Curettage, phenolization, and cementation in paediatric Ewing's sarcoma with a complete radiological response to neoadjuvant chemotherapy.

PURPOSE: Although wide resection is the standard treatment for Ewing's sarcoma (ES), it has complications especially in children. In this study, we compared the oncologic and functional outcomes of wide resection with extended curettage and local adjuvant therapy (phenolization and cementation), as a less extensive surgery for paediatric ES with a complete radiologic response to neoadjuvant chemotherapy. METHODS: Children aged ≤ ten years, with ES of non-expendable long-bones and complete radiologic response to neoadjuvant chemotherapy, were included in this case-control study. Twenty-six patients were treated with extended curettage and local adjuvant therapy (case group) and 17 were managed with wide resection (control group). The average follow-up period was 60.1 ± 28.7 months (range 30-168 months). Functional outcome was assessed with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: Three local recurrences (11.5%) and three distant metastases (11.5%) were observed in the case group. Two local recurrences (11.7%) and two metastases (11.7%) were recorded in the control group. The rate of local recurrence was not statistically different between the two study groups (p = 0.668). The rate of metastasis was not statistically different between the two study groups as well (p = 0.668). The complication rates were 15% in the case group and 53% in the control group (p = 0.005). The mean MSTS score was 98.3% and 74% in the case and control group, respectively (p < 0.001). CONCLUSION: The oncologic outcome of extended curettage and local adjuvant therapy in paediatric ES with complete radiological response to neoadjuvant chemotherapy is comparable to wide resection, yet it offers considerably better functional results.

An unusual presentation of talus fracture in a child: a case report.

Talar fracture in children is extremely rare. In 1919, Anderson described talar fractures and used the term of aviator astragalus in his series. We report a case of talar neck fracture in a 9-year-old boy which does not match with any type of Hawkins' classification. We describe the radiological features of the fracture and outline its therapy and prognosis. To the best of the authors' knowledge, such a case with this unusual presentation has not been previously reported in the literature.

An unusual presentation of ossified intramuscular hemangioma: a case report.

Intramuscular cavernous hemangiomas represent less than 1% of all hemangiomas. Typical presentation is a soft-tissue mass and/or pain without cutaneous changes. Whereas calcification of hemangiomas is common; ossification of these lesions is very rare. We describe a case of ossified intramuscular hemangioma of quadriceps presented with painless knee extension contracture and thigh mass.

Conversion of fused knee following distal femur tumor surgery to total knee arthroplasty.

Conversion of knee arthrodesis to total knee arthroplasty is a difficult procedure accompanied by many complications due to soft tissue and extensor mechanism contracture and bone defects. We report two cases of distal femur osteosarcoma that had been undergone wide resection arthrodesis initially. Arthrodesis was converted to total knee arthroplasty with hinged prosthesis after many years. We describe patients' history and outline their surgical therapy and prognosis. To the best of the authors' knowledge, few cases have been previously reported in the literature.