Forearm deformity secondary to giant solitary ulna exostosis is rare. We describe a rare presentation of symptomatic solitary giant exostosis involving the entire distal ulna resulting in ulnar bowing of the forearm in a five-year-old boy. The tumour was completely resected and the defect was reconstructed with an allograft wrapped with a free autogenous periosteal tubular sleeve to deliver fresh pluripotential cells for better incorporation and integration. The distal ulna physes was preserved. An osteotomy was performed on the radius to correct the deformity. One year after surgery, the deformity remains corrected with normal bone length and excellent hand function. There is no evidence of local recurrence and the allograft has fully incorporated.
Reduction of a malunited femoral diaphyseal fracture can be achieved by osteotomy and immediate internal fixation or gradual skeletal traction followed by delayed internal fixation. We retrospectively reviewed 27 patients with malunited and shortened femur. Nine patients with mean shortening of 4.7 cm (2.5-10.0) underwent acute one-stage reduction and gained 2.5 to 5.0 cm length. Eighteen patients with mean shortening of 5.3 cm (3.5 to 9.0) underwent twostage reduction and gained 2.0 to 5.0 cm length. There was no paralysis in either group. No infection occurred in the one-stage procedure. Intramedullary fixation demonstrated superior results compares to plate fixation.
Extensive peri-acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti-protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86).
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.
Biopsy is a crucial step in the management of musculoskeletal sarcoma. The surgical approach to the biopsy site is important, as the tract must be removed en bloc with the tumour during limb sparing surgery so as to reduce the risk of local recurrence. The biopsy tracts of 26 osteosarcoma patients were evaluated histologically for tumour infiltration. Horizontal sections of 1 mm thickness with 2 cm radius from were evaluated from each excised biopsy tract. Five out of 26 cases (19.2%) showed positive tumour infiltration. One case (3.85%) had tumour infiltration in the pseudocapsule, two cases (7.69%) had tumour infiltration into the muscle and two other cases (7.69%) had tumour infiltration into the subcutaneous tissue. None had skin infiltration. We conclude that resection of the entire biopsy tract is indeed mandatory for surgical treatment of osteosarcoma.