[Fractures of the lower part of the humerus in adults].
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Adolescent↗
Biomedical subjects
S Boriani
Publications and source records attributed to S Boriani.
[Value and limitations of computerized tomography in the study of benign tumors of the bone].
In order to stress the role of CT in the evaluation of benign tumors of the bone the authors studied by means of a high-resolution CT scanner 74 patients that later underwent surgery (70 cases) and histological examination (all cases). CT findings were compared with the surgical and histological data. The results prove that the diagnostic contributions of CT are less important in the evaluation of benign than in malignant bone tumors. The major contributions of CT were:--the capability of detecting the presence of osteoid osteoma not found by means of conventional radiographic techniques;--differentiation between benign osteochondroma and peripheral chondrosarcoma by measurement of the peripheral cartilaginous cap: this criterion, on the other hand, does not seem to be always reliable and useful;--differential diagnosis of different types of cystic and fibrocystic diseases (simple and aneurysmal bone cyst, fibrous dysplasia);--evaluation of soft-tissue tumoral masses and of their extra-osseus extent in giant cell tumor and chondroblastoma; this allows us to establish the real extension of the tumor and to plan surgery more accurately.
Adolescent↗
Giant-cell tumor of bone.
Of 327 patients who had a giant-cell tumor of bone and were seen at the Istituto Rizzoli, 293 were treated at the Institute, and 280 of these were followed for two to forty-four years. The distribution according to sex and age of the patient and site of the tumor was similar to the distributions in major reports of large series. The tumor usually involved the metaphysis and the epiphysis, but was occasionally limited to the metaphysis, and in only 2 per cent of the patients was it adjacent to an open growth plate. The tumor on occasion invaded the articular space, also involving the ligaments and the synovial membrane. Extension to an adjacent bone through the joint occurred in 5 per cent of the tumors. Our radiographic grading, which is roughly comparable with the staging system of Enneking et al., was Grade I in 4 per cent, II in 74 per cent, and III in 22 per cent of 266 patients before treatment. A pathological fracture was apparent on the first radiograph in 9 per cent of the patients. In the 280 patients with adequate follow-up, 331 surgical procedures were performed. The rate of local recurrence was 27 per cent in the 151 intralesional procedures, 8 per cent in the 122 marginal excisions, and zero in the fifty-eight wide or radical procedures. These results did not correlate with the radiographic grade of the lesion. Of the fifty-one local recurrences that were seen after treatment at our institution, 90 per cent appeared in the first three years after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Giant cell reparative granuloma and other giant cell lesions of the bones of the hands and feet.
The present paper is a clinico-pathologic study of 52 osteolytic lesions containing giant cells, affecting the hands and feet and comprising 11 giant cell reparative granulomas, nine giant cell tumors, six chondroblastomas, and 26 aneurysmal bone cysts. The nature of osteolytic lesions of hands and feet must be carefully established in order to plan appropriate treatment without damaging the surrounding structures. Giant cell reparative granuloma has to be distinguished from other lesions containing giant cells. Clinical and radiologic findings proved of limited diagnostic value; the definitive diagnosis can be established only by histologic examination. Surgical treatment is discussed.
Bone Cysts↗
Solitary plasmacytoma of the bone in a case of Hodgkin's disease.
This report describes a case of solitary plasmacytoma of the bone which occurred in a 35-year-old male 3 years after mantle field irradiation for Hodgkin's disease, nodular sclerosing, stage IA. The possible significance of this rare association is discussed.
Adult↗
Sarcomatous degeneration of giant cell tumours.
Sarcomatous degeneration in giant cell tumours (G.C.T.) usually only occurs in patients of late adult age. Unlike other Centres, we have not up to now observed primary malignant G.C.T. In 327 cases registered at the Tumour Centre of the Rizzoli Institute, there were 10 cases of sarcomatous degeneration. In 8 of these, radiotherapy had been used as the initial treatment of the tumour. The incidence of sarcomatous degeneration when the radiation dose exceeded 4000r was 29%. The prognosis in such cases is very serious, the only feasible treatment being amputation. The possibility of sarcomatous degeneration must be considered before deciding to adopt radiotherapy as the method of primary treatment in giant cell tumours.
Adult↗
Scintigraphic study of the evolution of cortical homografts in the treatment of fractures.
Twelve patients who had undergone osteosynthesis with a metal plate combined with a frozen homoplastic bone graft for the treatment of fractures or pseudarthrosis were subjected to bone scintigraphy with 99 Tc MDP. This investigation showed the graft to be a site of early and specific accumulation of the tracer. This finding supports early colonization of the graft by vascular structures and osteoblastic cells. In view of the small number of cases studied and our incomplete knowledge of the metabolic processes involved these considerations must remain hypotheses but given the excellent clinical results obtained, the relationships between homoplastic bone and host bone merit further investigation.
Adult↗
Diagnostic approach to bone tumours.
A standardized preoperative diagnostic approach in correct stages is essential in the prognostic evaluation and therefore in the subsequent treatment of bone tumours. A protocol is proposed, based on an initial (primary) series of investigations followed by a more sophisticated (secondary) series of examination based on the suspected diagnosis so obtained. The usefulness and indications for the different instrumental tests available today are evaluated (bone scintigraphy, CT scan, arteriography) both in benign and malignant bone tumours. Various biopsy techniques are discussed and illustrated.
Biopsy↗
Septic complications in resection surgery for bone tumours.
Septic complications occurring in 482 resections for bone tumours performed from 1976 to 1984 at the Rizzoli Orthopaedic Institute Tumour Centre are reviewed. There were 56 cases of infection (11.6%), the incidence of which was related to the type of resection surgery, type of reconstruction, and such risk factors as radiotherapy, the use of acrylic cement, and immunodepression due to antiblastics. With the proper treatment of such septic complications, however, good functional results may be maintained and amputation avoided.
Amputation, Surgical↗
[Computerized tomography in spinal osteoblastoma. Observations in 10 cases].
In order to stress the role of computed tomography (CT) in the evaluation of benign spinal osteoblastoma, the authors examined by CT 10 patients with surgically and histologically proved osteoblastomas of the spine. Basing on surgical and histopathological findings CT proved to be a very important method for attesting the presence of the tumors (usually showed by radiographic examination), and specially for their staging and follow-up. CT in fact showed the real extent of the tumor into the spinal canal and towards the paraspinal soft tissues, and allowed the early detection of post surgical relapses. The authors conclude that CT is a primary diagnostic modality for preoperative planning and follow-up of benign osteoblastoma.
Adolescent↗
[Computerized tomography in the assessment of soft-tissue neoplasms. Observations in 124 cases].
In order to evaluate the role of Computed Tomography (CT) in prediction of nature, staging and follow-up of soft-tissue tumors, the authors examined by CT 124 patients with soft tissue neoplasms who later underwent surgery (116 cases) or fine needle biopsy (8 cases). Comparison between CT and surgical or anatomical results showed that CT was able to correctly predict the benignancy or malignancy of the masses in 76% of cases but it was very seldom able to allow an histological prediction. On the contrary CT was found to be a very useful tool for pre-therapeutic staging and follow-up of the tumors, because it gave many diagnostic information which influenced therapeutic choices and strategies.
Adolescent↗
Surgical treatment of infected pseudarthrosis of the humerus.
The authors report 16 cases of infected lesions of the humerus with delayed consolidation or pseudarthrosis. The treatment consisted of radical surgical debridement, freshening of the bone fragments with removal of all necrotic tissue, and stabilisation with a Hoffmann-Vidal external fixation device. Healing occurred between 3 and 6 months after operation. The one case of failure was attributable to inappropriate technique (inadequate resection of the ends of the fragments).
Debridement↗
Bone metastases of neuroblastoma: the role of the orthopaedic surgeon.
The authors report 38 cases of bone metastases of neuroblastoma. They discuss the problems of diagnosis and treatment from the point of view of the orthopaedic surgeon, who is frequently confronted with a patient with localised bone symptoms in whom the primary neuroblastoma has not previously been diagnosed. The authors propose a diagnostic protocol and discuss the situations in which operative intervention by the orthopaedic surgeon may be indicated.
Adolescent↗
Biopsy: considerations on surgical technique derived from a study of 749 cases of bone tumour.
Based on a study of 749 consecutive cases submitted to open biopsy over a 12 year period, the authors discuss the possible grave consequences that can arise out of wrong attitudes or faulty technique. The statistical analysis, together with illustrative cases, demonstrates the difficulties, mistakes and biological damage that can result. Biopsy should always be associated with other methods of investigation, such as C.A.T. scanning, scintigraphy and angiography. It is a delicate and sometimes difficult procedure which requires close collaboration with the radiologist and pathologist. At the present time, our tendency is towards biopsy at the time of operation (with frozen sections) or to needle biopsy.
Adolescent↗
[Periastragalic luxations (study of 12 long-term controlled cases)].
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Adolescent↗
Multiple non-ossifying fibromata with extraskeletal anomalies: a new syndrome?
Ten patients with multiple non-ossifying fibromata are reported. All had associated extraskeletal congenital anomalies such as café-au-lait spots, mental retardation, hypogonadism or cryptorchidism, ocular anomalies or cardiovascular malformations. The radiographic picture and the distribution of the skeletal lesions are characteristic and constant. There are lucent areas in the shaft with a sclerotic margin; these areas narrow the medullary canal or may completely fill it. It is suggested that these features characterise a new malformation syndrome, possibly allied to neurofibromatosis. After skeletal maturation is complete, the skeletal lesions may (like non-ossifying fibromata) regress and undergo spontaneous healing.
Abnormalities, Multiple↗
Periosteal chondroma. A review of twenty cases.
We are reporting on the cases of twenty patients with periosteal chondroma to stress the importance of a proper clinical and radiographic diagnosis of this lesion. Awareness of the features of the lesion helps to prevent overtreatment of this benign condition, because the cytological findings may be ominous. Even the radiographic pattern may be suggestive of malignant disease. Periosteal chondromas apparently arise from under the periosteum of the diaphysis or metaphysis in adolescents and young adults. Close cooperation between the surgeon, the radiologist, and the pathologist is necessary to achieve proper diagnosis and treatment. Marginal excision is usually effective treatment.
Adolescent↗
[Clinico-radiographic study on homoplastic cortical grafts].
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Bacterial Infections↗