Aneurysmal bone cyst is a pseudoneoplastic skeletal disorder. The material of the Tumor Center at the Rizzoli Orthopaedic Institute refers to 198 cases, 25 (12.6%) with spinal localization. The X-ray pattern of aneurysmal bone cyst is represented by an osteolytic area more or less evidently involving the vertebra, with frequent extension to the surrounding soft tissues. Its maturing evolution is typical, and occurs both spontaneously and after surgical and/or radiation therapy.

Adolescent↗

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[Humoral immunity and chronic osteomyelitis].

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Antibody Formation↗

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[Convex pes valgus: surgical treatment].

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Child, Preschool↗

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A histomorphologic study of explants of massive allografts: preliminary results.

The authors report their experience in the histologic study of massive allografts, explanted as a result of oncological, mechanical or biological complications. The study was conducted according to the method of inclusion in methyl methacrylate that does not involve decalcification. A description is provided of all of the phases of fusion between graft and host bone in the site of the osteotomies, as well as distribution of revascularization and rehabilitation of the graft, attachment of the soft tissues, and finally, modifications in the joint cartilage of the osteoarticular grafts. The allograft must be considered to be osteoconductive, and is only weakly osteoinductive. Incorporation of the graft is a slow and incomplete process that follows sequential phases. The Volkmann's canals in the osteotomies constitute the preferred paths for rehabilitation of the graft that is on the order of millimeters on the surface and centimeters in the site of the osteotomies. The greatest modifications have been observed in the joint cartilage. The cartilaginous cells appear to be vital only from a morphological point of view.

Adolescent↗

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Arthrodesis of the knee after tumor resection: a comparison between autografts and allografts.

Cases of arthrodesis of the knee performed after bone tumor resection using autografts (Group I) and allografts (Group II) were compared (follow-up was comparable). The two groups show differences in type of pathology, treatment and length of resection. Nonetheless, the percentage of complications and the final results were similar. Despite the fact that arthrodesis of the knee is used less and less for reconstruction, it is our belief that the use of autografts should be substituted by allografts whenever possible.

Adolescent↗

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Patellar resurfacing in tumor endoprosthesis: a study in regard to power transmission.

Relation between quadriceps muscle mass and knee extension strength was investigated after resection of malignant bone tumor and endoprosthetic replacement of the distal femur in 19 patients with patellar resurfacing (Group A) and 16 patients without resurfacing (Group B). In all cases, a modular cementless, hinged prosthesis had been used. Age and follow-up period were comparable in the 2 groups. Muscle mass was measured ultrasonographically and strength was evaluated isokinetically. All the data on the operated side are given as percentage of the non-operated side. There was a positive correlation between muscle mass and strength in both groups. By linear regression analysis, a slightly lower value of strength was predicted in the unresurfaced group than in the resurfaced group. Analysis of covariance revealed that the influence of patellar resurfacing on strength was significant. This factor should also be considered in making a decision about patellar resurfacing with a tumor endoprosthesis.

Adolescent↗

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The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection. A multicentric European study.

A multicentric study was conducted by the European Musculoskeletal Oncology Society on 113 cases of resection for tumors of the major long bones and reconstruction with massive allografts, as intercalary diaphyseal or for arthrodesis. The follow-up was at least 12 months. There was a 14% incidence of infection, with a higher frequency (18.5%) in intercalary grafts as compared to arthrodeses (7%). Fracture of the graft occurred in 15.5% of the cases with a prevalence in the humerus (28.5%) as compared to the tibia (21.4%) and femur (14.7%). Fracture constantly occurred after osteosynthesis with screws, in 16% of the cases after osteosynthesis with a plate, and in 12.5% of the cases after osteosynthesis with an intramedullary nail. It was observed in 32% of the grafts preserved at -30 degrees, in 17% of those irradiated, and in 7% and 7.6% of those preserved at -180 degrees and -80 degrees, respectively. Delayed union and non-union was observed in 57% of the cases: 63% in intercalary grafts, 48% in arthrodeses. Final results after treatment of complications were excellent and good in 63% of the entire series. The results should, however, be evaluated after 3 years, as during this period of time important transformation phenomena of the graft occur. Complications are observed in 75% of the cases, but they may be reduced if planning is correct and surgery is accurate. Each complication may be dealt with and resolved without high risks for preservation of the limb.

Adolescent↗

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Gastrocnemius flaps in the surgical treatment of sarcomas of the knee.

The authors discuss their experience with the pediculated gastrocnemius flap used in the oncological surgery of the knee, in 27 patients. Three groups of patients are evaluated: in one group the method was used in patients affected with bone sarcoma and associated with reconstruction of the resected bone segment; in another group the method was used after infection had occurred as a result of reconstructive surgery; in the third group the method was used at the same time as excision of sarcomas of the soft tissues. The gastrocnemius flap may be used to cover sufficiently wide areas of loss of skin and muscular substance around the knee, and may be effectively used to cover metallic prostheses or composite reconstructive implants (bone-cement-metal). We recommend using the covering technique at the same time as resection and reconstruction are performed in order to avoid the risk of infection, and thus reduce any changes in chemotherapy protocols that postoperative infection would require in these patients. The use of the gastrocnemius flap associated with excision of sarcomas of the soft tissues must be reserved for selected cases. The high incidence of local recurrence after such excisions indicates that either wider excisions using distant free flaps or the association of radiotherapy should be considered.

Adolescent↗

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The effect of intra-arterial versus intravenous cisplatinum in the neoadjuvant treatment of osteosarcoma of the limbs: the experience at the Rizzoli Institute.

The effect of intra-arterial versus intravenous infusion of cisplatinum on the histological response of osteosarcoma of the limbs was evaluated based on the results of three studies in which CDP was preoperatively associated with MTX and ADM (1st study), and with MTX, ADM, and IFO (2nd and 3rd studies). In the chemotherapeutic protocol that involved 3 drugs the percentage of "good histological responses to chemotherapy" (defined as tumor necrosis > 90%) was significantly higher in the 40 patients who were administered CDP by intra-arterial infusion as compared to that observed in the 39 patients treated with CDP by intravenous route (78% versus 46%: P .004). In the two sequential studies where 4 drugs were used, the percentage of good histological responses was essentially the same for patients treated with CDP administered intravenously, and for those treated with CDP administered intra-arterially (78% versus 84%). Regardless of the route of infusion used to administer cisplatinum the percentage of "good" histological responses was significantly higher in the 109 patients treated with the 4-drug protocol as compared to the 79 patients treated with the 3-drug protocol (82% vs 62%; P .04). This difference may essentially be attributed to the higher percentage of good responses observed in the 4-drug protocol in patients treated with CDP administered intravenously (78% vs 46% for patients treated i.v. with the 3-drug protocol; P .006). For the patients instead treated with CDP administered intra-arterially the percentage of good responses was essentially the same with the 4-drug protocol and with the 3-drug protocol (84% vs 78%; P ns). These data lead us to conclude that in the neoadjuvant treatment of osteosarcoma of the limbs a preoperative 4-drug protocol (MTX, CDP, ADM, IFO) is more effective than a 3-drug protocol (MTX, CDP, ADM), and that in a 4-drug preoperative chemotherapy protocol intra-arterial infusion of CDP does not offer particular advantages as compared to intravenous infusion.

Adolescent↗

PubMedDate not supplied

Neurologic deficit after resection of the sacrum.

The authors describe neurologic deficit (sensory, motor, and sphincteral) resulting from sacrifice of the sacral nerve roots removed during resection of the sacrum. The anatomical and functional bases of sphincteral continence and the amount of neurologic deficit are discussed based on level of sacral resection. A large review of the literature on the subject is reported and discussed. The authors emphasize how the neurophysiological bases of sphincteral continence (rectum and bladder) and of sexual ability are still not well known, and how the literature reveals disagreement on the subject. A score system is proposed to evaluate neurologic deficit. The clinical model of neurologic deficit caused by resection of the sacrum may be extended to an evaluation of post-traumatic deficit.

Anal Canal↗