As simple as it sounds? The treatment of simple bone cysts in the proximal femur in children and adolescents: Retrospective multicenter EPOS study of 74 patients.

Purpose: Simple bone cysts are among the most prevalent benign cystic tumor-like lesions in children. Proximal femoral simple bone cysts may require specific treatment because of increased fracture risk. With limited literature available on this specific localization, consensus regarding optimal treatment is lacking. We present a large international multicenter retrospective cohort study on proximal femoral simple bone cysts. Methods: All consecutive pediatric patients with proximal femoral simple bone cyst from 10 tertiary referral centers for musculoskeletal oncology were included (2000-2021). Demographics, primary treatment, complications, and re-operations were evaluated. Primary outcomes were time until full weight-bearing and failure-free survival. Results: Overall, 74 simple bone cyst patients were included (median age 9 years (range = 2-16), 56 (76%) male). Median follow-up was 2.9 years (range = 0.5-21). Index procedure was watchful waiting (n = 6), percutaneous procedure (n = 12), open procedure (n = 50), or osteosynthesis alone (n = 6). Median time until full weight-bearing was 8 weeks (95% confidence interval = 0.1-15.9) for watchful waiting, 9.5 (95% confidence interval = 3.7-15.3) for percutaneous procedure, 11 (95% confidence interval = -0.7 to 13.7) for open procedure, and 6.5 (95% confidence interval = 5.9-16.1) for osteosynthesis alone (p = 0.58). Failure rates were 33%, 58%, 29%, and 0%, respectively (p = 0.069). Overall failure-free survival at 1, 2, and 5 years was 77.8% (95% confidence interval = 68.2-87.4), 69.5% (95% confidence interval = 58.5-80.5), and 62.0% (95% confidence interval = 47.9-76.1), respectively. Conclusion: A preferred treatment for proximal femoral simple bone cysts remains unclear, with comparable failure rates and times until full weight-bearing. Watchful waiting may be successful in certain cases. If not feasible, osteosynthesis alone can be considered. Treatment goals should be cyst control, minimizing complications and swift return to normal activities. Therefore, an individualized balance should be made between undertreatment, with potentially higher complication risks versus overtreatment, resulting in possible larger interventions and accompanying complications. Level of evidence: Level IV, retrospective multicentre study.

Multifocal giant cell tumor of the carpus: Unusual presentation. Case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Giant cell tumors (GCTs) of bone in the carpus are rare. Carpal GCTs are usually solitary lesions; multifocal involvement is exceptional. These lesions have a higher risk of local recurrence after intralesional curettage than those in other body areas. CASE PRESENTATION: We present a case of a 28-year-old male with a six-month history of a palpable mass in the dorsal aspect of the left wrist. Physical examination revealed a 2 cm, mildly tender mass. Magnetic resonance revealed a large intermediate signal lesion involving completely hamate bone and the distal portion of the triquetrum. Histological examination confirmed a giant cell tumor of the carpus. The patient underwent en-bloc resection of the hamate bone extending to the distal part of the pyramidal. The defect was reconstructed using polymethylmethacrylate cement (PMMA), and intercarpal arthrodesis with the capitate was achieved. Follow-up at 18 months revealed a good clinical evolution, wrist range of motion of 30° of extension, 30° of flexion, and 10° of ulnar and radial deviation without evidence of tumoral recurrence. CLINICAL DISCUSSION: The current literature suggests a high incidence of local recurrence in carpal GCT, so wide excision with carpal arthrodesis is recommended, especially in Campanacci III and multifocal involvement. CONCLUSION: Carpal GCT is exceptional, mainly affecting the hamate, capitate, and scaphoid. Most literature supports wide excision of carpal GCT owing to the high recurrence rate with intralesional procedures.

Complete tumor necrosis after neoadjuvant chemotherapy defines good responders in patients with Ewing sarcoma.

BACKGROUND: Survival in patients who have Ewing sarcoma is correlated with postchemotherapy response (tumor necrosis). This treatment response has been categorized as the response rate, similar to what has been used in osteosarcoma. There is controversy regarding whether this is appropriate or whether it should be a dichotomy of complete versus incomplete response, given how important a complete response is for in overall survival of patients with Ewing sarcoma. The purpose of this study was to evaluate the impact that the amount of chemotherapy-induced necrosis has on (1) overall survival, (2) local recurrence-free survival, (3) metastasis-free survival, and (4) event-free survival in patients with Ewing sarcoma. METHODS: In total, 427 patients who had Ewing sarcoma or tumors in the Ewing sarcoma family and received treatment with preoperative chemotherapy and surgery at 10 international institutions were included. Multivariate Cox proportional-hazards analyses were used to assess the associations between tumor necrosis and all four outcomes while controlling for clinical factors identified in bivariate analysis, including age, tumor volume, location, surgical margins, metastatic disease at presentation, and preoperative radiotherapy. RESULTS: Patients who had a complete (100%) tumor response to chemotherapy had increased overall survival (hazard ratio [HR], 0.26; 95% CI, 0.14-0.48; p < .01), recurrence-free survival (HR, 0.40; 95% CI, 0.20-0.82; p = .01), metastasis-free survival (HR, 0.27; 95% CI, 0.15-0.46; p ≤ .01), and event-free survival (HR, 0.26; 95% CI, 0.16-0.41; p ≤ .01) compared with patients who had a partial (0%-99%) response. CONCLUSIONS: Complete tumor necrosis should be the index parameter to grade response to treatment as satisfactory in patients with Ewing sarcoma. Any viable tumor in these patients after neoadjuvant treatment should be of oncologic concern. These findings can affect the design of new clinical trials and the risk-stratified application of conventional or novel treatments.

Do's and Don'ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients.

BACKGROUND: Aneurysmal bone cysts (ABC) are rare benign cystic bone tumors, generally diagnosed in children and adolescents. Proximal femoral ABCs may require specific treatment strategies because of an increased pathologic fracture risk. As few reports are published on ABCs, specifically for this localization, consensus regarding optimal treatment is lacking. We present a large retrospective study on the treatment of pediatric proximal femoral ABCs. METHODS: All eligible pediatric patients with proximal femoral ABC were included, from 11 tertiary referral centers for musculo-skeletal oncology (2000-2021). Patient demographics, diagnostics, treatments, and complications were evaluated. Index procedures were categorized as percutaneous/open procedures and osteosynthesis alone. Primary outcomes were: time until full weight-bearing and failure-free survival. Failure was defined as open procedure after primary surgery, >3 percutaneous procedures, recurrence, and/or fracture. Risk factors for failure were evaluated. RESULTS: Seventy-nine patients with ABC were included [mean age, 10.2 (±SD4.0) y, n=56 male]. The median follow-up was 5.1 years (interquartile ranges=2.5 to 8.8).Index procedure was percutaneous procedure (n=22), open procedure (n=35), or osteosynthesis alone (n=22). The median time until full weight-bearing was 13 weeks [95% confidence interval (CI)=7.9-18.1] for open procedures, 9 weeks (95% CI=1.4-16.6) for percutaneous, and 6 weeks (95% CI=4.3-7.7) for osteosynthesis alone ( P =0.1). Failure rates were 41%, 43%, and 36%, respectively. Overall, 2 and 5-year failure-free survival was 69.6% (95% CI=59.2-80.0) and 54.5% (95% CI=41.6-67.4), respectively. Risk factors associated with failure were age younger than 10 years [hazard ratios (HR)=2.9, 95% CI=1.4-5.8], cyst volume >55 cm 3 (HR=1.7, 95% CI=0.8-2.5), and fracture at diagnosis (HR=1.4, 95% CI=0.7-3.3). CONCLUSIONS: As both open and percutaneous procedures along with osteosynthesis alone seem viable treatment options in this weight-bearing location, optimal treatment for proximal femoral ABCs remains unclear. The aim of the treatment was to achieve local cyst control while minimizing complications and ensuring that children can continue their normal activities as soon as possible. A personalized balance should be maintained between undertreatment, with potentially higher risks of pathologic fractures, prolonged periods of partial weight-bearing, or recurrences, versus overtreatment with large surgical procedures, and associated risks. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Extrapulmonary tuberculosis: mimicking metastases in a patient with melanoma in a high TB-burden country; case report.

This is a case report that includes an analysis about extrapulmonary tuberculosis and his singularities, cause can be confused with cancer. Our patient an 83-year-old woman from Pasto-Colombia presents a mimicking metastasis with melanoma. This guides us to understand that extrapulmonary tuberculosis is a rare pathology, but it should be considered as a potential differential diagnosis of any osteolytic lesion. That is the reasons for to be one of the great imitators in medicine, we come up with are totally necessary in a differential diagnosis with malignancies, a high index of suspicion.

Publisher Correction: Science diplomacy for plant health.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Biologic osteosynthesis in the treatment of benign and malignant bone tumors.

BACKGROUND AND OBJECTIVES: Mechanical augmentation with metal implants in the treatment of bone tumors limits magnetic resonance imaging and computerized tomography scan imaging due to the scattering effect. In addition, modulus of elasticity differences may cause chronic pain. We present a surgical technique in which cortical allografts are used as plates. This is a two-center experience focusing on functional and radiographic outcomes and complications. METHODS: Under IRB approval, we performed a retrospective patient review. Demographics, treatment indications, tumor characteristics, and complications were collected. Radiographic studies were reviewed to determine the time to osseous incorporation. The last follow-up functional evaluation included the Musculoskeletal Tumor Society (MSTS) score, the Karnofsky scale, and Eastern Cooperative Oncology Group (ECOG). RESULTS: Thirty patients, seventeen female and thirteen male, 16-year-old in average were included. The most common diagnoses were the humeral aneurysmal bone cyst and unicameral bone cyst. The Median follow-up was 6 years. Cortical allograft incorporation median time was 8.8 months whereas allograft void bone incorporation was 3 months. The average time to full weight-bearing without impact activity was 3.1 months. The most common complication was symptomatic hardware. Other complications included a superficial infection successfully treated with antibiotics, a temporary radial nerve neuropraxia, and an allograft fracture requiring revision surgery. Most patients had an MSTS score higher than 90 (excellent). Patients with malignant tumors had ECOG of 0 and a Karnofsky score of 100. CONCLUSION: Biological osteosynthesis is a bone preserving and effective modality for mechanical augmentation with excellent functional results and low complication rates.

Bone Allograft Prosthesis Composite to Revise a Failed Massive Allo-Prosthesis: Case Report and 10 Years of Follow-Up.

An 18-year-old male patient with a high-grade osteosarcoma was initially treated with resection and reconstruction using an osteochondral allograft. The allograft collapsed after five years, and thus a revision with a constrained knee prosthesis was performed. After one year, the implant failed due to a fracture, requiring another revision with a new allo-prosthetic composite. The long-term results were satisfactory. Allo-prosthetic composites may offer good long-term results after sarcoma resection. The failure of a massive bone allograft does not preclude the use of another allograft to maintain the bone stock and preserve the function.

Malignant Solitary Fibrous Tumor of the Humerus: A Case Report of an Extremely Rare Primary Bone Tumor.

Solitary fibrous tumor (SFT) is a spindle-shaped cell neoplasm originally described in the pleura, but subsequently found in many anatomic sites. Only few cases of primary SFTs in the bone have been previously described in the literature. We present the case of an 86-year-old man with a 1-week history of pain in his left arm. Imaging studies demonstrated a well-defined osteolytic lesion in the proximal humerus measuring 6.1 cm in diameter. Sections showed a round to spindle-shaped cell neoplasm with prominent mitotic activity (28 mitoses per 10 high-power fields) and areas of necrosis, focally surrounding staghorn-shaped vessels. The tumor cells were positive for CD34, CD99, Bcl-2, and STAT6 and negative for smooth muscle actin, epithelial membrane antigen, and cytokeratin AE1/AE3. These findings were consistent with a malignant SFT involving the left humerus. Although extremely rare, SFT should be considered in the differential diagnosis of primary bone tumors. This is the first case report of a primary SFT in a long bone with malignant histological features.

Reconstrucción traqueal bajo oxigenación con membrana para circulación extracorpórea para el manejo de una lesión traumática: reporte de caso y revisión bibliográfica / Tracheal reconstruction under oxygenation with membrane extracorporeal circulation for the management of a traumatic lesion: case report and literature

Introducción. El traumatismo traqueal es una condición poco frecuente que puede ser ocasionada por traumas abiertos, cerrados o iatrogénicos; su presentación clínica es variable y el diagnóstico suele ser clínico, apoyándose en la radiografía de tórax, la tomografía cérvico-torácica y la fibrobroncoscopia. Su manejo representa todo un reto médico y quirúrgico, y se requieren múltiples herramientas para su adecuado tratamiento. La terapia con oxigenación con membrana para circulación extracorpórea ha sido ampliamente utilizada en el manejo de pacientes con falla respiratoria aguda, en los cuales los métodos convencionales de asistencia respiratoria mecánica no son suficientes para garantizar una adecuada oxigenación. Caso clínico. Se presenta el caso de una paciente con una lesión traqueal iatrogénica reparada quirúrgicamente, bajo asistencia con oxigenación con membrana para circulación extracorpórea, para garantizar la oxigenación tisular y la adecuada recuperación y supervivencia de la paciente. Conclusiones. La terapia con oxigenación con membrana para circulación extracorpórea es una excelente alternativa para el manejo quirúrgico de las lesiones traqueales complejas que amenazan la vida del paciente, ya que permite brindar un soporte vital y un adecuado intercambio gaseoso durante el procedimiento

ntroduction: Tracheal trauma is a rare condition that can be caused by open, closed, or iatrogenic trauma; its clinical presentation is variable and the diagnosis is usually clinical, supported by chest X-ray, thoracic CT and bronchoscopy. Its management represents a medical and surgical challenge, requiring multiple tools for the proper treatment of this entity. Extracorporeal membrane oxygenation therapy has been widely used in the management of patients with acute ventilatory failure in whom conventional methods of mechanical ventilation are insufficient to ensure adequate oxygenation of the patient. Case report: We present the case of a patient with a surgically repaired iatrogenic tracheal lesion conducted with extracorporeal membrane oxygenation to maintain tissue oxygenation and assure recuperation and survival. Conclusions: Extracorporeal membrane oxygenation therapy is an excellent alternative for the surgical management of complex tracheal lesions that threaten the patient's life, allowing vital support and adequate gas exchange during the procedure

Casos clínicos para docencia en ortopedia oncológica / Clinical reports to education for orthopedic oncology

Las neoplasias óseas son infrecuentes, con una incidencia menor del 0,01%. Por esta razón, el ortopedista general puede tener dificultad en identificar los síntomas y signos que sugieren una neoplasia ósea y practicar un tratamiento inapropiado o tardío. El propósito de este artículo es presentar una serie de casos de pacientes con complicaciones oncológicas y su manejo.

Condrosarcoma mesenquimal extraóseo: reporte de caso / Extraosseus mesenquimal chondrosarcoma: case report

El condrosarcoma mesenquimal extraóseo es una lesión rara que representa menos del 2% de las neoplasias cartilaginosas malignas, histológicamente caracterizada por áreas altamente celulares compuestas por células redondas mesenquimales primitivas alternando con focos de diferenciación cartilaginosa. Siendo una lesión de alto grado histológico, tiende a producir metástasis pulmonares por lo que la sobrevida global no es superior al 26% a 10 años. Se presenta este reporte por ser una lesión infrecuente y por representar un diagnóstico diferencial insospechado.

Síndrome de Jaffe-Campanacci: reporte de un caso / Jaffe-Campanacci syndrome: case report

El síndrome de Jaffe-Campanacci es una rara entidad caracterizada por múltiples fibromas no osificantes con máculas café-au-lait; está asociado a malformaciones congénitas extraesqueléticas y retardo mental. Reportamos el caso de un hombre de 22 años con las características del síndrome de Jaffe-Campanacci pero sin malformaciones extraesqueléticas, y lo comparamos con los diferentes casos reportados en la literatura de los últimos 15 años, a fi n de seguir buscando patrones epidemiológicos que nos ayuden a descubrir su etiología.

Adamantinoma de la tibia con componente de quiste óseo aneurismático secundario / Adamantinoma of the tibia component of secondary aneurysmal bone cyst

El adamantinoma de los huesos largos es uno de los tumores malignos menos frecuentes, representando únicamente el 1%. Su localización en la tibia es la más común, y el tratamiento indicado es la resección en bloque y salvamento de extremidad. En algunos reportes de la literatura se describe con poca frecuencia un componente óseo aneurismático. En este artículo reportamos el caso de un paciente masculino quien presentó un adamantinoma de la tibia proximal con un gran componente de quiste óseo aneurismático que enmascaró su patología de base, y retrasó el diagnóstico y su tratamiento. Presentamos el tratamiento realizado, su evolución y las complicaciones presentadas.

Banco de Huesos y Tejidos Fundacion Cosme y Damian / Cosmo and Damian Foundation. Bone and tissue bank

Se realiza la presentación del Banco de Huesos y Tejidos de la Fundación Cosme y Damián; insistiendo en principios filosóficos de su existencia, las normas internacionales y propias que controlan su funcionamiento. Se explica la complejidad y los procesos. Igualmente un resumen de los principiosbiológicos del comportamiento de los injertos y algunas aplicaciones prácticas en la otorrinolaringología y cirugía de cabeza y cuello.

Quiste óseo aneurismático grado 3 del tercio proximal de fémur manejo con arcos costales alogénicos: reporte de un caso / Grade 3 aneurysmal bone cyst of the proximal femur with costal arches allogeneic management: a case report

El Quiste Óseo Aneurismático (QOA) representa el 1% a 2% de todos los tumores óseos primarios, presentándose en el 80% de las veces en las primeras dos décadas de la vida, con cierta predilección por la metáfisis de los huesos largos tubulares; con una prevalencia discretamente mayor en el género femenino. La mayoría de los pacientes son tratados con curetaje asociado o no con injertos óseos y otros coadyuvantes locales. Se hace la presentación del caso una de niña de cinco años, que sufrió una fractura patológica pertrocantérica del fémur derecho secundaria a un QOA agresivo, cuyo tratamiento consistió en resección intralesional con injerto de matriz ósea desmineralizada y dos aloinjertos de arcos costales a manera de clavos cefalomedulares para reconstrucción. Después de 19 meses de seguimiento, observamos adecuada incorporación de los injertos con preservación de la articulación y buen resultado funcional.

La conducta del ortopedista en la prevención, diagnóstico y tratamiento de la osteoporosis en mujeres posmenopáusicas con fractura de cadera en cuatro hospitales de Bogotá - Colombia, 2001-2003 / The conduct of the orthopedist in the prevention, diagnosis and treatment of osteoporosis in postmenopausal women with hip fracture at four hospitals of Bogotá - Colombia, 2001-2003

Las publicaciones internacionales han mostrado que el ortopedista juega un papel de “reparador” de las fracturas y muy poco en la prevención de las mismas. Se realizó un estudio observacional descriptivo tipo serie de casos para estudiar el comportamiento del ortopedista en las mujeres posmenopáusicas con fractura de cadera por osteoporosis en cuatro centros hospitalarios de Bogotá. Resultados: No había información en el 82% de las historias clínicas sobre los antecedentes médicos, familiares y factores de riesgo para osteoporosis. Se reportaban medidas de prevención en el 35% de los casos. Estudios con DEXA o Ultrasonido: 1% Tratamiento y Prevención: El 1% con Estrógenos, Bifosfonatos o Calcitonina. El 31% con Calcio. Conclusiones: Los resultados hablan del bajo interés y el escaso conocimiento que tenemos de la osteoporosis y del papel que tenemos como “reparadores” de las fracturas y muy poco en su prevención.