An Image-Guided Percutaneous Core Needle Biopsy for Accurate Assessment of Musculoskeletal Tumors: A Targeted Diagnosis.

Background Accurate diagnosis of musculoskeletal tumors is essential for guiding appropriate treatment strategies. Percutaneous core needle biopsy (PCNB) is increasingly recognized as a valuable method for obtaining tissue samples for histopathological examination. This study aims to evaluate the diagnostic accuracy and clinical utility of PCNB in diagnosing musculoskeletal tumors. Methodology A total of 152 cases suspected of musculoskeletal tumors underwent PCNB at our tertiary care center between 2020 and 2023. Pre-biopsy evaluation included comprehensive clinical assessment and imaging studies. Core biopsies were performed under image guidance, with specimens sent for histopathological examination and culture sensitivity analysis. Diagnostic yield, accuracy, and performance metrics of PCNB were assessed. Results PCNB demonstrated a diagnostic yield of 93.4%. However, in cases where initial biopsies were inconclusive, repeat core biopsy or open biopsy provided the necessary diagnostic clarity. PCNB demonstrated a remarkable diagnostic accuracy of 97.9%, with a specificity and positive predictive value of 100%. There were no post-biopsy complications and no instances of local recurrence from the biopsy tract. Conclusions PCNB can be a reliable method for diagnosing musculoskeletal tumors, offering high diagnostic accuracy and minimal complications. The utilization of image guidance enhances precision and reduces the risk of complications. PCNB proves effective in diagnosing both primary tumors and bone infections, facilitating timely and appropriate treatment strategies in orthopedic oncology.

Our Experience With Extracorporeal Irradiation and Reimplantation of the Irradiated Bone for the Reconstruction of Bone Defects Following Tumor Resection.

BACKGROUND: With tremendous improvement in the survival of patients with malignant bone tumors, there is a greater emphasis on the functional outcome and durability of reconstruction following tumor resection. Tumor resection and extracorporeal irradiation (ECI) followed by reimplantation of the irradiated bone in malignant bone tumors is drawing popularity across various centers. In this study, we aim to put forward our experience with ECI, the outcomes achieved, and the complications faced by us. METHODS: This is a prospective study conducted in patients with malignant and locally aggressive bone tumors who underwent ECI at our center. A total number of 20 patients were selected for the study and followed up for a mean duration of 32.5 months (maximum duration: 58 months, minimum duration: eight months). Orthopedic outcome was measured using the Enneking score. We assessed for local recurrence, functional outcome, union, and complications during the follow-up. RESULTS: During the course of follow up, local recurrence was seen in two patients. The mean MSTS score of the remaining patients was found to be 23.6. Complications seen included limb length discrepancy, surgical site infection, and graft lysis. CONCLUSION: Tumor resection and ECI is an effective procedure for biological reconstruction which gives satisfactory functional outcomes. In spite of certain complications, patients expressed satisfaction with the overall outcome of the procedure.

Campanacci Grade III Giant Cell Tumors of Distal End Radius Treated With Wide Excision and Reconstruction: A Retrospective Case Series.

Introduction Campanacci Grade III Giant Cell tumors of the distal radius are difficult to manage as they are associated with a high recurrence rate. Wide excision of the distal radius and reconstruction with an ipsilateral proximal fibula or ulnar translocation reduces the recurrence rate significantly and gives acceptable function to the hand and wrist. Methods and materials This was a retrospective study of eight patients with Campanacci grade III giant cell tumors of distal radius treated with wide excision of distal radius followed by reconstruction at our institute. Four cases were operated on with ulnar translocation and four cases were operated on with ipsilateral proximal fibula grafting after wide excision of the distal radius. Patients were studied for the Musculoskeletal Tumor Society (MSTS) score and visual analogue scale (VAS) score for pain at one year, recurrence, and complications. Results The mean MSTS score of the total series was 24.75 ± 1.6. The mean VAS score for the total series was 1.62 ± 0.4. Of the eight cases, two cases had a recurrence, one patient had persistent wrist paint, and two patients had wrist subluxation. Conclusion Wide excision of the distal radius followed by reconstruction with a proximal fibula or ulnar translocation is a good option to avoid repeated surgeries in patients with Campanacci grade III giant cell tumors of the distal radius and achieve acceptable functional results for the wrist and hand.

Efficiency of vitamin D supplementation in patients with mechanical low back ache.

BACKGROUND: Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mechanical Low back ache (mLBA). AIM: This study was designed to 1. Explore the relationship of hypovitaminosis D with mLBA in the absence of other confounding factors 2. Formulate and validate an appropriate treatment protocol and 3. Explore the differences in outcomes with various oral formulations of vitamin D available in Indian market. MATERIALS & METHODS: Three randomised groups of patients with mLBA and hypo.D between 18 and 45 years of age without any co morbid conditions were studied for the effectiveness of adjunctive vit.D supplementation of 6,00,000 IUs (60,000 IUs/day for ten consecutive days) in the form of granule or nano syrup or soft gel capsule for the treatment of mLBA. Review evaluation of pain, functional disability and vit.D was done at three weeks and an additional evaluation of vit.D was done at nine months. Evaluation with 3,00,000 IUs of vit.D (60,000 IUs/day for five consecutive days) was done with nano syrup in a different cohort. RESULTS: High prevalence of hypo.D (96%) was noted in patients with mLBA. Significant improvement was noted after supplementation of vit.D. The subjects of nano syrup group have shown significantly better improvement compared to others (P < 0.000). Non obese and chronic patients have shown significantly better results than their peers. Though there was significant difference in vit.D before treatment, the difference of improvement between the genders, deficiency and insufficiency, in-door and out-door, smokers and non smoker subgroups was not significant. Seasonal variation in vit.D before and after the treatment was significant. CONCLUSION: Hypovitaminosis D can be a potential causative factor for mLBA in addition to the other known causes. Proper evaluation and adjunctive vit.D supplementation can effectively break the vicious cycle of low back ache with significant improvement in serum vit.D level, effective relief of pain and significant functional improvement without any adverse effects. Improvement in vit.D was not significantly related to its initial status and obese individuals have shown significantly lesser improvement. The results with nano syrup formulation were significantly better compared to others. Formulation based dosage adjustments assume significance in view of these results.

Reconstruction of Traumatic, Open Supracondylar Femoral Fractures by Autologous Fibular Strut Grafting and Cortico-Cancellous Bone Grafting-A Single-Centre, Observational Study.

OBJECTIVES: To study the safety and efficacy of staged reconstruction of distal femoral (supracondylar) bone loss using autologous fibular strut, cortico-cancellous bone grafting. DESIGN: Single-centre, observational study, with review of literature. SETTING: Urban Level I Trauma Center. PATIENTS/PARTICIPANTS: Eighteen consecutive patients (mean age: 35 ± 8.5 years, all males) with open supracondylar fracture and intercondylar extension (OTA/AO type C3), operated between January 2010 and February 2014 with severe bone loss in 11 patients and moderate loss in 7. INTERVENTION: Single free fibular strut was used in 12 femurs and dual fibula in 5 femurs with autologous cortico-cancellous bone grafting in all. MAIN OUTCOME MEASURES: Clinical union, radiological union, and knee function using the Sanders' score. RESULTS: Mean follow-up was 45.5 ± 17 months. The mean radiological union time was 18 ± 2.6 weeks. Functional assessment after union revealed one patient with excellent knee function, 9 with good, 8 with fair, function according to Sanders' scoring. The mean knee range was 49 degrees (range 5-110 degrees) in which 9 patients achieved a knee range >80 degrees. Mean limb shortening was 2 cm (range 0-7 cm). No limb shortening was observed in 5 patients. Patients were pain free and had no significant graft or donor site morbidity. CONCLUSIONS: Staged fibular strut grafting, cortico-cancellous bone grafting for traumatic open supracondylar femoral fractures with significant bone loss is a promising technique with a good safety profile and long-term efficacy. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.