scholarly journals Low-Grade Chondrosarcomas: Diagnosis and Treatment

2021 ◽  
Author(s):  
Ozgur Erdogan ◽  
serdar demiröz ◽  
emre kaya ◽  
güray altun ◽  
volkan gürkan
Keyword(s):  
High Speed ◽  
Tumor Location ◽  
Low Grade ◽  
Recurrence Rates ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Multiple Parameters ◽  
Treatment Type ◽  
High Speed Burr

Abstract Background: Multiple parameters are needed to distinguish between enchondroma and low-grade chondrosarcoma (LGCS). This study aimed to investigate the diagnosis, surgery type according to bone type, recurrence rates, and complications of LGCS in the appendicular and axial skeletons. Methods: A total of 52 surgically treated patients with LGCS, between March 2007 and May 2019, were retrospectively examined. Following diagnosis, the patients were operated on with intralesional curettage for long bones or wide local excision (WLE) for axial bones. The retrieved data included demographics, tumor location, surgical treatment type, local adjuvants, complications, and Musculoskeletal Tumor Society scores.Results: The final cohort included 52 patients (52 tumors; 35 female and 17 male). The male:female ratio was 1:2. The mean age was 44 ± 17 years. Forty of the tumors were treated with intralesional procedures (all with a high-speed burr and phenol), 6 with autograft, 8 with allograft, and 28 with cement augmentation, while 7 were treated with WLE.Conclusions: The use of phenol as an adjuvant may reduce recurrence rates. Using a putty graft alone may result in nonunion. Applying a thin layer of putty on the cementum can create callus tissue on the cementum. Even in the upper limb, plate and screw fixation should be used to prevent fractures in metaphyseal–diaphyseal curettages.

3D Printing Guide Plate for Accurate Hemicortical Bone Resection in Low-Grade Bone Sarcoma

2020 ◽  
Author(s):  
Hongwei Wu ◽  
Xian'an Li ◽  
Shuo Yang ◽  
Jie Bu ◽  
Xuezheng Xu ◽  
...  
Keyword(s):  
3D Printing ◽  
Bone Sarcoma ◽  
Long Bone ◽  
Low Grade ◽  
Joint Function ◽  
Bone Resection ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Guide Plate ◽  
Post Operation

Abstract Background: Surgical resection and reconstruction for low grade bone sarcoma in the metaphysis of the long bone remains challenging. We hypothesize that 3D printing osteotomy guide plate could assist to accurately resect the tumor lesion and save the joint function without higher recurrence rate. Methods: From January 2017 to August 2019, ten patients with low-grade malignant bone tumor in metaphysis of the limbs were treated with hemicortical resection using 3D printing guide plate and biological reconstruction. Results: Four patients were paracorticular osteosarcoma, five cases had highly differentiated chondrosarcoma, and one case was a chondromyxoid fibroma. Two of the cases involved the proximal humerus, while eight cases involved the distal femur. There was neither post-operation infection, internal fixation loosening, nor fracture occurrence in any of the patients. The Musculoskeletal Tumor Society score averaged at 27.1, while the International Society of Limb Salvage imaging score examination averaged 87.8%. Conclusions: Here, we demonstrate that the 3D printing osteotomy guide plate assisted hemicortical bone resection is a beneficial strategy to effectively resect the primary low-grade malignant bone tumors in the metaphysis of long bone and restore excellent joint function.

scholarly journals Adjuvant Therapy by High-Speed Burr May Cause Intraoperative Bone Tumor Seeding: An Animal Study

2020 ◽  
Author(s):  
Pai-han Wang ◽  
Chia-Lun Wu ◽  
Chao-Ming Chen ◽  
Jir‐You Wang ◽  
Po-Kuei Wu ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
High Speed ◽  
Residual Tumor ◽  
Femoral Bone ◽  
Intralesional Curettage ◽  
Tumor Spread ◽  
Tumor Seeding ◽  
High Speed Burr ◽  
Cadaver Femur ◽  
Tumor Cell Killing

Abstract BackgroundBone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery.MethodsA porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr.ResultsThe intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III.ConclusionsHigh-speed burring may cause tumor seeding, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The correlation between high-speed burring and tumor seeding was highly suspect in this pilot study.

scholarly journals Giant Cell Tumor of the Capitate Bone

2018 ◽  
Vol 10 (03) ◽  
pp. 158-161 ◽  
Author(s):  
Ahmadreza Afshar ◽  
Ali Tabrizi ◽  
Ali Aidenlou ◽  
Ata Abbasi
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
High Speed ◽  
Cell Tumor ◽  
Intralesional Curettage ◽  
Allogenic Bone ◽  
High Speed Burr ◽  
The Right ◽  
Allogenic Bone Graft ◽  
Capitate Bone

AbstractThis case report describes a 16-year-old female patient with a giant cell tumor in her right capitate bone. The tumor was removed by intralesional curettage. A high-speed burr was used to extend the margins of the curettage, and alcohol irrigation was used for adjuvant therapy. The cavity of the capitate was filled with allogenic bone graft. There was no recurrence after 2 years of follow-up, and the right wrist radiographs demonstrated healing of the lesion.

scholarly journals PROSPECTIVE INTERVENTIONAL STUDY OF ASSESS FUNCTIONAL OUTCOME OF GIANT CELL TUMOUR OF DISTAL END RADIUS TREATED BY EN BLOE RESECTION AND RECONSTRUCTION BY ULNAR TRANSLOCATION

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Suresh Bishnoi ◽  
Sanjay Yadav ◽  
Pankaj Jain ◽  
Shreekant Meena
Keyword(s):  
Giant Cell ◽  
Soft Tissues ◽  
Giant Cell Tumour ◽  
Wrist Joint ◽  
Cell Tumour ◽  
Recurrence Rates ◽  
Superficial Infection ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Msts Score

Background: Giant cell tumour (GCT) of bone is a relatively rare, locally aggressive benign neoplasm associated with a wide pathological spectrum, ranging from latent benign to highly recurrent and, occasionally, malignant metastatic potential. Methods: This retrospective study was conducted on 30 hospitalized patients for surgery in in Jaipur.  We followed up all patients with GCT of the distal radius who were treated with en bloc excision and custom prosthetic replacement. All cases were evaluated based on clinical and radiological examinations, passive range of motion (ROM) of the wrist joint, complications, and Musculoskeletal Tumor Society (MSTS) score. Results: Mean follow-up period was 52.36 months, mean resected length of the radius was 7.11±2.31 cm. One patient had tumor recurrence in the soft tissues after 16.32±2.31 months (recurrence rate 10.00 %). No patient had fracture, recurrence in the bone, metastases, or immune rejection. No complications were seen, such as loosening, rupture, or dislocation of the custom prosthesis. One patient developed superficial infection at the operative site which resolved after a course of antibiotics for 4 weeks. One patient experienced pain, which could be endured without the need for analgesics. Average ROM was 40.6° of dorsiflexion, 29.8° of volar flexion, 46.2° of supination, and 37.8° of pronation. Mean grip strength was 70 % (41–84 %). Overall revised MSTS score averaged 81.36 % with one being excellent, five good, and five satisfactory. Conclusion: The optimal treatment for GCTs arising around the knee remains controversial. Despite the trend towards better oncological control of this tumour after wide resections, the recurrence rates achieved through a more conservative procedure such as the curettage-based interventions seem to be acceptable. Additionally, curettage and local adjuvants allow for overall better function of the knee, in particular with proximal tibia GCTs. Keywords: GCT, MSTS, ROM

scholarly journals Outcome of Chondroblastoma Treated With Intralesional Curettage and Autogenous Iliac Bone Graft: A Retrospective Study

2020 ◽  
Author(s):  
Lei Yang ◽  
Panyi Yang ◽  
Daoxi Wang ◽  
Xiaodong Yang ◽  
Lang Li ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Case Series ◽  
Primary Treatment ◽  
Iliac Bone ◽  
Retrospective Case ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Rare Benign Tumor ◽  
The Mean

Abstract BackgroundChondroblastoma is a rare benign tumor mainly occurred in epiphyses and apophyses of long bones, and usually affects the young people. The primary treatment for chondroblastoma is intralesional curettage. The aim of this study was to evaluate the clinical result of patients suffering chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and autogenous iliac bone grafting. MethodsFrom January 2000 to January 2010, 15 patients with chondroblastoma were treated with intralesional curettage and electrocauterization of the cavity, and 14 of them received autogenous iliac bone grafting. After operation, patients were immobilized with splint for 4 weeks and followed up for at least 10 years. The recurrence was examined by clinical manifestation and X ray. The clinical outcome included complications and the Musculoskeletal Tumor Society Score (MSTS).ResultsTotally, 15 patients with chondroblastoma were enrolled in our study, including 9 males and 6 females, with a mean age of 13 years old (range from 8 to 21 years). The most common chief compliant were pain and limited joint motion, others including local swelling and increased skin temperature. The mean duration of symptom was 5 months (range from 2-14 months). Tumors mostly affected the proximal humerus (7/15), distal femur (4/15), proximal femur (1/15), proximal tibia (2/15) and femoral head (1/15). With a mean follow up of 12years (range from 10-16 years) , two patients had complications of upper limb shortening and one patient suffered re-operation due to tumor recurrence. The mean postoperative MSTS was 28.1 (range, 24 to 30) points, which was significantly higher than the preoperative score of 17.6 (range, 12 to 21) points.ConclusionsThorough curettage with electrocauterization and autogenous iliac bone grafting has good functional outcomes in the treatment of chondroblastoma, but still has a low risk of recurrence and complications.Level of EvidenceLevel IV, retrospective case series.

scholarly journals Adjuvant Therapy by High-Speed Burr May Cause Intraoperative Bone Tumor Seeding: an animal study

2020 ◽  
Author(s):  
Pai-han Wang ◽  
Chia-Lun Wu ◽  
Chao-Ming Chen ◽  
Jir‐You Wang ◽  
Po-Kuei Wu ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Bone Cement ◽  
High Speed ◽  
Residual Tumor ◽  
Femoral Bone ◽  
Intralesional Curettage ◽  
Tumor Spread ◽  
Tumor Seeding ◽  
Wide Range ◽  
High Speed Burr

Abstract Background Bone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery. Methods A porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr. Results The intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III. Conclusions High-speed burring may cause explosive bone cement spray, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The wide range of bone cement spray caused by high-speed burr was inspected in this pilot study, which may lead to tumor seeding.

scholarly journals Surgical treatment of chondroblastoma using extended intralesional curettage with phenol as a local adjuvant

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986103 ◽  
Author(s):  
Karem M Zekry ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
Yoshihiro Araki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
High Speed ◽  
Bone Substitutes ◽  
Good Alternative ◽  
Intralesional Curettage ◽  
Synthetic Bone ◽  
Rapid Restoration ◽  
High Speed Burr ◽  
Time Of Presentation

Purpose: The aim of this study is to report the clinical and radiological outcomes following surgical treatment of chondroblastoma by means of an extended intralesional curettage using high-speed burr, with phenol as a local adjuvant which is followed by the implantation of synthetic bone graft, aiming to lower the recurrence rate of this tumor. Patients and Methods: This retrospective study included 20 patients with chondroblastoma lesions during the period between 2000 and 2015. Results: Fifteen males and five females were followed up for a mean of 63.35 (26–144) months with average age at the time of presentation was 20.8 (range: 12–32) years. Nineteen patients (95%) were complaining of pain at the time of presentation, and the lesion was discovered accidently in one patient. The mean operative time was 138.5 min (75–250). At the most recent follow-up, all patients had regained full physical function without pain at the operation site. Conclusion: The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling.

10 Years Follow up of Chondroblastoma Treated with Intralesional Curettage: A Retrospective Study

2020 ◽  
Author(s):  
Lei Yang ◽  
Panyi Yang ◽  
Daoxi Wang ◽  
Xiaodong Yang ◽  
Lang Li ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Case Series ◽  
Primary Treatment ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
The Mean

Abstract Introduction: Chondroblastoma is a rare benign tumor mainly occurred in epiphyses and apophyses of long bones, and usually affects the young people. The primary treatment for chondroblastoma is intralesional curettage. The aim of this study was to evaluate the clinical and radiologic results of patients suffering chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and bone grafting. Patients and Methods: From January 2000 to January 2010, 15 patients with chondroblastoma were treated with intralesional curettage and electrocauterization of the cavity, among which14 patients received bone grafting. After operation, patients were immobilized with splint for 4 weeks and followed up for at least 10 years. The recurrence was examined by clinical manifestation and X ray. The clinical outcome included complications and the Musculoskeletal Tumor Society Score (MSTS).Results: Totally, 15 patients with chondroblastoma were enrolled in our study, including 9 males and 6 females, with a mean age of 13 years old (range from 8 to 21 years). The most common chief compliant were pain and limited joint motion, others including local swelling and increased skin temperature. The mean duration of symptom was 5 months (range from 2-14 months). Tumors mostly affected the proximal humerus (7/15), distal femur (4/15), proximal femur (1/15), proximal tibia (2/15) and femoral head (1/15). Eight patients were undiagnosed or misdiagnosed before operation, only 7 patients with a consideration of chondroblastoma. With a mean follow up of 12years (range from 10-16 years) , two patients had complications of upper limb shortening and1 patient suffered re-operation due to tumor recurrence. The mean postoperative MSTS score was 28.1 (range, 24 to 30) points, which was significantly higher than the preoperative score of 17.6 (range, 12 to 21) points.Conclusion: Thorough curettage with electrocauterization and bone grafting has a good functional outcome in the treatment of chondroblastoma, but still has a low risk of recurrence and complications.Level of Evidence: Level IV, retrospective case series.

‘Umbrella construct’ – an innovative technique for reconstruction of the proximal humerus after curettage in locally aggressive benign bone tumours

2020 ◽  
pp. 175857321989598
Author(s):  
Ashish Gulia ◽  
Ajay Puri ◽  
Srinath Gupta ◽  
Vineet Kurisunkal
Keyword(s):  
Proximal Humerus ◽  
Bone Tumours ◽  
Reconstruction Technique ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Oncological Outcomes ◽  
Joint Congruity ◽  
The Mean ◽  
Benign Bone Tumours

Aim Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique ‘ Umbrella construct’ where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated. Methods Between January 2006 and June 2017, 11 cases (10 giant cell tumours, 1 chondroblastoma) underwent curettage followed by reconstruction with Umbrella construct. There were six females and five males with a mean age of 23 years (range 14–36 years). The maximum longitudinal extent of disease was 9 cm (range 5–9 cm). Results The median follow-up was 54 months (range 34–122 months). The mean allograft incorporation time was 7 months (5–8 months). One patient had a graft fracture which was managed conservatively. Two cases developed local recurrence and the construct was revised to a prosthesis in both. The mean MSTS score for the nine cases with retained graft was 27 (23–29). Conclusions Umbrella construct is an effective reconstruction modality which helps to maintain joint congruity and limb length. It has acceptable oncological outcomes with good function.

scholarly journals 3D printing guide plate for accurate hemicortical bone tumor resection in metaphysis of distal femoral: a technical note

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hongwei Wu ◽  
Shuo Yang ◽  
Jianfan Liu ◽  
Linqin Li ◽  
Yi Luo ◽  
...  
Keyword(s):  
3D Printing ◽  
Distal Femur ◽  
Tumor Resection ◽  
Bone Sarcoma ◽  
Technical Note ◽  
Low Grade ◽  
Joint Function ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Guide Plate

Abstract Background Surgical resection and reconstruction for low-grade bone sarcoma in the metaphysis of the distal femur remain challenging. We hypothesized that 3D printing osteotomy guide plate could assist to accurately resect the tumor lesion and save the joint function. Methods From January 2017 to August 2019, five patients diagnosed with low-grade bone sarcoma in the metaphysis of the distal femur were treated with hemicortical resection using 3D printing guide plate. Autologous bone graft was inactivated in a high-temperature water bath and re-implanted in situ fixed with plate and screw. Patients were followed up from 17 to 33 months. The Musculoskeletal Tumor Society Score was used to evaluate the joint function. X-ray was used to evaluate the bone union. Results One patient was paracorticular osteosarcoma, and four cases had highly differentiated chondrosarcoma. All cases were involved in the metaphysis of the distal femur. Patients were followed up from 13 to 33 months, with an average of 23.6 months. There was neither post-operation infection, internal fixation loosening, nor fracture occurrence in any of the patients. The Musculoskeletal Tumor Society Score averaged at 28.1, while the International Society of Limb Salvage imaging score examination averaged 89.8%. Conclusions Here, we demonstrate that the 3D printing osteotomy guide plate-assisted hemicortical bone resection is a beneficial strategy to effectively resect the primary low-grade malignant bone tumors in the metaphysis of the distal femur and retained satisfied joint function.

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