The Management of Sacral Schwannoma: Report of Four Cases and Review of Literature

Sacral schwannoma is a rare retrorectal tumor in adults. Postoperative sacral neurological deficit is difficult to avoid. Currently, there is no established consensus regarding best treatment options. We present the management and outcomes of sacral schwannoma in 4 patients treated with intralesional curettage and postoperative radiation. There were 3 women and one man (average age: 45.5 years) with long duration of lumbosacral pain with or without radiculopathy. Intralesional curettage was performed by posterior approach and adjuvant radiation therapy with dosage of 5000–6600 cGy was given after surgery. The mean follow-up time was 18 months (range 4–23 months). Symptoms of radiculopathy had decreased in all patients. The recent radiographic findings show evidence of sclerosis at the sacrum one year postoperatively, but the size was unchanged. Intralesional curettage and adjuvant radiation therapy can be used in the treatment of sacral schwannoma to relieve symptoms and preserve neurological function

Effects of Different Durations of 9-Square Dance Exercise Versus Treadmill Exercise on the Physical Fitness and Quality of Life of Healthy Volunteers: A Pilot Randomized Controlled Trial

Objective: To evaluate the impact of 9-square dance exercise (9SDE) on physical fitness and quality of life compared to traditional treadmill exercise (TME). Materials and Methods: In total, 33 healthy volunteers (10 men, 23 women) were recruited and randomly assigned into three groups: 9 square dance exercise for 8 minutes (9SDE-8), 9 square dance exercise for 30 minutes (9SDE-30), or treadmill exercise (TME). Exercises were done three times a week for 12 weeks and physical fitness tests were performed for all the groups at weeks 0, 6, and 12. Participants were assessed using the European Quality of Life Measure 5 Domains and 5 Levels questionnaire (EQ-5D-5L). Results: Significant improvements in cardiorespiratory endurance, leg strength, and flexibility were demonstrated in the 9SDE-30 group (p<0.05). There was no significant difference in physical fitness between the 9SDE-30 and TME groups. The 9SDE-8 group showed a significant improvement in utility in the EQ-5D-5L questionnaire (p<0.05), while the TME group showed a significant improvement in directly evaluated health status (p<0.05). 9SDE-30 and TME showed similar improvements in cardiorespiratory endurance and leg strength. Conclusion: Considering its low-resource requirement and overall utility, coupled with its effectiveness in promoting cardiovascular fitness and leg strength, 9SDE represents a viable exercise alternative for those with limited time and resources

Three-dimensional Kinematic Analysis and Muscle Activation of the Upper Extremity in Ruesi Dutton Exercises

Objective: To investigate 3-D upper extremity joint angles and muscle activities in selected Ruesi-Dutton exercises. Material and Methods: Twenty-six healthy participants (mean age of 25.65, mean height of 165.08 cm, and mean weight of 56.69 Kg) volunteered to take part in this study. 3-D motion analysis consisted of eight cameras synchronized with a wireless electromyography (EMG) system to collect kinematic data and muscle activity. Participants performed five postures, including the Kae Lom Kho Mue posture, Kae Puat Thong Kae Kho Thao posture, Kae Kiat posture, Kae Puat Thong Sabak Chom posture, and Kae Lom Puat Sisa. The upper extremity joint angles and range of motion (ROM) and EMG were analyzed. Results: Most postures were in the normal range of motion. The percentage of MVIC was more than 1% and the Trapezius muscle is the most active in all postures. Conclusion: The data in this research is useful to help select the correct posture and exercise for a specific condition

The Friedman-Eilber Resection Arthroplasty of the Pelvis

It has been argued that internal hemipelvectomy without reconstruction of the pelvic ring leads to poor ambulation and inferior patient acceptance. To determine the accuracy of this contention, we posed the following questions: First, how effectively does a typical patient ambulate following this procedure? Second, what is the typical functional capacity of a patient following internal hemipelvectomy? In the spring of 2006, we obtained video documentation of eight patients who had undergone resection arthroplasty of the hemipelvis seen in our clinic during routine clinical followup. The minimum followup in 2006 was 1.1 years (mean, 8.2 years; range, 1.1–22.7 years); at the time of last followup in 2008 the minimum followup was 2.9 years (mean, 9.8 years; range, 2.9–24.5 years). At last followup seven of the eight patients were without pain, and were able to walk without supports. The remaining patient used narcotic medication and a cane or crutch only occasionally. The mean MSTS score at the time of most recent followup was 73.3% of normal (range 53.3–80.0%; mean raw score was 22.0; range 16–24). All eight patients ultimately returned to gainful employment. These observations demonstrate independent painless ambulation and acceptable function is possible following resection arthroplasty of the hemipelvis

The prognostic factors of recurrent GCT: A cooperative study by the Eastern Asian Musculoskeletal Oncology Group

Background Giant-cell tumor (GCT) of bone is a common primary benign tumor with high local recurrence and potential distant metastasis or malignant transformation. We haveinvestigated the clinical behavior of recurrent GCT of bone in the extremities. Methods We retrospectively reviewed 110 patients with recurrent GCTs of bone in the extremities treated by the Eastern Asian Musculoskeletal Oncology Group. The factors that affected the number of recurrences and distant metastasis were analyzed. Results The median interval between initial surgery and the first recurrence of GCTwas 16 months (2-180 months). All patients received additional surgery for first recurrence. Twenty-five patients had a second recurrence and 6 patients had a third recurrence. The mean interval between theinitial surgery and the first recurrence correlated withthe eventual number of recurrences-14.1 months for the repeated recurrence groups (two and three recurrences) and 28.3 months for the single recurrence group (p = 0.016). Campanacci grade did not correlate with repeated recurrence (p = 0. 446). The venue of the initial surgery did not correlate with recurrence but did affect preservation of the adjacent joint (chi-squared test; p =0.046). Campanacci grade II and III also correlated withsacrifice of the adjacent joint (p = 0.020). The incidence of lung metastasis and malignant transformation were 7.5% (8 out of 107 patients) and 2.7% (3 out of 110 patients), respectively. Repeat recurrence was associated with lung metastasis (p = 0.018). © The Japanese Orthopaedic Association 2011

Experience of total scapular excision for musculoskeletal tumor and reconstruction in eastern Asian countries

Total scapulectomy and reconstruction has been performed for scapular tumor, however, most of the reconstruction methods have resulted in poor functional outcomes and there is still room for improvement. Most of the reports of reconstruction after scapulectomy are from a single institution. In the present study, we investigated functional outcomes after total scapulectomy in a multicenter study in The Eastern Asian Musculoskeletal Oncology Group (EAMOG). Thirty-three patients who underwent total scapulectomy were registered at EAMOG affiliated hospitals. The patients were separated into no reconstruction group (n=8), humeral suspension group (n=15) and prosthesis group (n=10). Functional outcome was assessed by the Enneking score. One-way ANOVA was used to compare parameters between the patient groups. Complications included five local recurrences, one superficial infection, one dislocation and one clavicle protrusion. The average follow-up period was 43.5. months. The average active flexion range was 45.8° (0-120°), and 37.1° in abduction (0-120°). The mean total functional score was 22.9 out of 30 (15-29), which is a satisfactory score following resection of the shoulder girdle. There were significant differences in reconstruction methods for active range of motion. Bony reconstruction provided better range of motion in this study. There was a variety of reconstruction methods after scapulectomy in the eastern Asian countries. Although better functional score was obtained using scapular prosthesis or recycled bone and prosthesis composite grafting, postoperative function is still lower than preoperative function. Modified designed prosthesis with or without combination of recycle bone or allograft would restore the lost shoulder function in the future. © 2016 The Authors.Embargo Period 12 month

Late Distal Ureteral Stricture in Internal Hemipelvectomy Without Bone Reconstruction: A Case Report

Apichat Asavamongkolkul,1 Ekkarin Chotikawanich2 1Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Apichat Asavamongkolkul, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand, Tel/Fax +66 2-419-7968, Email [email protected]: We report the case of a patient with Ewing sarcoma involving the right pelvis in a 14-year-old girl who had multicycles of neo-adjuvant chemotherapy and preoperative radiation therapy. She underwent an internal hemipelvectomy type I resection, according to Enneking and Dunham’s classification without bony reconstruction. There was no intra- and perioperative complication. The patient has good function and needs no gait aids. She can walk with equinus foot compensated for leg shortening 5 centimeters and without a shoe-lift. There is no sign of disease relapse. However, she developed late ureteral stricture at 8-year postoperatively and was successfully treated with a ureteral stent.Keywords: internal hemipelvectomy, Ewing sarcoma, ureteric stricture, limb-sparing surgery, radiation therapy, mesh graf