Osteosarcoma in the distal femur two years after an ipsilateral femoral shaft fracture: a case report

<p>Abstract</p> <p>Introduction</p> <p>The duration of symptoms preceding a definitive diagnosis of osteosarcoma is quite long. Pathological radiological signs are often evident by the time of diagnosis. Although several case reports have been published on osteosarcoma of the femur, to the best of our knowledge this report is the first one with such an unusual clinical course.</p> <p>Case presentation</p> <p>We describe the case of a 58-year-old Caucasian man who presented with a femoral shaft fracture. Two years post-trauma osteosarcoma in the ipsilateral distal femur was diagnosed. Was it coincidence? We think that the history of the trauma is crucial to answering this question.</p> <p>Conclusion</p> <p>This case report underlines the need to keep up awareness of pathological fractures in emergency medicine and trauma surgery. When radiographs do not raise any suspicion but the history of trauma or the physical examination does, we recommend further radiological and/or histological diagnostic examinations.</p

A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial

BACKGROUND: Subacromial impingement syndrome (SIS) is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have disadvantages – unnecessary operations and smaller improvements in shoulder function, respectively. This paper describes the design of a new interdisciplinary treatment strategy for SIS (TRANSIT), which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery. METHODS/DESIGN: The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a randomized controlled trial (RCT). Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection. After inclusion they will receive injection treatment again by their general practitioner. When, after this treatment, there is a second recurrence within a year post-injection, the participants will be randomized to either an arthroscopic subacromial decompression (intervention group) or continuation of usual medical care (control group). The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems. At inclusion, at randomization and three, six and 12 months post-randomization an outcome assessment will take place. The primary outcome measure is the patient-reported Shoulder Disability Questionnaire. The secondary outcome measures include both disease-specific and generic measures, and an economic evaluation. Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses. DISCUSSION: The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial impingement syndrome are presented. The results of this study will improve insight into the best moment of referral for surgery for SIS

Guideline for diagnosis and treatment of subacromial pain syndrome

Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears

Shoulder complaints : incidence, prevalence, interventions and outcome

Shoulder complaints have a high incidence in general practice: 29 of 1000 patients visit their GP with this complaint. Nearly half of these patients consulted the GP only once, and for the majority of this group a wait-and-see policy or a prescription for NSAIDs sufficed. 38% of the patients with new shoulder complaints were sooner or later referred to a physiotherapist (84%) or a hospital specialist (16%). The most common shoulder complaint is subacromial impingement syndrome (SIS). The subject of this thesis is a randomised controlled trial for treatment of SIS comparing a new treatment strategy involving early operation and physiotherapy as needed, and usual care involving NSAIDs, corticosteroids and/or physiotherapy. There were no statistically significant differences between the groups regarding the functional status of patients. The new treatment was more expensive and patients experienced statistically more complications. These data do not justify the conclusion that an early operation is beneficial over usual treatment of SIS.

Improving medial cootprint coverage in double-row cuff repair using FiberTape

Fiber Tape has been designed to provide increased tissue cut-through resistance to prevent cuff repair failure. We hypothesize that this increased friction results in the FiberTape dragging the tendon laterally and adversely affecting tendon-footprint contact. Our aim was to compare our standard FiberTape repairs with a modified technique. In 5 cadavers, supraspinatus repairs using our standard technique was compared with a modification where the tendon was cinched down. The FiberTape tendon interface on the bursal side was marked and length of redundant FiberTape that was pulled through from the undersurface of the repair measured. The length of redundant Fiber-Tape pulled through from the medial row for each suture after cinching was on average 6.1mm (range, 3 to 10 mm). We also observed better approximation of cuff to footprint using our modified technique by comparing the undersurface of the repair in 2 specimens. Redundant suture material on the undersurface of medial row equates to poorer tendon to bone contact and the presence of fluid in the healing zone. Optimal contact area and pressures are necessary to maximize tendon healing. Improved tendon to bone contact can be achieved by cinching the medial row when FiberTape is used in a suture bridge technique.5 page(s

Specific patient-related prognostic factors for rotator cuff repair:a systematic review

Background: Many studies that describe factors affecting outcome in primary rotator cuff repair (RCR) have been published, but so far there is no review that summarizes them. This systematic review was conducted to identify prognostic factors influencing functional (clinical) outcome and radiologically proven cuff integrity after RCR. Methods: A literature search was conducted up to July 2013 for prospective studies that describe prognostic factors affecting outcome in primary RCR. Inclusion criteria were open or arthroscopic repair of a fullthickness supraspinatus or infraspinatus tear. Included outcome measures were shoulder function and cuff integrity. Studies describing revision surgery, muscle transpositions, and subscapular or partial-thickness tears and those with retrospectively collected data were excluded, as were studies without linear or multivariate regression. The literature search resulted in 662 hits, and 12 of those studies were included in this review. Results: Moderate evidence was found for increasing age, larger tear size, and additional biceps or acromioclavicular procedures to have a negative influence on cuff integrity at follow-up as well as for Workers' Compensation Board status to have a negative influence on functional outcome after RCR. There is limited evidence that performance of an additional acromioclavicular procedure has a negative influence on functional outcome. There was insufficient evidence for other described prognostic factors. Conclusion: Several patient-specific factors influencing functional and radiologic outcome after RCR have been identified. These factors can guide orthopedic surgeons in their decision-making process as to whether to operate on their patients. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees