Resection of thumb metacarpal Ewing Sarcoma and primary reconstruction with non-Vascularized osteoarticular metatarsal autograft

Ewing sarcoma is a primary bone malignancy that rarely occurs in the hand. Resection and reconstruction will usually result in reduced or loss of thumb function. We describe a case of successful transplantation of non- vascularized osteoarticular second metatarsal autograft following wide resection of Ewing sarcoma of first metacarpal in an 11-year-old girl. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve mobility of the joint. This enabled preservation of thumb function by a relatively simple surgical technique. Detailed surgical procedures and excellence function after 2 years following surgery are described

Langerhans cell histiocytosis with extensive spinal and thyroid gland involvement presenting with quadriparesis: an unusual case in an adult patient

Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults

A Pilot Study of AnkLe InstabiLity Following Long Segment FibuLar Graft Harvesting

Graffibula adalah satu teknik; untuk mengembalikan keutuhan tulang rangka akibat kecacatan tulang. Walaupun teknik ini amat berguna, namun banyak fapuran berkaitan dengan tSU pengambilan tulang fibula ini terufamanya berkaitan ketidakstabilan sendi pergelangan kaki. Fibufar graft is a useful technique to restore skeletal integrity of bony defects. Despite the benefits of this procedure, there are reported problems associated with donor site, particularly with regards to ankle stabilit

Functional outcomes after internal and external hemipelvectomy in HUSM

Background: Although great advancements have been made in survival rates over the last half century with adjuvant therapies and current surgical techniques, hemipelvectomy as the surgical treatment for pelvic tumours continue to have significant associations with morbidity and complications. Using the Enneking’s criteria as adopted by the Musculoskeletal Tumor Society (MSTS), we evaluated the functional outcomes of patients who have had an internal hemipelvectomy with and without reconstruction, and external hemipelvectomy. Method: We evaluated patients who underwent hemipelvectomy in our institution between 2001 and 2010. Patients who had had an internal or external hemipelvectomy surgery at any point in their clinical course were included in the study. Patients with follow up periods of less than four months were not included. MSTS scores were obtained at various times after the surgery. Results: A total of 50 patients who had undergone various types of resection and reconstruction techniques were included in this study. The average age is 40.1 years (range 12-79). Average duration of follow up is 10 months. The average MSTS percentage score was 44.32% (range: 6.67%-100%). Results show that external hemipelvectomy in our patients have a high morbidity and mortality rate. Various techniques of resection and reconstruction give different functional scores. Conclusion: Hemipelvectomies have a profound impact on patients’ lives as illustrated by their low MSTS scores. Proper patient selection is crucial to obtain the best outcome. This study is an effort to obtain a proper reference for preoperative discussion with patients and relatives regarding expected outcomes following such a procedure

Functional outcomes after internal and external hemipelvectomy in HUSM

Background: Although great advancements have been made in survival rates over the last half century with adjuvant therapies and current surgical techniques, hemipelvectomy as the surgical treatment for pelvic tumours continue to have significant associations with morbidity and complications. Using the Enneking’s criteria as adopted by the Musculoskeletal Tumor Society (MSTS), we evaluated the functional outcomes of patients who have had an internal hemipelvectomy with and without reconstruction, and external hemipelvectomy. Method: We evaluated patients who underwent hemipelvectomy in our institution between 2001 and 2010. Patients who had had an internal or external hemipelvectomy surgery at any point in their clinical course were included in the study. Patients with follow up periods of less than four months were not included. MSTS scores were obtained at various times after the surgery. Results: A total of 50 patients who had undergone various types of resection and reconstruction techniques were included in this study. The average age is 40.1 years (range 12-79). Average duration of follow up is 10 months. The average MSTS percentage score was 44.32% (range: 6.67%-100%). Results show that external hemipelvectomy in our patients have a high morbidity and mortality rate. Various techniques of resection and reconstruction give different functional scores. Conclusion: Hemipelvectomies have a profound impact on patients’ lives as illustrated by their low MSTS scores. Proper patient selection is crucial to obtain the best outcome. This study is an effort to obtain a proper reference for preoperative discussion with patients and relatives regarding expected outcomes following such a procedure

Evaluation of blood loss during internal (limb-salvage) hemipelvectomy for pelvic tumours : what have we learned so far?

Introduction: Pelvic tumour resections are complex and associated with extensive bleeding. Despite various blood management options in orthopaedic surgery, their used are limited particularly for pelvic tumour resections. Identifying predictive factors for a large amount of blood loss during surgery is essential. Objective: To evaluate the volume of blood loss in limb salvage pelvic resections and identify the risk factors for large amount of perioperative blood loss. Methodology: We retrospectively reviewed 25 patients underwent pelvic tumour resections performed between 2000 and 2010 in a single institution. Tumours originating from the sacrum were excluded. Total blood volume loss consisted of estimated intra-operative blood loss and the drainage volume on the first day after surgery. Loss of more than 3000ml of blood was classified as large amount of blood loss. Statistical analysis performed using Fisher’s exact test. Results: Six (24.0%) patients had total blood loss greater than 3000ml. Resections of primary bone sarcomas (osteosarcoma and chondrosarcoma) have the highest mean blood loss volume (6556.67ml and 1768.57ml, respectively). Most important factor associated with large amount of blood loss is the involvement of the acetabulum. Neo-adjuvant therapies and pre-operative embolization were not shown to be associated with extensive blood loss.. Conclusion: Resections of pelvic tumours involving the acetabular region are likely to have a large amount of blood loss perioperatively and should be anticipated. Radiation therapy prior to surgery was believed to increase the risk of bleeding intra-operatively, was not observed in this study

Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children

This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoo

Resection of thumb metacarpal Ewings Sarcoma and primary reconstruction with a non-vascularized, autologous, osteoarticular metatarsal graft

Introduction: Ewings sarcoma is a rare, malignant neoplasm; rarely originates in the bones of the hand. Historically, treatment involves a combination of chemotherapy and radiotherapy. The role of surgical intervention remains limited, depending on the anatomic location. Resection and reconstruction will usually result in reduced or loss of function. Methodology: We reviewed a case of an 11-year girl with Ewings sarcoma of the first metacarpal bone of her dominant right hand with a solitary lung metastasis. Results: Treatment consisted of neo- and adjuvant chemotherapy, and wide resection of the first metacarpal followed by reconstruction of her thumb with a non-vascularised, intercalated, autologous second metatarsal graft. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve mobility of the joint. Her donor site was reconstructed with an autologous tricortical iliac bone graft. Two years following surgery, she achieved near normal functioning of her dominant hand, with no donor site morbidity and local recurrence. The surgical techniques are described together with the excellent functional outcomes in the patient. Conclusion: The use of non-vascularised, autologous metatarsal bone graft to reconstruct the thumb following tumour resection is an excellent option available. It is relatively simple and can be performed as a single resection and reconstruction procedure

Anterior Stabilisation of Sacroilliac Joint for Complex Pelvic Injuries

Sacroilliac joint diasthesis from high energy trauma is always complicated with chronic pain and long term morbidity. Open anterior stabilisation with plate allow direct reduction and stabilisation with biomechanically advantages. Here we report on four cases of pelvic injury with sacroiliac joint disruption treated with anterior plate stabilisation through a surgical approach similar to that used for anterior ring fractures