Treatment of fibrous dysplasia of the proximal femur by means of pedicled iliac crest bone graft: a case report.

In this report, we present a case of treatment of fibrous dysplasia (FD) of the proximal femur with the pedicled iliac crest bone graft. An 18-year-old patient presented with hip pain and polyostotic dysplasia with involvement of the proximal femur and a history of pathological fracture. The patient was operated on using vascularized bone graft from the iliac crest and osteosynthesis with Dynamic Hip Screw (DHS®). With vascularized bone graft, we found an improvement on X-ray with no reabsorption, and with osteosynthesis, we controlled the pain and prevented pathological fracture and progression of the deformity. Several other studies where the pedicled iliac crest bone graft has been successfully used for the management of defects in the proximal femur (osteonecrosis of the femoral head and pseudarthrosis of the femoral head) can be found in the medical literature. However, the pedicled iliac crest bone graft in a patient with FD of the proximal femur is unique.

Tumor miofibroblástico inflamatorio del plexo braquial / Inflammatory myofibroblastic tumor of the brachial plexus

Se presenta un caso de tumor miofibroblástico inflamatorio del plexo braquial en un varón de 8 años de edad. La resonancia magnética nuclear (RMN) revela la imagen de una masa con un comportamiento agresivo y que englobaba todo el plexo braquial y la arteria y vena subclavia. Se realizó una extirpación completa por el abordaje transclavicular y transesternal. Este abordaje eleva un colgajo osteomuscular que compromete la porción medial de la clavícula, parte del manubrio esternal, la articulación esternoclavicular y el músculo esternocleidomastoideo. Se describe y discute este abordaje que da acceso a todo el plexo braquial y a los grandes vasos permitiendo un excelente control de los mismos. El estudio histológico reveló una proliferación neoplásica consistente en células fusiformes miofibroblásticas asociada a un infiltrado inflamatorio que incluye células plasmáticas, linfocitos y algunas células gigantes tipo osteoclasto. Por inmunohistoquímica existía positividad a la actina, vimentina y a ALK-1 (AU)

The author report the presence of an unpublished inflammatory myofibroblastic tumor of the brachial plexus in a 8 years old boy. Magnetic resonance (MR) images revealed a fusiform mass surronding both subclavian vessels and nerve trunks, divisions and fascicles of the whole left brachial plexus. To obtain a definitive treatment we performed a resection using an trans-clavicular and trans-sternal approach and removed the tumor completely. This approach is based on the elevation of the osseomuscular flap, which comprises the medial portion of clavicle with the sternoclavicular joint, vertex of manubrium and the sternocleidomastoid muscle. This allows a total exposure of the brachial plexus and excelent vascular control. Histological study revealed neoplasic proliferation consisted in spindled myofibroblastic cells, mostly inmunohistochemically positive for actin, vimentin and ALK-1, associated with inflammatory infiltrate including plasma cells, lymphocytes and some giant cells osteoclastic type (AU)