Modified "SUPERhip2" to Reconstruct Postinfectious Femoral Neck Pseudoarthrosis (Hunka Type 3): A Case Report.

CASE: We report a case of a 3-year-old girl who developed a post-infectious femoral neck pseudoarthrosis after a proximal hematogenous femoral osteomyelitis (type 3 according to Hunka classification of the sequelae of the septic hip in children). The patient was treated by a modified "SUPERhip 2" procedure (a reconstructive procedure described to reconstruct congenital femoral neck pseudoarthrosis). This report describes the surgical technique in details and discusses the advantages, pitfalls, and complications and possible complications. CONCLUSION: Our modification simplifies the "SUPERhip 2" procedure. Postinfectious neck pseudoarthrosis was successfully treated, and we believe this modification is applicable for the treatment of congenital femoral neck pseudoarthrosis as well.

Soft Tissue Sarcomas: A 16-Year Experience of a Tertiary Referral Hospital in North Jordan.

Background and Objectives: Sarcomas are rare malignant tumors of mesenchymal origin. Their low prevalence and histological heterogeneity make their diagnosis a challenging task. To the best of our knowledge, the epidemiology of soft tissue sarcomas (STSs) was not well studied in Jordan. This study thus aimed to determine STS epidemiologic trends at King Abdullah University Hospital (KAUH); a tertiary hospital that provides cancer healthcare for 70% of the population in Irbid Governorate, North Jordan. The findings of this study will provide a good reference point of the burden of STSs in Jordan and the Middle East region. Materials and Methods: All cases with confirmed STS diagnoses who attended KAUH from January 2003 until December 2018 were included in the initial analysis. Bone sarcomas, gastrointestinal stromal tumors and uterine sarcomas were not included in the study. Information collected from the pathology reports and electronic medical records was used to determine STS prevalence, incidence rate, age and gender distributions, histological types and anatomic location. Cases were reviewed by three pathologists with interest in soft tissue tumors. The findings were compared with literature. Results: In total, 157 STS cases were reported (1.9% of cancers diagnosed at KAUH during the 16-year study period). Crude annual incidence rate (IR) per 100,000 person-years ranged from 0.48 in 2015 to 1.83 in 2011 (average = 1.04). Age-standardized IR (ASR)(World WHO 2000-2025) was 1.37. Male:female ratio was 1.3:1. Median age was 39 years. Age ranged from <1 year to 90 years. Overall STS rates increased with age. The most common histological types were liposarcoma (19%), rhabdomyosarcoma (17%) and leiomyosarcoma (10%). The most common anatomic location was the extremity (40.1%), followed by the trunk (14.7%), then head and neck (10.8%). Conclusion: STSs are rare in North Jordan. A slight increase in their incidence was identified during the study period similar to global trends. The collection of relevant data on established risk factors along with a broader scale evaluation of the epidemiology of STS in the Middle East region is recommended to better evaluate disease burden and trends.

Primary Bone Tumors in North of Jordan.

OBJECTIVE: Primary tumors of bone are relatively uncommon. Little information is available about the etiology, pathophysiology, risk factors and epidemiologic features of bone tumors. In this article, we present the epidemiological data about the primary (benign and malignant) bone tumors in Jordan. METHODS: Retrospectively, we identified and assessed those patients who were diagnosed with primary bone tumor between January 2004 and December 2018 at King Abdullah University Hospital. The following information was obtained: demographics (age, sex), clinical presentation, and location of the tumor. Also, the histopathological results and finding and recurrence of the tumors were retrieved. The included primary bone tumors were those tumors fulfill the World Health Organization classification of soft tissue and bone tumors. RESULTS: During the study period, four-hundred and thirty-seven cases of the primary bone tumor were diagnosed in our institution. More than half of the cases were males (52.5% males and 47.5% females). In most cases, young adults are affected. The mean age for the diagnosis of giant cell tumor of bone (GCTB) is 34.1 years. The appendicular skeleton was involved in 269 (81.5%) patients while the axial skeleton in 60 patients. The most common encountered pathology is the multiple myeloma with 120 patients. After that, osteochondroma was diagnosed in 110 patients. Females were mostly affected by giant cell tumor while the osteochondroma and chondrosarcoma were seen mostly in males. Multiple myeloma tends to develop in elderly while juvenile ossifying fibroma occurred in young pediatrics and Ewing sarcoma in school-age children and adolescents. Giant cell tumor and osteoid osteoma have the tendency to recur. CONCLUSION: The diagnosis of primary bone tumors is of particular important. The reporting of epidemiological studies is essential in order to expand our knowledge regarding this uncommon type of tumors.

Epidermal inclusion cyst of the knee.

Epidermoid cysts are asymptomatic, slowly enlarging, firm to fluctuant, dome-shaped lesions. Epidermoid cysts frequently appear on the trunk, neck, face, and scrotum, behind the ears and in the palmoplantar region. We review all the cases of epidermoid cyst of the knee and present a case of non-traumatic-induced epidermal cyst in the popliteal fossa of a 66-year-old male with 10-year history of right knee swelling, which appeared firstly as a small mass 2 × 2 cm in the popliteal aspect of the knee. The mass was increasing gradually in size until 2 years ago when it increased suddenly to gain the dimensions of 4 × 6 cm. MRI of the right knee revealed a well-defined cystic lesion in the subcutaneous tissue measuring about 7 × 5 × 5 cm containing internal debris and septations. He underwent complete surgical excision of the mass. The pathological results revealed an epidermal inclusion cyst. To the best of our knowledge, this is the second description for epidermal inclusion cyst involving the popliteal fossa. We were able to retrieve three cases of epidermal cyst of the knee from the literature since its first description in 2004. Including our case, we had a total of four cases of epidermal cyst of the knee. Three males and one female constituted the patients' sample. The mean age for the patients is 55. The epidermal cyst occurred equally in both knees. The popliteal fossa was the location for two epidermal cysts. Similarly, the prepatellar region was the location for another two cysts.

Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures.

Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20-94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11-31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.

Comparison if the addition of multilevel vertebral augmentation to conventional therapy will improve the outcome of patients with multiple myeloma.

BACKGROUND: This was a prospective study to evaluate the effect of multilevel vertebral augmentation in addition to conventional therapy in multiple myeloma patients. METHODS: We treated 27 patients, whom were recently diagnosed to have multiple myeloma by two ways of treatment. Thirteen patients (group I) were treated with conventional therapy and 14 patients (group II) with adding vertebroplasty and kyphoplasty. Patients were evaluated pre-treatment and at half, one, two and 3-years post-treatment by using Oswestry Disability Index (ODI), the Stanford Score (SS) and the Spinal Instability Neoplastic Score (SINS). RESULTS: Mean values of ODI, SS and SINS were 31.9 (63.8%), 4.3 and 13.8 for group I and 33.2 (66.4%), 4.6 and 12.8 for group II before starting treatment. Group II showed improvement better than group I at all follow-up intervals with best results at first 6 months. P-values at the end of the study were ODI = 0.047, SS = 0.180 and SINS = 0.002. Mortality rates were equal of both groups (four patients of each group). CONCLUSION: Adding vertebral augmentation to conventional therapy improves multiple myeloma patients' quality of life, but didn't affect the mortality rate.