Bilateral cadaveric Achilles tendon graft in reconstruction after Achilles tendon tumor resection.

The standard approach to reconstruction after resection of a diffuse-type tenosynovial giant cell tumor is a local patch with free flaps. However, in cases in which the Achilles tendon involvement is extensive, and the entire tendon must be removed, an autologous flap graft might not be adequate to allow a return to function. We report a case of a 52-year-old female patient who developed bilateral tumors of the Achilles tendon, with a 10-year duration. By the time, she sought medical help, both Achilles tendons required removal. We chose to use Achilles tendon allografts to replace the Achilles tendons. Postoperatively, the patient did well. The allograft shortened the recovery time, and the patient regained full ankle range of motion.

Endoprótese não cimentada no tratamento de tumor de células gigantes de tíbia, 18 anos de evolução / Cementless endoprosthesis in the treatment of giant cell tumor of the tibia, eighteen years of evolution

Trata-se de um relato de caso de tumor de células gigantes de tíbia proximal justarticular com fratura patológica. Paciente do sexo feminino, apresentando dor e aumento de volume local após ocorrência de queda da própria altura. Foi submetida ao exame clínico, ao estudo radiográfico e biópsia por punção. Feito diagnóstico de tumor de células gigantes. A paciente foi então tratada com ressecção tumoral e utilização de endoprótese não convencional parcial de tíbia com preservação da superfície articular do platô tibial. A paciente evoluiu com melhora dos sintomas e manutenção da função articular do membro operado, ausência de recidiva e complicações, sem necessidade de reintervenções cirúrgicas em um seguimento de 18 anos.

A case report of a giant cell tumor of the proximal tibia justarticular with a pathological fracture. A female patient presenting pain and increase of local volume after a falling incident from an unelevated height. She underwent clinical examination, to radiographic study, and a puncture biopsy. A diagnosis of giant cell tumor was made. The patient was then treated with tumor resection and use of an unconventional partial endoprosthesis of the tibia with preservation of the surface of the tibial plateau. The patient evolved with improvement of symptoms and maintenance of joint function of the operated limb, absence of recurrence and complications, without necessity of reoperation during 18 years of follow-up.

Tumor de células gigantes del extremo distal del radio y reconstrucción ósea / Tumeur de cellules géantes de l'extrémité distale du radius et réparation osseuse / Giant cells tumor of radius distal end and bone reconstruction

Se presenta el caso de una mujer de 40 años de edad, de la raza negra, con un tumor del extremo distal del radio derecho, con diagnóstico histológico de tumor de células gigantes de bajo grado de malignidad y con la propuesta de amputación del miembro. Se le realizó una cirugía conservadora con exéresis total de la lesión, respetando el margen oncológico, y practicada en dos tiempos. Se utilizó un injerto libre de peroné, se realizó una artrodesis de la muñeca y la fijación interna del injerto con el sistema AO. Se logró la consolidación del injerto y la incorporación activa de la paciente a la sociedad. Se expone el diagnóstico, tratamiento, seguimiento, rehabilitación y pronóstico del caso(AU)

This is the case of a black women aged 40 presenting with a tumor of distal end of right radium with histological diagnosis of low-grade malignancy giant cells tumor and proposal of limb amputation. A conservative surgery was performed with a two-steps total exeresis of lesion sparing the oncologic margin. A fibular free-graft was used and wrist arthrodesis and internal fixation of graft using AO system. There was a good graft consolitadion and an active incorporation of patient to social activities. The diagnosis, treatment, follow-up, rehabilitation and case prognosis are exposed(AU)

Le cas d'une femme âgée de 40 ans, de race noire, atteinte d'une tumeur de l'extrémité distale du radius droit, avec un diagnostic histologique de tumeur de cellules géantes peu maligne, et avec une proposition d'amputation du membre affecté, est présenté. Elle a subi une chirurgie conservatrice par exérèse totale de la lésion, pratiquée en deux temps et en respetant les limites de la tumeur. Une greffe libre de péroné a été utilisée, tandis qu'une arthrodèse du poignet et la fixation interne de la greffe par système AO ont été réalisées. La consolidation de la greffe et le retour de la patiente à la vie quotidiene sont réussies. Le diagnostic, le traitement, le suivi, la rééducation et le pronostic de ce cas sont exposés(AU)

[Interscapular-thoracic resection in the treatment of patients with tumors of the musculoskeletal system]. / Mezhlopatochno-grudnaia rezektsiia v lechenii bol'nykh opukholiami oporno-dvigatel'nogo apparata.

Data of 13 patients with tumors of the locomotor system subjected to +interscapular-thoracic resection (ITR) are presented. Main technical aspects of ITR are described. Complications took place in 6 patients, including marginal necrosis of the skin in 4 patients. As a whole the 5-year survival made up 49.9% +/- 13.8%. Data are presented on rehabilitation measures which allow to widen the functional possibilities of the extremity.

Free vascularized fibular graft for replacement of the radius after excision of giant cell tumor: case report.

A case is reported in which a giant cell tumor of the distal end of the radius was treated by massive resection and reconstruction with a free vascularized bone graft taken from the fibula. The postoperative course was uneventful. Angiograms made eight weeks after surgery showed patent anastomoses. One year after surgery there was no evidence of recurrence of the tumor, and roentgenograms showed no degenerative changes and bony union with hypertrophy at the junction of the radius and the graft. An excellent clinical result was obtained, and the patient was able to return to his original occupation as an illustrator.

[Experimental and clinical studies on the Jikei total knee prosthesis (author's transl)].

Total knee prostheses for a dog were developed and were inserted into knee joints of seven adult dogs to study the mobility of the artificial joint, the degree of fixation to bone and the durability of the prosthesis, to examine the reactions in the surrounding tissues and the internal organs in the JIKEI total knee prosthesis in clinical use. As a result of surgery, it was proved that the length in the hinged part of the prosthesis needed to be seventy percent of the length of the excised area of the joint to gain good mobility and supportability of the knee joint after surgery. As a result of findings based on necropsy, wear at the hinged part of the prosthesis was mild and debris caused in wear was not harmful for the living body if breakage does not occur there. Histopathological findings revealed that collagenous fibrous tissue with new bone formation was observed on the inner wall of the bone around the stem of the prosthesis four months after surgery. Then it was proved that the fixation of the prosthesis to the bone was sufficient. Therefore the author would like to mention that bone cement is not necessary for the fixation between bone and prostheses. The JIKEI total knee prosthesis (universal type) based on the results of these experimental studies has been developed and was used to the clinical cases. The clinical results until four years after surgery have been most satisfactory with loss of pain, good supportability and movement of joints in almost all of the cases.