Biomedical subjects
Publications and source records attributed to F H Sim.
A girl, aged 2 years, 11 months, who had pain and swelling of the proximal humerus, was found to have osteoblastic osteogenic sarcoma of the humerus. Among 937 consecutive patients with osteogenic sarcoma examined at the Mayo Clinic, she is the youngest child seen, as well as only the sixth child younger than 6 years of age in this series.
The clinical records and roentgenograms of fifty-four patients had the typical features of osteoid-osteoma, but no histological evidence of a nidus was found at initial surgery. The symptoms of thirty-one patients were relieved by initial operation and those of twenty-three were not. In two cases, Brodie's abscess was identified in the surgical specimen. A second operation in eighteen patients brought relief in thirteen, and a nidus was found histologically in seven of these patients. A parosteal osteogenic sarcoma was found in one of the patients who had no relief of symptoms. Three patients underwent a third operation and were relieved of symptoms, a nidus being found in two. Thus, symptoms were relieved in thirty-six of forty-two patients in whom no nidus or other pathological entity was found, indicating the significance of this symptomatic sclerotic osseous lesion.
An increased awareness of the importance of anaerobic organisms in human infections and improvements in culture techniques are probably responsible for the apparent increasing incidence of anaerobic infections. Clostridial infections are medical emergencies. Prevention is the first step in treatment, and close adherence to the well-established prinicples of trauma surgery with thorough débridement of all devitalized and necrotic tissue is of paramount importance.
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Limb-salvage surgery is a safe and effective treatment for malignancies of the musculoskeletal system. Careful evaluation and planning are necessary to avoid both early and late complications. Biopsy must be carefully performed to avoid unnecessary contamination and to obtain adequate tissue for an accurate diagnosis. Pathologic fractures present both a diagnostic and a therapeutic challenge, and evaluation strategies depend on the age of the patient. Treatment of a pathologic fracture depends on the location and the histology of the lesion and many host factors. Limb salvage may or may not be indicated. Instability is another problem with certain limb-salvage situations, e.g., when it is necessary to resect the scapula. Various approaches may obviate the problem. The salvage of failed limb-salvage procedures requires careful evaluation and planning. Patients with infections and local recurrences often require amputation surgery. Correctable problems following failed allograft reconstructions include collapse of the articular cartilage, joint instability, nonunion, and fracture of the allograft. Correctable problems following prosthetic arthroplasty include aseptic loosening, prosthetic fracture, and polyethylene wear. Approximately two thirds of patients with failed limb-salvage procedures will obtain a functional limb following revision surgery. Attention to these special problems may allow for greater success with limb-salvage surgery.
The standard for local control of malignant bone tumors has been amputation. During the last decade, limb-sparing surgery has been common in the multidisciplinary management of bone sarcoma. Efforts continue toward improving local control of tumor while retaining the function of the reconstructed limb. Major challenges include defining adequate surgical margins and developing biologic and prosthetic reconstructions that match life expectancy. Our review highlights important refinements of earlier techniques, current innovations, and future directions in limb-salvage surgery.