1/13. Chronic persistent knee pain after repeated diagnostic arthroscopy: osteoid osteoma, a primarily overlooked diagnosis in a young woman.We report a case of osteoid osteoma of the distal femur in an adolescent female patient that was primarily overlooked and led to repeated diagnostic arthroscopy of the knee. A thorough history and physical examination of the joint as well as adequate roentgenographic studies could have spared this patient two unnecessary arthroscopies and indicated the correct therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. Thyroid carcinoma after successful treatment of osteosarcoma: a report of three patients.We report three cases of papillary thyroid carcinoma occurring after successful treatment of osteosarcoma. Only one of the three patients received radiation therapy (to the chest) as part of the primary treatment of osteosarcoma. The onset of thyroid carcinoma occurred between 8 and 16 years from the cessation of osteosarcoma therapy. All patients are alive and disease-free from both malignancies. Whereas the association between osteosarcoma and thyroid carcinoma has not previously been recognized, there have been five case reports of these two entities occurring in the same patient. Three of these cases occurred in patients with werner syndrome. None of the patients reported here had physical stigmata of werner syndrome or a family history consistent with a hereditary cancer syndrome. Thyroid carcinoma occurs infrequently in patients with osteosarcoma, but in view of the rarity of these two disorders, this association may represent an inherited predisposition to these malignancies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/13. Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options.The fibula free flap became popular in orthopedic oncology for limb-sparing long bone tumor resection. It is particularly suitable for intercalary or resection arthrodesis options. In the present series, a surgical reconstruction algorithm was used, enabling each patient to receive a personalized technique. During the years 1998 to 2002, 30 patients underwent limb-sparing surgery for long bone sarcoma. There were 18 males and 12 females. Their mean age was 23 years (range, 9 to 70 years). The diagnoses were Ewing's sarcoma (11 patients), osteogenic sarcoma (eight patients), chondrosarcoma (five patients), giant cell tumor of bone (three patients), high-grade soft-tissue sarcoma (two patients), and leiomyosarcoma of bone (one patient). The majority of tumors where located in the lower extremity (23 patients), mostly in the femur (15 patients with four tumors in the proximal femoral shaft, five tumors in the distal femoral shaft, five tumors in the whole femoral shaft, and one tumor in the proximal femoral head). In seven patients, the upper extremity was involved; in six patients, the radius was involved; and in one patient, the humerus was involved. The free fibula flap was used in three types of approaches: vascularized fibula as an osseous flap only (18 patients), a combination of a vascularized fibula flap in conjunction with an allograft (Capanna's technique; 10 patients), and a free double-barreled fibula (two patients). All flaps survived. Postoperatively, all patients were monitored clinically, radiologically, and by radioisotope bone scan studies. Callus formation and union were shown 2.6 to 8 months postoperatively. patients who underwent lower extremity reconstruction were nonweightbearing for 3 to 9 months, with a transition period in which they used a brace and gradually increased weightbearing until full weightbearing was achieved. Eight patients had 11 recipient-site complications. Two patients (6.7 percent) had hematomas, and three patients (10 percent) had infection and dehiscence of the surgical wound with bone exposure in one patient; all complications resolved with conservative treatment only. Failure of the hardware fixation system occurred in two patients, mandating surgical correction. No fibula donor-site complications were recorded. In intercalary resections, the use of the vascularized fibula flap as an isolated osseous flap might be insufficient. Different body sites have different stress loads to carry, depending on the age of the patient and on his individual physical status. To achieve initial strength in the early period, the authors combined the free fibula flap with an allograft (Capanna's method) or augmented it as a double-barreled fibula. They propose a surgical algorithm to assist the surgeon with the preferred method for reconstruction of various long bone defects in different body locations at childhood or adulthood. Long bone reconstruction using a vascularized fibula flap, alone or in combination with an allograft, autogenous bone graft, or double-barreled fibula for limb-sparing surgery, is a safe and reliable method with a predictable bony union, good functional outcome, and a low complication rate.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/13. Malignancy supervening on an intramedullary nail.A primary, malignant, fibrous histiocytoma of bone occurring in association with a Hansen Street intramedullary nail occurred in a 39-year-old man. The physical and chemical characteristics of materials, in relation to the generation of secondary neoplasia are reviewed, but the problem of coincidence is difficult to exclude.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/13. Rotationplasty--a unique surgical procedure with a functional outcome.ROTATIONPLASTY is a surgical procedure that may be appropriate for children with severe congenital femoral deficiency or children with malignant tumors of the femur or proximal tibia. OSTEOTOMIES AND RESECTION of the femur and tibia are performed, allowing the patient's foot to be rotated 180 degrees and reattached while preserving the nerves, muscles, and blood supply. THE POSTERIOR-FACING foot functions as the patient's knee joint in a specially fitted prosthesis. Although the outcome is visually unusual, for some children, regaining function and physical capabilities outweighs cosmetic concerns. The surgical procedure is technically challenging and requires a multidisciplinary approach.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/13. Pseudoaneurysm of the popliteal artery as a complication of an osteochondroma. A review of the literature and a case report.False aneurysm of the femoral artery was associated with a solitary osteochondroma of the femur in a 22-year-old man. An extensive review of the literature and the problems related to diagnosis revealed that the aneurysm was apparently unique. Contrary to previous reports, computed tomography and angiography did not establish the diagnosis. The physical findings were more informative.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/13. Fat embolism syndrome complicating intraarterial chemotherapy with cis-platinum.A 19-year-old man with telangiectatic osteosarcoma of the left proximal femur was started on a course of neoadjuvant chemotherapy consisting of intraarterial administration of cis-platinum. Within 72 hours of receiving the first intraarterial dose, the patient developed signs and symptoms of fat embolism syndrome (FES). A physical examination revealed cyanosis, tachycardia, and seizure activity. Laboratory studies demonstrated a pO2 of less than 65 mmHg, lipuria, and a drop in hematocrit of three percentage points. There was no clinical or roentgenographic evidence of pathologic fracture. Tumor necrosis secondary to intraarterial cis-platinum therapy in this patient with osteosarcoma may have caused a sudden release of free fatty acids and embolization of fat macroglobules that precipitated this episode of FES. FES in association with the intraarterial administration of cis-platinum seems not to have been previously reported.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/13. Pseudomalignant heterotopic ossification ("myositis ossificans"). recurrence after excision with subsequent resorption.An eight-year-old boy presented with massive pseudomalignant heterotopic ossification around the upper femur. The mass was completely excised because of severe pain, systemic illness and a flexion contracture at the hip. Symptomatic improvement was swift, but two weeks later the mass had recurred and was even more extensive. During the subsequent 18 months of conservative management he has been free of pain and there has been progressive resorption and remodelling of the heterotopic bone. There is now no limitation of physical activity and movement at the hip is full.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/13. Eighteen-year anamnesis of osteoid osteoma--a diagnostic problem?The 18-year history of osteoid osteoma in a woman aged 43 is presented. The typical physical and radiographic findings are described. Total removal of the tumor resulted in prompt and permanent relief of symptoms. diagnosis, histopathology, differential diagnosis, treatment, and prognosis of the tumor are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/13. Osteoid osteoma of the femoral neck stimulating an inflammatory synovitis.The case report presents a nine-year-old child with an osteoid osteoma of the femoral neck, simulating an inflammatory synovitis. Osteoid osteoma is a common benign bone tumor. However, when intracapsular lesions occur they may pose a diagnostic challenge. Nonspecific clinical signs and symptoms, such as inflammatory synovitis, joint effusion, and soft tissue swelling, may pose a problem in diagnosis and treatment. The delay in diagnosis can range from six months to two years. When the hip is involved, the patient may have nonspecific pain, limp, restricted motion, and thigh atrophy. An accurate diagnosis may be difficult to elicit, requiring detailed history and physical examination and culminating in the use of computed tomography.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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