Reconstruction of lower extremity primary malignant and metastatic bone tumours with modular endoprosthesis

BACKGROUND Limb salvage surgeries - Are they useful compared to amputation in bone tumours (malignant/recurrent). Starting from 1980s, bone tumour treatment has seen a revolution with the advent of limb salvage surgeries. From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance. The surgeon must ensure adequate resection of the involved bone and soft tissue so as to minimize chance of local recurrence. At no stage must adequate disease clearance be compromised in an attempt to achieve limb salvage. We analyzed its relevance among our rural population at a tertiary level care centre. Limb salvage surgery basically involves resection and reconstruction. Reconstruction can be either biological or endo prosthetic. Biological can be autograft or allograft. Endoprosthesis can be fixed (custom-made) or modular. Expendable bones like fibula or ulna may not require reconstruction after resection. Prosthesis provide an immediate return to function and unlike bone they are not affected by ongoing adjuvant chemotherapy and radiotherapy. METHODS We conducted an 18-month prospective follow-up study on 10 patients (6 males and 4 females) who had undergone limb salvage surgeries during 2017 - 20 at Government Medical College, Thrissur. Wide excision, wide excision & biological autograft reconstruction, wide excision & modular endoprosthesis reconstruction are the different surgical modalities used. Patients were followed up clinically and radiologically in the orthopaedic out-patient department (OPD) at 6 weeks, 12 weeks and up to 1 ½ years at every 3 months. Functional scoring has been done using musculoskeletal tumour society (MSTS) - 87 scoring system. Study duration: 2017 October to 2020 October (3 years). RESULTS The average score is 64.6 % using the MSTS - 87 system. Maximum score was 83 % and the minimum was 62 %. Most of our patients are doing well and pursuing near-normal life with limb salvage surgeries with very minimal complications. One of our patients succumbed to the disease during the follow-up period. CONCLUSIONS Limb salvage is a better alternative to amputation in malignant and recurrent bone tumours in carefully selected and thoroughly evaluated patients. KEYWORDS Limb Salvage, Malignant & Recurrent Bone Tumours, MSTS - 87 Score, Wide Excision, Biological Autograft, Modular Endoprosthesis Reconstruction

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Treatment results of adult patients with primary bone tumours of the humerus with the use of the oncological modular endoprosthesis

Współczesna Onkologia ◽

10.5114/wo.2017.70113 ◽

2017 ◽

Vol 3 ◽

pp. 228-231

Author(s):

Tomasz Goryń ◽

Andrzej Pieńkowski ◽

Andrzej Komor ◽

Wirginiusz Dziewirski ◽

Marcin Zdzienicki ◽

...

Keyword(s):

Adult Patients ◽

Bone Tumours ◽

Treatment Results ◽

Primary Bone ◽

Primary Bone Tumours ◽

Modular Endoprosthesis

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Combining Values

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.marapr01 ◽

2002 ◽

Vol 7 (2) ◽

pp. 1-4, 12 ◽

Cited By ~ 1

Author(s):

Christopher R. Brigham

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Evaluation Method ◽

Proximal Phalanx ◽

Common Error ◽

The Third ◽

Whole Person ◽

Impairment Ratings ◽

Upper Extremity Impairment ◽

The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

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Quick Reference: Chapter 3: The Musculoskeletal System and Chapter 4: The Nervous System

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.mayjun03 ◽

2000 ◽

Vol 5 (3) ◽

pp. 4-4

Keyword(s):

Nervous System ◽

Lower Extremity ◽

Musculoskeletal System ◽

Multistep Method ◽

Manual Muscle Testing ◽

Motor Deficits ◽

Lower Extremity Weakness ◽

Residual Symptoms ◽

Muscle Testing ◽

Almost All

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, divides PNS deficits into sensory and motor and includes pain in the former. This article, which regards rating sensory and motor deficits of the lower extremities, is continued from the March/April 2000 issue of The Guides Newsletter. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Sensory deficits and dysesthesia are both disorders of sensation, but the former can be interpreted to mean diminished or absent sensation (hypesthesia or anesthesia) Dysesthesia implies abnormal sensation in the absence of a stimulus or unpleasant sensation elicited by normal touch. Sections 3.2k and 3.2d indicate that almost all partial motor loss in the lower extremity can be rated using Table 39. In addition, Section 4.4b and Table 21 indicate the multistep method used for spinal and some additional nerves and be used alternatively to rate lower extremity weakness in general. Partial motor loss in the lower extremity is rated by manual muscle testing, which is described in the AMA Guides in Section 3.2d.

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Q&A: Multiple Lower Extremity Impairments and AMA Guides, Third Edition, Revised

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2017.marapr05 ◽

2017 ◽

Vol 22 (2) ◽

pp. 15-16

Author(s):

Christopher R. Brigham ◽

Kathryn Mueller ◽

Steven Demeter ◽

Randolph Soo Hoo

Keyword(s):

Lower Extremity

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Spinal Impairment Evaluation: Fifth Edition Changes

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2001.janfeb01 ◽

2001 ◽

Vol 6 (1) ◽

pp. 1-3

Author(s):

Robert H. Haralson

Keyword(s):

Spinal Cord ◽

Lower Extremity ◽

Range Of Motion ◽

Upper Extremity ◽

Spinal Cord Injuries ◽

Clinical Findings ◽

Fourth Edition ◽

Treatment Results ◽

Standard Terminology ◽

Made In

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, was published in November 2000 and contains major changes from its predecessor. In the Fourth Edition, all musculoskeletal evaluation and rating was described in a single chapter. In the Fifth Edition, this information has been divided into three separate chapters: Upper Extremity (13), Lower Extremity (14), and Spine (15). This article discusses changes in the spine chapter. The Models for rating spinal impairment now are called Methods. The AMA Guides, Fifth Edition, has reverted to standard terminology for spinal regions in the Diagnosis-related estimates (DRE) Method, and both it and the Range of Motion (ROM) Method now reference cervical, thoracic, and lumbar. Also, the language requiring the use of the DRE, rather than the ROM Method has been strengthened. The biggest change in the DRE Method is that evaluation should include the treatment results. Unfortunately, the Fourth Edition's philosophy regarding when and how to rate impairment using the DRE Model led to a number of problems, including the same rating of all patients with radiculopathy despite some true differences in outcomes. The term differentiator was abandoned and replaced with clinical findings. Significant changes were made in evaluation of patients with spinal cord injuries, and evaluators should become familiar with these and other changes in the Fifth Edition.

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