Outcome analysis of solitary osteochondromas of femur managed surgically: a series of 32 patients

<p class="abstract"><strong>Background:</strong> Osteochondroma is the commonest benign bone tumor in humans. This tumor may either be solitary or present as multiple lesions. Solitary osteochondromas are much more common. Femur is the single most common long bone involved followed by tibia and humerus. Osteochondromas may be either asymptomatic or may present as pain, pressure symptoms or functional impairment. Most of the symptomatic lesions need surgical excision.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study which included 32 patients with solitary osteochondromas of femur, who were managed with surgical excision. Only the symptomatic cases were operated. Minimum follow-up period was 18 months after surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> This study involved 23 males (71.87%) and nine females (28.12%). 30 osteochondromas (93.75%) were located in the distal femoral metaphysis while as only two cases (6.25%) of proximal metaphyseal involvement were seen. The commonest indication for surgery was pain. Other indications included cosmetic causes, restricted joint movement, fracture of osteochondroma and paresthesia or numbness. The complications included post-operative hematoma formation which was seen in 2 patients (6.25%), infection which was seen in one patient (3.12%), post-operative hypoaesthesia in 2 patients (6.25%) and recurrence of the tumor occurred in one patient (3.12%).</p><p><strong>Conclusions:</strong> Surgical excision of the solitary symptomatic femoral osteochondromas is a rewarding and safe procedure with minimal complications. </p>

Extra Axial Chordoma of the Distal Femoral Metaphysis: A Case Report

Background Chordomas are malignant bone tumors that are derived from remnant embryonic tissue of the notochord and are typically found in the axial midline. When they are found outside of the axial skeleton, the diagnosis can be challenging and elusive. Often, they are overlooked on initial presentation in lieu of other more common lesions, including cartilage tumors (eg, enchondroma, chondrosarcoma, osteochondromatosis) due to their overlapping features. Case Report A 30-year-old female with a four-year history of intermittent left knee pain presented for initial evaluation. Physical exam of the knee was unremarkable except for moderate tenderness on palpation. Radiographs showed a lucent lesion with peripheral sclerosis, eccentrically located within the anteromedial femoral diaphysis. The patient was subsequently lost to follow-up. She presented again two years later with similar symptoms. Her physical exam remained unchanged, and repeat radiographs showed interval growth. She underwent open biopsy of the left distal femur, with pathology revealing tumor consisting predominantly of epithelioid cells set in an abundant myxoid matrix. Immunohistology showed cells that stained strongly for EMA, CK19, and brachyury. These findings support the diagnosis of extra-axial chordoma. Discussion Extra-axial chordomas remain a challenging diagnosis for clinicians due to their extreme rarity and overlapping features with other more common lesions. They are often misdiagnosed as extraskeletal myxoid chondrosarcomas or myoepitheliomas. Our patient’s insidious presentation and radiologic findings present a learning opportunity for clinicians to recognize extra-axial chordomas as a potential early diagnosis in someone presenting with a long history of intermittent and worsening knee pain.

Stroke Prevents Exercise-Induced Gains in Bone Microstructure But Not Composition in Mice

Ischemic stroke induces rapid loss in bone mineral density that is up to 13 times greater than during normal aging, leading to a markedly increased risk of fracture. Little is known about skeletal changes following stroke beyond density loss. In this study, we use a mild-moderate middle cerebral artery occlusion model to determine the effects of ischemic stroke without bedrest on bone microstructure, dynamic bone formation, and tissue composition. Twenty-seven 12-week-old male C57Bl/6J mice received either a stroke or sham surgery and then either received daily treadmill exercise or remained sedentary for 4 weeks. All mice were ambulatory immediately following stroke, and limb coordination during treadmill exercise was unaffected by stroke, indicating similar mechanical loading across limbs for both stroke and sham groups. Stroke did not directly detriment microstructure, but exercise only stimulated adaptation in the sham group, not the stroke group, with increased bone volume fraction and trabecular thickness in the sham distal femoral metaphysis. Stroke differentially decreased cortical area in the distal femoral metaphysis for the affected limb relative to the unaffected limb, as well as endosteal bone formation rate in the affected tibial diaphysis. Although exercise failed to improve bone microstructure following stroke, exercise increased mineral-to-matrix content in stroke but not sham. Together, these results show that stroke inhibits exercise-induced changes to femoral microstructure but not tibial composition, even without changes to gait. Similarly, affected-unaffected limb differences in cortical bone structure and bone formation rate in ambulatory mice show that stroke affects bone health even without bedrest.

Stroke prevents exercise-induced gains in bone microstructure but not composition in mice

ABSTRACTIschemic stroke induces rapid loss in bone mineral density that is up to 13 times greater than during normal aging, leading to a markedly increased risk of fracture. Little is known about skeletal changes following stroke beyond density loss. In this study we use a mild-moderate middle cerebral artery occlusion model to determine the effects of ischemic stroke without bedrest on bone microstructure, dynamic bone formation, and tissue composition. Twenty-seven 12-week-old male C57Bl/6J mice received either a stroke or sham surgery and then either received daily treadmill exercise or remained sedentary for four weeks. All mice were ambulatory immediately following stroke, and limb coordination during treadmill exercise was unaffected by stroke, indicating similar mechanical loading across limbs for both stroke and sham groups. Stroke did not directly detriment microstructure, but exercise only stimulated adaptation in the sham group, not the stroke group, with increased bone volume fraction and trabecular thickness in the sham distal femoral metaphysis. Stroke differentially decreased cortical area in the affected limb relative to the unaffected limb of the distal femoral metaphysis, as well as endosteal bone formation rate in the affected tibial diaphysis. Although exercise failed to improve bone microstructure following stroke, exercise increased mineral-to-matrix content in stroke but not sham. Together, these results show that stroke inhibits exercise-induced changes to femoral microstructure but not tibial composition, even without changes to gait. Similarly, affected-unaffected limb differences in cortical bone structure and bone formation rate in ambulatory mice show that stroke affects bone health even without bedrest.

The Anterolateral Complex of the Knee

The objective of this study was to clarify the layer-by-layer anatomy of the anterolateral complex of the knee. Twenty fresh-frozen human cadaveric knees (age range 38 - 56 yrs.) without any history of knee injury or surgery were used for this dissection study. After skin and subcutaneous tissue removal, the ITB was incised in its most anterior part and reflected posteriorly followed by blunt dissection of its deeper layers. Subsequently, an incision was made between the ITB and the short head of the biceps muscle with consecutive evaluation of the insertion site of the biceps tendon and its extensions. Once the deep layers of the ITB were identified, the connections to the lateral intermuscular septum and Kaplan fibers were cut. The superficial ITB was then reflected distally in order to assess the geographical relationship between the superficial and deep ITB as well as the distal anteromedial aspect of the biceps muscle. Finally, the anterolateral capsule was incised to evaluate its connections to the surrounding anatomic structures. The anterolateral aspect of the knee consists of three distinct layers. Superficially, the ITB with its insertion to Gerdy’s tubercle and extensions to the patella (iliopatellar band) was appreciated. Posterior reflection of the superficial ITB revealed a firm distinct connection of Kaplan fibers to the distal femoral metaphysis. The deep layer of the ITB runs from the Kaplan fibers in a distal direction and forms a functional arc. This arc is reinforced by the capsulo-osseous layer of the ITB, which originates from an area distal to the Kaplan fibers, the fascia of the lateral gastrocnemius and plantaris muscles. The distal half of the capsulo-osseous layer merges posteriorly with the fascia of the biceps muscle. The three layers of the ITB become confluent distally. Its insertion spanned from Gerdy’s tubercle to an area just posteriorly, with the capsulo-osseous layer forming the posterior part. The biceps muscle has fascial and aporoneurotical extensions, which insert to the proximal tibia together with the capsulo-osseous layer of the ITB. Layer 3 consists of the anterolateral capsule. In 7/20 (35%) specimens the mid-third capsular ligament was observed as a thickening within, but not separate from the anterolateral capsule. The anterolateral complex of the knee consists of the ITB with its three layers, the functional arc formed by the fibers between the distal femoral metaphysis and Gerdy’s tubercle, and the anterolateral capsule. In 35% of specimens a capsular thickening (mid-third capsular ligament) was identified. Surgeons should consider the complex anatomy of this functional unit, i.e. the anterolateral complex, when considering lateral extra-articular procedures.