months. Two patients developed infections of the pin holes. According to the criteria of Rasmussen, excellent results were achieved in 10, good results in 4 cases, moderate in 2, and poor in none. CONCLUSION: Half-ring external fixation combined with minimum internal fixation can be ideal for treatment of complex tibia plateau fracture.