Periosteal chondrosarcoma: a case report and review of the literature.

Periosteal chondrosarcoma occurs predominantly in the long tubular bones. The long-term survival rate is better and there are fewer local recurrences than with central chondrosarcoma. A case of periosteal chondrosarcoma is reported with a review of the literature. A 13-year-old girl presented with swelling of the distal right thigh of 3 weeks' duration. Radiographs and computed tomographic scan of the lesion showed a soft tissue mass, measuring 6 x 6 cm, with matrix calcification arising from the surface of the bone. An open biopsy followed by en bloc resection of the tumor was performed. The histologic features were those of a chondrosarcoma. An 8-year follow-up period has shown no local recurrence or distant metastases. The differential diagnosis of periosteal chondrosarcoma includes periosteal (chondroblastic) osteosarcoma and periosteal chondroma. Controversy exists as to whether periosteal chondrosarcoma is an entity distinct from periosteal osteosarcoma. The clinicopathologic features in this case and in the cases reported in the literature support the contention that periosteal chondrosarcoma is indeed distinct.

Femoral lengthening by callus distraction and cortical apposition (Z-osteotomy).

Nine patients underwent femoral lengthening by callus distraction with cortical apposition (Z-osteotomy). The average amount of lengthening was 4.8 cm (range, 2.9-6.0 cm). The average time of external fixator use was 70 days (range, 33-100 days). The average time for using the cast brace was 3.5 months. All patients had complete union. No patient required bone grafting. No patient had premature consolidation of the osteotomy. Complications included cellulitis around the pins in 2 patients, transient peroneal nerve palsy in 1 patient, and fracture after removal of external fixator in 2 patients. In this procedure the alignment and rotation is controlled by a strong external fixating device. The large area of cortical contact after z-osteotomy assists in rapid union of the distracted bone.

Pyogenic sacroiliitis in children.

Clinical findings, roentgenograms, computed axial tomography (CT scan), radionuclide studies, and management are reviewed in seven children with pyogenic sacroiliitis (PS). High suspicion and complete examination of the pelvis and sacroiliac (SI) joint, including flexion, abduction, external rotation, and extension (FABERE) test, are essential for diagnosis. Although initial roentgenograms may be negative, CT scan will show changes indicating involvement of the SI joint. Sequential technetium and gallium scans are valuable in localizing PS. Blood cultures and direct aspiration of the SI joint will identify the infecting organism. Patients are initially treated with intravenous antibiotics. Surgical treatment is reserved for patients with advanced stage of PS.

Foreign-body osteitis of the metacarpal bone.

Foreign-body granulomas in the hand can appear secondary to an unrecognized foreign material. In a six-year-old boy, an extensive sterile osteitis of the second metacarpal bone appeared adjacent to a wood splinter.

Cartilage necrosis due to pin penetration: experimental studies in rabbits.

An animal model was used to evaluate the role of pin penetration into the hip joint as the cause of chondrolysis. The gross and microscopic studies, as well as the biochemical studies, showed changes indicating cartilage destruction. These changes were more severe when the pins remained in the joint. Immunologic studies showed some type of immunological interaction. The immunologic response may be initiated by release of cartilage byproducts. The initial insult of the slip may cause release of cartilage byproducts from the exposed growth plate within the joint, and is compounded by penetration of the pin in the hip joint.

Stabilization of atlantoaxial instability.

Eight patients with atlantoaxial instability were treated by arthrodesis of the first and second cervical spine. Internal fixation was achieved by passing two 18 gauge stainless steel wires beneath the posterior arch of the atlas and around a threaded Steinmann pin which was drilled through the base of the spinous process of the axis. The wires were tightened over a preshaped iliac bone graft. A solid fusion was achieved in all patients. The risk of compression of the cord is decreased with this technique because the wires are not passed under the lamina of the axis. The lateral placement of the wires provides an excellent internal fixation and control of the forward flexion and rotation.

Traumatic venous aneurysm. Case report.

A traumatic venous aneurysm within the greater saphenous vein occurred in a 15-year-old hockey player. The patient had early diagnosis and surgical excision of the lesion. Venous aneurysm is a rare clinical entity and a pathologic curiosity in the absence of varicose veins. It can lead to serious complications, such as pulmonary embolism, portal hypertension, and rupture. Early diagnosis with the use of venography and surgical excision of the lesion can prevent major complications.

Radiation-induced chondrosarcoma of the clavicle complicating Hodgkin's disease. A case report.

Review of the literature reveals that postradiation chondrosarcoma is a rare secondary malignant bone tumor. This case report demonstrates a Grade 1 chondrosarcoma of the proximal right clavicle in a 17-year-old boy, eight years after extensive chemotherapy and radiation therapy for a Stage IIB Hodgkin's disease.

Management of dislocation of the hip in Down syndrome.

Six patients with Down syndrome were treated for dislocation of the hip (10 hips). Follow-up averaged 49 months. Group I consisted of three patients (six hips) with dislocatable hips and normal acetabula treated with capsular plication and/or proximal femoral osteotomy. Group II consisted of three patients (four hips) with dislocatable hips and dysplastic and insufficient acetabula treated with capsular plication, Salter osteotomy, and proximal femoral osteotomy. Results were rated as satisfactory in four patients (seven hips) and unsatisfactory in two patients (three hips).

Early diagnosis of acute rupture of the quadriceps tendon by arthrography.

Arthrographic study of the knee was performed in six patients for diagnosis of acute rupture of the quadriceps tendon. All of the patients gave a history of attempting to recover from a fall. Pain and tenderness over the suprapatellar area were common findings in all patients. Four patients had a positive arthrogram demonstrating extravasation of the radiopaque material outside the knee along the quadriceps tendon. Of these four patients, two had complete loss of quadriceps function, but the other two were able to partially extend the knee when the gravity was eliminated. Two patients had negative arthrograms; both had loss of active extension of the knee against gravity but were able to extend the knee when the gravity was eliminated. All four patients with a positive arthrogram had rupture of the quadriceps tendon, which was demonstrated at the time of surgery. In one patient with a negative arthrogram, exploration of the knee revealed an intact extensor mechanism. Arthrography of the knee is an aid to the diagnosis of rupture of the quadriceps tendon and when indicated can be performed in the emergency room.

Juvenile nodular aponeurotic fibroma in the area of the knee joint.

A case of calcifying aponeurotic fibroma of the knee occurred in a 14-year-old boy. Review of the literature reveals that calcifying aponeurotic fibroma is an uncommon benign tumor with a tendency for local recurrence. It is manifested by a progressively growing mass involving fat, fascia, and aponeurosis. Chondroid tissue and calcification within the areas of proliferated spindle cells are the characteristic features of this lesion and differentiate it from the other forms of fibromatosis.

Osteocartilaginous lesion of the acetabulum resembling osteoid osteoma.

An unusual acetabular lesion radiographically resembling osteoid osteoma appeared in a 10-year-old girl recovering from trauma of the hip joint. Abnormal growth of cells of triradiate cartilage displaced by injury is a possibility that is supported by observations at open operation and biopsy.

Tumoral calcinosis. Report of a case in a one-year-old child.

Tumoral calcinosis is a rare disease known as a progressively growing mass of calcific deposit at a periarticular area. The youngest reported case was the occurrence of the disease in a three-year-old child. This report describes tumoral calcinosis in the area of the knee in a one-year-old child and presents a brief review of the literature. As is usually the case, the blood chemistry was normal in the patient.

Arthrography (plica views). A noninvasive method for diagnosis and prognosis of plica syndrome.

In 45 patients with chronic knee problems arthrograms of the knee were obtained with emphasis on plica views. Thirty arthrograms showed radiographic evidence of plica syndrome. Three patients had thin bands in the proximal part of the suprapatellar pouch. Four patients had infrapatellar plicae. Eighteen patients had suprapatellar plicae, and five had mediopatellar plicae. The cross-table lateral view of the knee in different degrees of flexion is a valuable prognostic method. Five patients with suprapatellar plicae demonstrated excursion of the thick fibrotic band over the anteromedial femoral condyle during arthrography with the knee in different degrees of flexion. These patients did not respond to conservative treatment and required surgical excision of the plicae. Cross-table anteroposterior and tangential views with the medial side of the knee facing upward demonstrate impingement of the medial femoral condyle or the medial facet joint of the patella by the fibrotic mediopatellar plica. All patients (5 of 5) with mediopatellar plicae required surgical excision of the plicae.

Chondrosarcoma in children and adolescents.

Chondrosarcoma is rare in children. Only 12 patients with a diagnosis of chondrosarcoma were treated at Children's Hospital Medical Center in Boston during the period from 1957 to 1980. Pediatric chondrosarcoma has a relatively rapid onset, manifested by pain, a palpable mass and neurological symptoms with the lesion localized in the spinal column. The pelvis was the most frequent location. Ten patients had primary and two patients had secondary chondrosarcoma. Of the latter two, one developed chondrosarcoma in a preexisting osteochondroma and the other had irradiation for neuroblastoma. The poorest outcomes were in patients who had involvement of the pelvic girdle and spinal column. Grade 2 and 3 lesions had the worst prognoses with metastases occurring within 12 months. Eight patients died at the time of study, and the longest survival time was 80 months. If surgically feasible, the treatment is radical excision. Radiation therapy and chemotherapy should be reserved for recurrences or distant metastasis.

Dislocation of the hip in trisomy 21.

Almost one child in twenty with trisomy 21 will develop spontaneous dislocation of the hip between learning to walk and the age of 10 years. After the age of two years spontaneous habitual dislocation may occur. If left untreated, acute dislocation, subluxation and fixed dislocation follow in sequence. The natural history of the condition is described and the clinical and radiological features of 45 dislocations in 28 patients are presented. Nineteen had received no treatment. The most effective treatment was found to be pelvic or femoral osteotomy, combined with capsular plication, carried out in the phase of habitual dislocation. Once subluxation or fixed dislocation was present, the results of operation were poor and it is not recommended. All patients, even if left untreated, remain mobile. Pain is not a prominent feature.

Benign chondroblastoma.

Six patients with benign chondroblastoma were treated and followed between 1970-1979. Pain and limitation of motion were the most common presenting complaints. Diagnosis was made by radiographic, pathologic, and microscopic examination. Following curettage and bonegrafting, complete healing occurred within three years in four patients. There was one recurrence of the lesion in the femoral head. Early range-of -motion exercise, and progressive protected weight-bearing to reduce complications such as stiff joint or subchondral fractures were the key points in management of these patients.