scholarly journals A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 442
Author(s):  
Carmine Zoccali ◽  
Silvia Careri ◽  
Dario Attala ◽  
Michela Florio ◽  
Giuseppe Maria Milano ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Bone Growth ◽  
Tumor Resection ◽  
Young Patients ◽  
Femoral Stem ◽  
Distal Humerus ◽  
Limb Salvage Surgery ◽  
Reconstruction Technique ◽  
Bone Tumor Resection ◽  
The Right

For patients too young to be fitted with an expandable prosthesis, limb salvage surgery requires other strategies. The main problems are related to the impossibility of implanting an expandable prosthesis to the residual bone growth that is much too big in relation to the bone size, with the precocious implant loosening and/or the residual absence of bone growth, as well as the problem of limb length and shape difference. In this paper, we report a possible reconstruction solution using a composite prosthesis for an Ewing’s sarcoma of the proximal femur in an infant patient. After resection, a femoral stem was cemented into the distal third of a homoplastic humerus; a carbon fiber plate was used to stabilize the bone/homograft interface. At the one-year follow-up, the patient was free of disease and able to walk with only a slight limp. This case report describes a possible solution for very small patients. An adult humerus is of the right size to replace a child’s lower limb segments, and the distal humerus can be shaped, maintaining a cortex stiff enough to support a prosthesis. Very young patients might obtain a faster osteointegration of the graft than adults, due to their higher biological activity and, in this case, the diapasonal shape of the allograft might also have contributed to accelerated fusion. Moreover, the use of a graft to fit the prosthesis avoids loosening issues due to canal widening, hypothetically providing more growing time before system failure and revision surgery. However, although this technique is promising, further studies are necessary to confirm our findings and to verify if this procedure allows easier future prosthesis implantation.

scholarly journals Epiphyseal Sparing and Reconstruction by Frozen Bone Autograft after Malignant Bone Tumor Resection in Children

Sarcoma ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Ahmed Hamed Kassem Abdelaal ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
Shinji Miwa ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Limb Salvage ◽  
Bone Tumor ◽  
Treatment Options ◽  
Tumor Resection ◽  
Limb Salvage Surgery ◽  
Leg Length ◽  
Primary Bone Tumors ◽  
Bone Tumor Resection ◽  
Bone Autograft

Limb salvage surgery has become the standard treatment for malignant primary bone tumors in the extremities. Limb salvage represents a challenge in skeletally immature patients. Several treatment options are available for limb reconstruction after tumor resection in children. We report our results using the technique of epiphyseal sparing and reconstruction with frozen autograft bone in 18 children. The mean follow-up period for the all patients included in this study is 72 ± 26 m. Eight patients remained disease-free, seven patients lived with no evidence of disease, two were alive but with disease, and one patient died of the disease. Five- and ten-year rates of survival were 94.4%. Graft survival at 5 and 10 years was 94.4%. Functional outcome using the Enneking scale was excellent in 17 patients (94.4%) and poor in one patient (5.5%). Complications include 2 nonunions, 2 fractures, 2 deep infections, 1 soft tissue recurrence, and leg length discrepancy in 7 cases. This technique is a good reconstructive choice in a child with a nonosteolytic primary or secondary bone tumor, responsive to chemotherapy, without involvement of the articular cartilage. It is a straight forward, effective, and biological technique, which affords immediate mobilization of joints and possible cryoimmune effects, with excellent long term functional outcome and less complication.

scholarly journals Fixed-hinge cemented modular implants: An effective reconstruction technique following primary distal femoral bone tumor resection. A 136-case multicenter series

2020 ◽  
Vol 106 (3) ◽  
pp. 397-402
Author(s):  
Jean Camille Mattei ◽  
Benjamin Chapat ◽  
Benjamin Ferembach ◽  
Louis-Romée Le Nail ◽  
Vincent Crenn ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Reconstruction Technique ◽  
Femoral Bone ◽  
Modular Implants ◽  
Bone Tumor Resection

scholarly journals A CASE REPORT OF FEMUR OSTEOCHONDROMA IN 22 YEARS OLD FEMALE PATIENT

2020 ◽  
Vol 8 (10) ◽  
pp. 1263-1267
Author(s):  
Abdulrahman M. Bin Mohi ◽  
◽  
Ahmed A. Alzahrani ◽  
Bashar R. Reda
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Proximal Femur ◽  
Conflict Of Interest ◽  
Distal Femur ◽  
Tumor Resection ◽  
Surgical Excision ◽  
Low Grade ◽  
The Right ◽  
Hands And Feet

Chondromais considered a nonmalignant tumor that composed of mature hyaline cartilage and commonly occur in hands and feet. Overall incidents show that females are predominant comparing to males with evenly distributed range of ages. Multiple chondromas have to be differentiated from osteochondroma and chondrosarcoma. This paper reports three different types of lesions in one patient.Osteochondroma or exostosis is the most common benign tumor of the skeleton. It is a developmental osseous anomaly, which arises from exophytic outgrowth on bone surfaces characteristically. Osteochondroma account for about 12% of bone tumors. Here, we have described a 22 years old female patient with left knee joint pain and swelling of the left distal femur with limited movements. The incisional biopsy of the left distal femur identified low-grade chondrosarcoma and chondroma after histopathology. This underwent one-stage surgical excision of the tumor with a posterior approach and tumor resection from the femur. After surgery, an unusual pain appears in the right hip joint during the post-operative period.Machine resonance imaging (MRI), and X-ray of pelvis help to diagnose thewell-differentiated chondrosarcoma and chondroma. This was a case of osteochondroma in the right proximal femur, chondroma like lesion in the left proximal femur and chondrosarcoma in the left distal femur. Ethical consideration: Written informed consent was obtained from the patient for publication of this case report and accompanying images. Conflict of interest: There is no conflict of interest.

scholarly journals Assessment of Resection Margins in Bone Tumor Surgery

Sarcoma ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Corentin Malherbe ◽  
Bernard Crutzen ◽  
Jean Schrooyen ◽  
Giovanni Caruso ◽  
Frédéric Lecouvet ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Pathological Examination ◽  
Patient Specific ◽  
Resection Margins ◽  
Limb Salvage Surgery ◽  
Tumor Surgery ◽  
Surgical Guide ◽  
Median Error ◽  
Bone Tumor Resection

Limb salvage surgery is now the preferred procedure for bone tumor surgery. To decrease the risk of local recurrence, it is crucial to obtain adequate resection margins. The obtained margins must be evaluated postoperatively because they influence what treatment is given subsequently when margins are not adequate (e.g., surgical revision and radiotherapy). The study aims to evaluate margin assessment of tumor specimen by MRI compared to conventional histology (to establish the viability of using MRI) and assess the accuracy of a patient-specific instrument when narrow margins were aimed. The resection margins in 12 consecutive patients that were operated on for bone tumor resection were prospectively analyzed using three methods: MRI of the resection specimen, macroscopic evaluation of specimen slices, and microscopic pathological evaluation. The assessments were qualitative (R0, R1, and R2) and quantitative (distance in mm). MRI, macroscopic, and microscopic margins generated similar results for both the qualitative (all resections were R0) and quantitative assessments. The median error in safe margins was 2 mm with a surgical guide (PSI) and 5 mm without a surgical guide. Local recurrences were not detected after a mean follow-up period of 3.7 years (range, 2.1–5 years); however, four patients died during the study. In conclusion, MRI is a valuable tool for assessing safe margins. When specimens are not available for pathological assessment (e.g., extracorporeally irradiated autograft or autoclaved autograft), MRI could be used to evaluate margins. In particular, when tumor volume is high, MRI could also help to focus the pathological examination on areas of concern.

scholarly journals Surgical Treatment Alternative to the Hip Disarticulation in Pacients with Malignant Tumor of the Proximal Femur

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 34
Author(s):  
M. Moga ◽  
G. Dinache ◽  
M. Pogărăşteanu ◽  
S. Lupascu
Keyword(s):  
Surgical Treatment ◽  
Proximal Femur ◽  
Malignant Tumors ◽  
Young Patients ◽  
Incisional Biopsy ◽  
Treatment Alternative ◽  
Primary Bone Tumors ◽  
Primary Bone ◽  
The Right ◽  
Profunda Femoris

Abstract Background. Primary bone tumors are rare and affect especially young persons, being at the same time very aggressive and mutilating, often also implicating the disarticulation of the affected hip. That is why it is necessary to find alternatives of treatment, so that these young people to be able to keep their normal functionality and mental comfort. Objectives. The objective of this paper was to be able to offer a surgical treatment alternative to the hip disarticulation in case of malignant tumors of the proximal femur in young patients. Methods. We present the case of a 25-year-old female patient, who was hospitalized in our clinic for pain and functional impairment of the right hip. The clinical and radiological exams established the diagnosis of fracture of pathological bone of the proximal femur and it raised the suspicion of a tumor with malignant characters. We performed arteriography of the right inferior member, which showed a very good vascularized tumor, possibly vascular, localized to the proximal femur, arterially powered by the branches of right profunda femoris artery. We surgically intervened and made an incisional biopsy with anatomopathological exam, which established the diagnosis of osteosarcoma. Then, we practiced the segmental resection of the tumor, preceded by the embolization of the right femoral artery and after that the reconstruction with bipolar cemented modular prosthesis of the right hip. The patient had a favorable evolution, she did neuromotor rehabilitation, and then she presented to the oncologist for the initiation of adjuvant chemotherapy, which she followed conformably to the recommendations.

scholarly journals Porous Lattice Structure of Femoral Stem for Total Hip Arthroplasty

2020 ◽  
Author(s):  
◽  
A. I. Botello- Arredondo
Keyword(s):  
Body Weight ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Growth ◽  
Lattice Structure ◽  
Young Patients ◽  
Femoral Stem ◽  
The Body ◽  
Total Hip ◽  
Lattice Design

Total Hip Arthroplasty (THA) is one of the surgical procedures carried out satisfactorily in procedures for osteoarthritis and trauma lesions. ATC surgery reduces pain and improves the quality of life of young patients. Therefore, it is of great importance to improve the properties of hip implants, since current implants do not match their lifespan with the life expectancy of a young patient. This is because the solid prostheses that currently exist have a higher Young's modulus, and therefore are too rigid compared to the bone tissue. On the other hand, the cyclic and continuous loads to which the hip joint is subjected in daily activities, can cause loosening and consequent implant loss The present work proposes an implant manufactured with a porous lattice structure, which aims to reduce stiffness, allow bone growth and a more effective mechanical load transfer. Three computational models subjected to static charges were evaluated and compared: 1) healthy femur, 2) implanted femur with a commercial prosthesis, and 3) implanted femur with a prosthesis with lattice structure. For the computational analysis it was decided to perform a static analysis of a person standing on the left foot; a load equivalent to the body weight was applied on the head of the femur, balancing the reaction forces in the system of forces (contact force, body weight, and abductor muscle).. The results were shown in terms of displacement, compression and deformation. The model implanted with a prosthesis with a lattice design presented a slight decrease in displacement, and a decrease in compression and deformation values, which indicated that the proposed design has a better distribution and transport of the loads through its structure.

Complex Pelvic Reconstruction using Patient-Specific Instrumentation and a 3D-Printed Custom Implant following Tumor Resection

2018 ◽  
Vol 02 (02) ◽  
pp. 061-067 ◽  
Author(s):  
David Hennessy ◽  
Megan Anderson ◽  
Santiago Lozano-Calderón
Keyword(s):  
Proximal Femur ◽  
Tumor Resection ◽  
Computer Assisted Surgery ◽  
Implant Design ◽  
Patient Specific ◽  
Computer Assisted ◽  
Limb Salvage Surgery ◽  
Assisted Navigation ◽  
Patient Specific Instrumentation ◽  
Custom Implant

AbstractResection of a periacetabular sarcoma is a difficult surgical problem due to the complex bony and soft tissue anatomy. The challenge of pelvic tumor resection lies in achieving clear margins while also reconstructing the defect with a durable construct. Limb salvage surgery involving these types of tumors, as well as other tumors of the pelvis, has made great progress recently due to remarkable technological innovation in the field of computer-assisted surgery and custom implant design. In this study, the authors review the case of a 9-year-old child with an osteosarcoma arising from the proximal femur with local spread into the hip joint and a skip metastasis in the ipsilateral acetabulum. They undertook limb-sparing extra-articular resection of the sarcoma with a reconstruction consisting of a 3D-custom printed pelvic implant and a proximal femur extendible prosthesis. The resection of the pelvis was performed with patient-specific cutting guides, rather than computer-assisted navigation. The resection resulted in a clear margin and the patient has had no evidence of local recurrence. These patient-specific guides closely matched the planned resection in terms of orientation in the pelvis, which allowed for straightforward implantation of the custom prosthesis at the time of surgery. The result has been a durable reconstruction that has produced an excellent functional outcome for this patient.

Bone tumor resection guide using three-dimensional printing for limb salvage surgery

2018 ◽  
Vol 118 (6) ◽  
pp. 898-905 ◽  
Author(s):  
Jong Woong Park ◽  
Hyun Guy Kang ◽  
Kwun Mook Lim ◽  
Dae Woo Park ◽  
June Hyuk Kim ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Bone Tumor ◽  
Salvage Surgery ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Limb Salvage Surgery ◽  
Three Dimensional Printing ◽  
Bone Tumor Resection ◽  
Dimensional Printing

scholarly journals Severe bone disease caused by primary hyperparathyroidism: a case report and review of the literature

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096648
Author(s):  
Yu Wang ◽  
Jie Liu
Keyword(s):  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Bone Disease ◽  
Distal Humerus ◽  
Left Lobe ◽  
Pathological Examination ◽  
Hypoechoic Mass ◽  
Brown Tumors ◽  
Restricted Mobility ◽  
The Right

Bone disease is an important complication of hyperparathyroidism. We herein report a rare case of severe bone disease caused by primary hyperparathyroidism. A 33-year-old man presented with pain and restricted mobility in his right upper limb and right hip due to a fall 3 days previously. X-ray examination showed a fracture of the proximal and distal humerus. Computed tomography examination showed a supracondylar fracture of the right humerus, a fracture of the right femoral neck, a fracture of the right sciatic branch, and multiple brown tumors. Ultrasonography showed a 3.5- × 1.6-cm hypoechoic mass below the left lobe of the thyroid. The patient was diagnosed with primary hyperparathyroidism based on increased serum calcium and parathormone concentrations, pathological fractures, and multiple brown tumors. He therefore underwent bilateral lower parathyroidectomy. Pathological examination revealed a parathyroid adenoma. The patient recovered well after surgery and was followed up for 6 months with no symptoms of hyperparathyroidism. This case report suggests that clinicians should be aware of the possibility of severe bone disease secondary to primary hyperparathyroidism. Active and early diagnosis and surgical treatment are important in such cases.

scholarly journals RONC-26. A CASE OF RADIATION NECROSIS OF THE CEREBELLUM 16 YEARS AFTER CHEMORADIOTHERAPY FOR MEDULLOBLASTOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii460-iii460
Author(s):  
Mayuko Miyata ◽  
Masahiro Nonaka ◽  
Akio Asai
Keyword(s):  
Radiation Necrosis ◽  
Tumor Resection ◽  
Pathological Examination ◽  
Secondary Cancer ◽  
Brain Necrosis ◽  
Cerebellar Medulloblastoma ◽  
Cerebellar Peduncle ◽  
The Right ◽  
The Brain

Abstract BACKGROUND If new lesions are observed during follow-up of the malignant tumor after treatment, it is difficult to distinguish whether the tumor is a recurrent lesion, secondary cancer, or radiation necrosis of the brain. We have encountered a patient with symptomatic radiation necrosis of the cerebellum 16 years after treatment of medulloblastoma. CASE PRESENTATION: A 24-year-old man who had received a tumor resection and chemoradiotherapy for cerebellar medulloblastoma at the age of 8 presented with dizziness. For the past 16 years, there was no recurrence of the tumor. He subsequently underwent MRI scan, and T1-Gd image showed enhanced lesion in the right cerebellar peduncle. Cerebrospinal fluid cytology analysis was negative for tumor. We suspected tumor reccurence or secondary cancer, and performed lesion biopsy. The result of the pathological examination was radiation necrosis of the cerebellum. DISCUSSION: The interval of radiation necrosis of the brain and radiotherapy can vary from months to more than 10 years. So, whenever a new lesion is identified, radiation brain necrosis must be envisioned. According to guidelines in Japan, there is no absolute examination for discriminating tumor recurrence from radiation brain necrosis and diagnosis by biopsy may be required. CONCLUSION We experienced a case of symptomatic radiation necrosis of the cerebellum 16 years after treatment. In patients showing new lesion after long periods of time, the possibility of radiation necrosis to be considered.

Sign in / Sign up

Export Citation Format

Share Document