RESUMEN

PURPOSE: To compare the results for patients treated with intercalary endoprosthetic replacement (EPR) or intercalary allograft reconstruction for diaphyseal tumours of the femur in terms of: (1) reconstruction failure rates; (2) cause of failure; (3) risk of amputation of the limb; and (4) functional result. METHODS: Patients with bone sarcomas of the femoral diaphysis, treated with en bloc resection and reconstructed with an intercalary EPR or allograft, were reviewed. A total of 107 patients were included in the study (36 EPR and 71 intercalary allograft reconstruction). No differences were found between the two groups in terms of follow-up, age, gender and the use of adjuvant chemotherapy. RESULTS: The probability of failure for intercalary EPR was 36% at 5 years and 22% for allograft at 5 years (p = 0.26). Mechanical failures were the most prevalent in both types of reconstruction. Aseptic loosening and implant fracture are the main cause in the EPR group. For intercalary allograft reconstructions, fracture followed by nonunion was the most common complication. Ten-year risk of amputation after failure for both reconstructions was 3%. There were no differences between the groups in terms of the mean Musculoskeletal Tumor Society score (27.4, range 16-30 vs. 27.6, range 17-30). CONCLUSIONS: We have demonstrated similar failure rates for both reconstructions. In both techniques, mechanical failure was the most common complication with a low rate of limb amputation and good functional results. LEVEL OF EVIDENCE: Level III, therapeutic study.

Asunto(s)

Amputación Quirúrgica/estadística & datos numéricos , Trasplante Óseo , Neoplasias Femorales/cirugía , Osteosarcoma/cirugía , Implantación de Prótesis , Insuficiencia del Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Diáfisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Adulto Joven

RESUMEN

OBJECTIVE: To analyze orders requested from a musculoskeletal tissue bank and to evaluate the percentage of tissue implantation. MATERIAL AND METHODS: Two hundred and sixty-five orders for musculoskeletal tissue were analyzed over the course of a year. EXCLUSIONS: 5 duplications and 5 orders for which there was no availability to cover the need. We analyzed the number of surgeries in which the graft was finally used. RESULTS: Of a total of 255 orders, the graft was used in 178 (70%), and the graft was not used in 77 (30%). Of the 178 used, there was a partial refund in 23 (10%). Of the 77 orders not used, surgery was performed in 32 (13%) without the use of bank tissue, while surgery was discontinued in the remaining 45 (17%). DISCUSSION: A non-utilization rate of 30% was identified, of which 17% was from surgery that was not performed and 13% from surgery that was performed, but the tissue was returned to the tissue bank, because it was not required. In a further 10% there was partial return of the tissue. Based on this analysis, we consider that it is important to have direct confirmation of the surgery to avoid sending tissue for discontinued surgeries, since in addition to the economic impact, the bank must ensure adequate temperature maintenance during transportation and storage in the transplantation centre, to avoid discarding said tissue if it is returned.

Asunto(s)

Sistema Musculoesquelético , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Bancos de Tejidos/estadística & datos numéricos , Trasplante de Tejidos/estadística & datos numéricos , Argentina , Humanos

RESUMEN

This poster aims to achieve an "in vitro" comparative study between three methods: 2D digital images planning and execution without navigation (freehand with ruler and caliper), 3D planning and execution without navigation (freehand with ruler and caliper) and 3D planning and execution guided with navigation. 3D planning and navigated procedures potentially improve sarcoma resection.

Asunto(s)

Neoplasias Óseas/cirugía , Sarcoma/cirugía , Cirugía Asistida por Computador , Humanos , Imagenología Tridimensional

RESUMEN

BACKGROUND: Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term. MATERIALS AND METHODS: From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA). RESULTS: The overall allograft survival rate, as calculated with the Kaplan-Meier method, at 5 and 10 years was 79 % (95 % CI 64-93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion. CONCLUSION: This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts. LEVEL OF EVIDENCE: IV.

Asunto(s)

Articulación del Tobillo/cirugía , Neoplasias Óseas/cirugía , Trasplante Óseo/métodos , Deformidades Adquiridas del Pie/cirugía , Enfermedades del Pie/cirugía , Recuperación del Miembro/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Adolescente , Adulto , Anciano , Aloinjertos , Articulación del Tobillo/diagnóstico por imagen , Trasplante Óseo/estadística & datos numéricos , Calcáneo/trasplante , Niño , Preescolar , Criopreservación , Femenino , Deformidades Adquiridas del Pie/diagnóstico por imagen , Supervivencia de Injerto , Humanos , Lactante , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Preservación de Órganos , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Adulto Joven

RESUMEN

PURPOSE: We propose to study a group of patients with primary bone sarcoma of the pelvis treated with limb salvage surgery and analyze overall survival, local recurrence rates and functional outcomes. METHODS: A retrospective review was performed, and all patients diagnosed with pelvic primary bone sarcomas between 1990 and 2012 were analyzed. Patients treated with limb salvage surgery and with a minimum of 12-month follow-up for patients alive were included. The overall survival and the local recurrence rate were calculated for the assessment of oncological results. The associations with gender, age, histological grade, type of surgery, margins chemotherapy response and use of navigation were examined. RESULTS: Fifty-two patients were included in the study. The mean age was 37 years (range 10-82), and mean follow-up was 44 months (range 8-189). Forty-five (86 %) tumors were histologically classified as high-grade sarcomas, four (8 %) as low-grade sarcomas and three (6 %) as dedifferentiated sarcomas. Cancer-specific overall survival was 37.5 % for 5 years and 31 % for 10 years. Local recurrence rate was 30 %. High-grade tumors and chemotherapy necrosis below 90 % were negative prognosis factor. Postoperative complication rate was 34.5 % (n:18), being deep infection the most prevalent (n:13). Reconstruction of the pelvis after an oncology resection for primary pelvic sarcomas increased the incidence of complication significantly (p < 0.001). CONCLUSION: Primary bone sarcomas involving the pelvis are suggestive of a high-grade tumor and present poor oncologic outcomes. Pelvic reconstruction after a limb salvage surgery is associated with a high risk of complication. LEVEL OF EVIDENCE: Case series, Level IV.

Asunto(s)

Neoplasias Óseas/cirugía , Recuperación del Miembro , Recurrencia Local de Neoplasia/cirugía , Osteosarcoma/cirugía , Huesos Pélvicos/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/mortalidad , Quimioterapia Adyuvante/métodos , Niño , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Recuperación del Miembro/métodos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/mortalidad , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Proximal fibula malignant and locally aggressive benign bone tumors are uncommon and usually treat by surgery. Bloc resection of the knee can compromise knee stability due to of the resection of the posterolateral ligament complex. MATERIAL AND METHODS: We analyzed 28 consecutive patients treated for a proximal fibula bone tumor between 1980 and 2006 (osteosarcoma: 9, giant cell tumor: 9, Ewing sarcoma: 8 and chondrosarcoma: 2). Sixty-one percent were male and the median age was 21 years (range: 8-60). The mean follow-up was 86 months. The posterolateral complex was reinserted at tibial metaphyseal level. Patients were evaluated functionally using the Musculoskeletal Tumor Society scale (MSTS). RESULTS: Overall survival rate was 89%, local recurrence rate was 11%, and secondary amputation rate was 6% at 7 years of median follow-up. The average MSTS score was 93%. Five patients had neurological complications. No patient experienced subjective instability or vascular insufficiency. CONCLUSIONS: Bloc resection of the proximal fibula for the treatment of aggressive or malignant primary bone tumors allowed us to obtain local tumor control, and overall survival rate for sarcomas of 89% at 7 years. The posterolateral ligament complex tibial reinsertion provided functional knee stability without major functional consequences in the medium term.

Asunto(s)

Neoplasias Óseas/cirugía , Peroné/cirugía , Adolescente , Adulto , Neoplasias Óseas/patología , Niño , Femenino , Peroné/patología , Humanos , Articulación de la Rodilla/fisiología , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Adulto Joven

RESUMEN

BACKGROUND: The purpose of this paper is to assess the survival and the different factors predisposing to increased local and overall complications in a group of patients treated surgically for bone metastases. MATERIAL AND METHODS: A total of 97 patients were included in our study, 45 females and 52 males. Mean age was 59 years (range 22-81) and the mean follow-up was 23 months (range 3-76). Were performed 104 surgical interventions. Patient survival was estimated with the Kaplan-Meier method. Complications, recurrences and the most significant factors were analyzed. RESULTS: Overall patient survival was 73% at one year, 47% at 2 years, and 6% at 5 years. Patient survival was greater in patients with a histologic diagnosis of metastatic renal cancer (p > 0.05) and a higher incidence of local relapses (p > 0.05). Intralesional surgery significantly affected the relapses. CONCLUSIONS: Patients with metastatic renal cancer had the greatest survival rate. However, they were associated with a higher rate of local relapses and postoperative failure.

Asunto(s)

Neoplasias Óseas/mortalidad , Neoplasias Óseas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/complicaciones , Neoplasias Óseas/secundario , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia , Adulto Joven

RESUMEN

PURPOSE: The purpose of this study was to perform a magnetic resonance imaging (MRI) follow-up study of bone bruises in a group of patients with acute anterior cruciate ligament (ACL) ruptures that were reconstructed and followed-up for a minimum of 2 years. TYPE OF STUDY: Cohort study. METHODS: The study group included 21 patients with a mean age of 31 years whose initial MRI scans showed associated bone bruises. Patients were included if they had an acute isolated ACL tear, no documentation of an episode of repeated injury to the affected knee during the follow-up period, and no evidence of cartilaginous injury at the time of arthroscopy. All patients had preoperative MRI scans and underwent arthroscopic ACL reconstruction using a bone-patellar tendon autograft an average of 2 months after injury. The preoperative MRI scans were analyzed using a 3-level grading system based on the appearance and location of bone bruises. A second MRI of the knee was obtained from 24 to 64 months postoperatively (average 34 months). The presence of resolution of bone bruises was determined and correlation with clinical scoring established. RESULTS: This study showed resolution of all type I lesions and 91% of type II lesions (10 of 11). In all type III lesions, an articular cartilage thinning and depression was observed after 2 years of follow-up. In 15 patients (71%), MRI showed that the bone bruises had resolved without apparent sequelae. In the remaining 6 patients (29%), sequelae of the osteochondral lesion were evident on MRI. CONCLUSIONS: According to our clinical data, there was no correlation between scores obtained from patients with resolved lesions against those with osteochondral sequelae. Although long-term clinical implications of these findings are uncertain, a severe occult osteochondral lesion sustained at the time of ACL rupture seems to be persistent on MRI even after a successful reconstruction.

Asunto(s)

Lesiones del Ligamento Cruzado Anterior , Contusiones/diagnóstico , Traumatismo Múltiple/diagnóstico , Tibia/lesiones , Tibia/patología , Adulto , Ligamento Cruzado Anterior/cirugía , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/diagnóstico , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Cuidados Preoperatorios , Remisión Espontánea , Rotura

RESUMEN

An evaluation of long-term survival and radiographic deterioration of 118 knee osteoarticular allografts in 114 patients was performed. Radiographic analysis was done according to the Musculoskeletal Tumor Society grading system. A failure was defined as when the allograft was removed during a revision procedure or amputation. Ten patients were lost to followup during the first 2 years after surgery. Eighteen patients without allograft failures died of complications related to the tumor. Twenty-six allografts failed because of infection (13 allografts), local recurrence (eight allografts), massive resorptions (three allografts) and fractures (two allografts). Sixty-four allografts still were in place at a mean of 98 months (range, 36-360 months) after implantation. The Kaplan-Meier 5-year survival rate for the knee osteoarticular allografts was 73% and the limb preservation rate was 93%. The mean radiographic score was 83%. Sixty-four percent of the allografts showed no radiologic changes or minor articular deterioration. Fourteen percent had narrowing of the joint space of more than 2 mm, and 22% had some form of subchondral bone collapse. Five patients required joint resurfacing to preserve the original allograft. Most of the allograft failures occurred during the first 4 years, and the allograft survival rate for the current series remained unchanged after 5 years.

Asunto(s)

Neoplasias Óseas/cirugía , Trasplante Óseo , Articulaciones/trasplante , Articulación de la Rodilla/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Adulto , Anciano , Artrografía , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/mortalidad , Niño , Condrosarcoma/diagnóstico por imagen , Condrosarcoma/mortalidad , Condrosarcoma/cirugía , Femenino , Tumor Óseo de Células Gigantes/diagnóstico por imagen , Tumor Óseo de Células Gigantes/mortalidad , Tumor Óseo de Células Gigantes/cirugía , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteosarcoma/diagnóstico por imagen , Osteosarcoma/mortalidad , Osteosarcoma/cirugía , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Pronóstico , Reoperación , Sarcoma de Ewing/diagnóstico por imagen , Sarcoma de Ewing/mortalidad , Sarcoma de Ewing/cirugía , Tasa de Supervivencia , Trasplante Homólogo

Asunto(s)

Neoplasias Óseas/cirugía , Trasplante Óseo , Calcáneo/cirugía , Adolescente , Adulto , Neoplasias Óseas/diagnóstico por imagen , Calcáneo/diagnóstico por imagen , Condrosarcoma/diagnóstico por imagen , Condrosarcoma/cirugía , Estudios de Seguimiento , Tumor Óseo de Células Gigantes/diagnóstico por imagen , Tumor Óseo de Células Gigantes/cirugía , Humanos , Masculino , Radiografía , Trasplante Homólogo

RESUMEN

OBJECTIVE: To assess prospectively the incidence, nature, and severity of injuries to polo riders competing in the 1996 Argentine High Polo season. METHODS: Assessment, documentation, and provision of care for all injuries sustained during the 1996 season by one of the authors. Riders were also surveyed retrospectively for their previous polo injuries. RESULTS: 34 riders took part in the study. Nine injuries were sustained prospectively and 55 injuries were reviewed retrospectively (64 total). The injuries were categorised as minor (10), moderate (13), and major (41). Twenty five (39%) injuries occurred in the arms, 20 (31%) in the legs, 12 (19%) in the head, 3 (5%) in the back, and 4 (6%) in the face. A fracture occurred in 25 (39%) injuries as most resulted from a fall from the horse. Additionally, facial lacerations occurred prospectively in five riders but did not result in missed play. An overall injury rate of 7.8/1000 player-game hours was calculated. CONCLUSIONS: Although many sports have injury rates much greater than 8/1000 player-game hours, the severity of most injuries occurring in polo was classified as major, with fractures and facial lacerations common. The use of a helmet with a face protector is recommended to decrease injury to players. A doctor experienced in the management of serious trauma should be present at all polo matches.

Asunto(s)

Traumatismos en Atletas/epidemiología , Deportes , Adulto , Distribución por Edad , Animales , Argentina/epidemiología , Traumatismos en Atletas/diagnóstico , Caballos , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo

RESUMEN

Las lesiones osteocondrales (OC) no reveladas por los estudios radiográficos convencionales (contusiones óseas) han sido descritas mediante resonancia magnética (RM) en un alto porcentaje de los pacientes con lesión aguda del ligamento cruzado anterior (LCA). El objetivo de este estudio prospectivo es el de analizar a un grupo de pacientes con rotura del LCA y lesión OC asociada diagnosticada por RM inicial, evaluándolos en forma clínica y con una segunda RM luego de 2 años de la reconstrucción del LCA. Las lesiones OC fueron clasificadas en las RM pre y posoperatorias en 3 grados, según el aspecto de las imágenes y su relación espacial con la superficie articular: grado I (hemorragia difusa intramedular sin contig³idad con el hueso subcondral), grado II (hemorragia contigua al hueso subcondral) y grado III (depresión o solución de continuidad del contorno de la superficie articular). Fueron evaluados 21 pacientes que presentaban lesiones OC en las RM preoperatorias. Quince (71 por ciento) presentaban resolución de la contusión ósea sin secuela evidente en la RM de control. Los 6 pacientes restantes (29 por ciento) presentaban una secuela de la lesión OC que consistía en disminución del grosor del cartílago articular, depresión de la cortical o defecto osteocondral. De acuerdo con nuestros resultados, las lesiones grados I y II tenderían hacia una resolución espontánea en un alto porcentaje de los casos, por esta razón, en la mayoría de los casos no se debería actuar sobre la lesión condral ni alterarse los protocolos de rehabilitación. Por el contrario, en las lesiones grado III se observa secuela en la RM, en estos casos es factible considerar la conveniencia de un tratamiento preventivo

Asunto(s)

Ligamento Cruzado Anterior , Espectroscopía de Resonancia Magnética , Osteocondritis/diagnóstico , Osteocondritis/diagnóstico por imagen , Argentina

RESUMEN

Las lesiones osteocondrales (OC) no reveladas por los estudios radiográficos convencionales (contusiones óseas) han sido descritas mediante resonancia magnética (RM) en un alto porcentaje de los pacientes con lesión aguda del ligamento cruzado anterior (LCA). El objetivo de este estudio prospectivo es el de analizar a un grupo de pacientes con rotura del LCA y lesión OC asociada diagnosticada por RM inicial, evaluándolos en forma clínica y con una segunda RM luego de 2 años de la reconstrucción del LCA. Las lesiones OC fueron clasificadas en las RM pre y posoperatorias en 3 grados, según el aspecto de las imágenes y su relación espacial con la superficie articular: grado I (hemorragia difusa intramedular sin contigüidad con el hueso subcondral), grado II (hemorragia contigua al hueso subcondral) y grado III (depresión o solución de continuidad del contorno de la superficie articular). Fueron evaluados 21 pacientes que presentaban lesiones OC en las RM preoperatorias. Quince (71 por ciento) presentaban resolución de la contusión ósea sin secuela evidente en la RM de control. Los 6 pacientes restantes (29 por ciento) presentaban una secuela de la lesión OC que consistía en disminución del grosor del cartílago articular, depresión de la cortical o defecto osteocondral. De acuerdo con nuestros resultados, las lesiones grados I y II tenderían hacia una resolución espontánea en un alto porcentaje de los casos, por esta razón, en la mayoría de los casos no se debería actuar sobre la lesión condral ni alterarse los protocolos de rehabilitación. Por el contrario, en las lesiones grado III se observa secuela en la RM, en estos casos es factible considerar la conveniencia de un tratamiento preventivo

Asunto(s)

Osteocondritis/diagnóstico , Osteocondritis , Ligamento Cruzado Anterior , Espectroscopía de Resonancia Magnética , Argentina