The position, orientation, and relative size of the fibularis longus tubercle in normal patients: A weightbearing CT assessment.

The fibularis longus attaches to the base of the first metatarsal at the fibularis/peroneus longus tubercle (FLT/PLT). Theoretically, differences in FLT morphology may reflect changes in the function of the fibularis longus. This study defines the normal limits of the FLT position, orientation, and size in patients with morphologically normal foot anatomy. A retrospective analysis of 131 feet without deformity in 72 patients undergoing weightbearing CT (WBCT) at a single center was conducted. The position and morphology of the FLT was assessed with novel measurements including tubercle-floor distance, tubercle-metatarsal angle, and the angle between the floor and a line bisecting the FLT (bisecting angle). Roundness of the FLT was compared to a triangle limiting its shape (triangular ratio), with lower values indicating increasing roundness. We also report relative size of the FLT to the first metatarsal (X/Y ratio), and relative size of the first metatarsal and FLT to the second metatarsal (XY/Z ratio). There were no significant side to side differences for any measurement (p > 0.05). Mean values were: tubercle-floor distance 28.02 ± 2.63 mm, tubercle-metatarsal angle 32.7 ± 6.32 degrees, bisecting angle 65.58 ± 6.27 degrees, triangular ratio 0.69 ± 0.04, X/Y ratio 1.13 ± 0.20, and XY/Z ratio 3.44 ± -0.72. Bisecting angle strongly correlated with tubercle-metatarsal angle (Pearson correlation 0.840, p < 0.001) suggesting FLT rotation occurred independent of foot position. ICC was >0.943 for all measurements. This study reports the morphology of the FLT in individuals with normal feet. This normative data may be used in future studies examining differences between groups of patients with foot pathology, helping us better understand the role of fibularis longus in the development and treatment of foot disorders.

MRI-histopathological correlation in paediatric conventional central chondrosarcoma: a report of 17 cases.

OBJECTIVE: To describe the MRI features of paediatric conventional central chondrosarcoma (CC-CS) and correlate with histological grade. MATERIALS AND METHODS: A retrospective review of children/adolescents with histologically confirmed CC-CS. Data collected included age, sex, skeletal location, and histology from needle biopsy or resection, which was classified as atypical cartilaginous tumours/grade 1 CS (ACT/Gd 1 CS), high-grade chondrosarcoma (HGCS), and dedifferentiated chondrosarcoma (DD-CS). MRI studies were reviewed independently by 2 radiologists blinded to the histology grade, who graded the tumours as ACT/Gd 1 CS, HGCS, and DD-CS based on MRI features. RESULTS: The study included 7 males and 10 females with mean age 13.9 years (range 6-18 years). Tumours were located in the femur (n = 6), humerus (n = 3), tibia, ilium, scapula, and ulna (n = 1 each), and the small bones of the hands or feet (n = 4). Final histology grade was ACT/Gd 1 CS in 15 cases and HGCS in 2 (both grade 1 CS with focal transition to grade 2), 15 based on surgical specimens, 1 based on open biopsy, and 1 on needle biopsy alone. Predicted MRI grade for the 2 readers was ACT/Gd 1 CS in 11 cases each and HGCS in 6 cases each, indicating a mismatch between predicted MRI grade and histological grade in 8 (47%) cases (4 cases with one reader mismatch and 4 cases with both). CONCLUSIONS: MRI findings in paediatric CC-CS may be misleading, showing features suggestive of HGCS 7 of 17 (41.2%) of cases. This should be taken into consideration when planning surgical treatment.

Osteosarcoma: Current Concepts and Evolutions in Management Principles.

Osteosarcoma is a rare malignancy arising from mesenchymal tissue, and represents the most common bone sarcoma. The management of osteosarcoma is challenging, and requires a multidisciplinary approach. In daily clinical practice, surgery, radiotherapy, and conventional chemotherapy constitute the therapeutic armamentarium against the disease. However, a significant number of patients with initially localized osteosarcoma will experience local or distant recurrence, and the prognosis for metastatic disease remains dismal. There is a pressing need to identify novel therapeutic strategies to better manage osteosarcoma and improve survival outcomes. In this study, we present recent advances in the therapeutic management of osteosarcoma, including surgical and medical advances. The role of immunotherapy (immune checkpoint inhibitors, adoptive cellular therapy, cancer vaccines) and other targeted therapies including tyrosine kinase inhibitors is discussed; however, additional studies are required to delineate their roles in clinical practice.

Magnetic Resonance Imaging Features and Prognostic Indicators of Local Recurrence after Curettage and Cementation of Atypical Cartilaginous Tumour in the Appendicular Skeleton.

Objective: The aim of this study is to determine MRI features that may be prognostic indicators of local recurrence (LR) in patients treated with curettage and cementation of atypical cartilaginous tumours (ACTs) in the appendicular skeleton. Materials and Methods: This study is a retrospective review of adult patients with histologically confirmed appendicular ACT. The data collected included age, sex, skeletal location and histology from curettage, the presence of LR and oncological outcomes. The pre-operative MRI characteristics of the ACT reviewed by a specialist MSK radiologist included lesion location, lesion length, degree of medullary filling, bone expansion, cortical status and the presence of soft tissue extension. Results: A total of 43 patients were included, including 9 males and 34 females with a mean age of 42.8 years (range: 25-76 years). Tumours were located in the femur (n = 19), humerus (n = 15), tibia (n = 5), fibula (n = 2) and radius and ulna (n = 1 each). A total of 19 lesions were located in the diaphysis, 12 in the metadiaphysis, 6 in the metaphysis and 6 in the epiphysis. The mean tumour length was 61.0 mm (range: 12-134 mm). The mean follow up was 97.7 months (range: 20-157 months), during which 10 (23.3%) patients developed LR, 7 (70%) of which were asymptomatic and 3 (30%) of which presented with pain. Four patients required repeat surgery with no associated death or evidence of metastatic disease. LR was significantly commoner with tumours arising in the epiphysis or metadiaphysis, but no MRI features were predictive of LR. Conclusions: No relationship was found between the apparent 'aggressiveness' of an ACT of the appendicular skeleton on MRI and the development of LR following treatment with curettage and cementation.

catena-Poly[{µ(3)-4,4',6,6'-tetra-bromo-2,2'-[butane-1,4-diylbis(nitrilo-methan-ylyl-idene)]diphenolato}{µ(2)-4,4',6,6'-tetra-bromo-2,2'-[butane-1,4-diylbis(nitrilo-methanylyl-idene)]dipheno-lato}dicopper(II)].

The asymmetric unit of the title coordination polymer consists of a dinuclear neutral complex mol-ecule of formula [Cu(2)(C(18)H(14)Br(4)N(2)O(2))(2)](n). One of the Cu(II) ions is coordinated in a distorted square-planar geometry, whereas the other is coordinated in a distorted square-pyramidal geometry, the long apical Cu-O bond [2.885 (4) Å] of the square-pyramidal coordination being provided by a symmetry-related O atom creating a one-dimensional polymer along [010]. π-π stacking inter-actions [centroid-centroid distance = 3.783 (4) Å] and short inter-chain Br⋯Br inter-actions [3.6142 (12)-3.6797 (12) Å] are observed.

Bis(dimethyl-formamide-κO){4,4',6,6'-tetra-chloro-2,2-[butane-1,4-di-yl(nitrilo-methanylyl-idene)]diphenolato-κ(4)O,N,N',O'}nickel(II).

In the title Schiff base complex, [Ni(C(18)H(14)Cl(4)N(2)O(2))(C(3)H(7)NO)(2)], the geometry around the Ni(II) atom is distorted octa-hedral. It is coordinated by the N(2)O(2) donor atoms of the tetra-dentate Schiff base ligand and the O atoms of two dimethyl-formamide mol-ecules, which are cis to one another. The benzene rings are almost normal to each other [dihedral angle = 88.60 (14)°]. The various intra-molecular C-H⋯O hydrogen bonds make S(5) and S(6) ring motifs. In the crystal, mol-ecules are linked by pairs of weak C-H⋯Cl inter-actions, forming inversion dimers.

catena-Poly[{µ(3)-4,4',6,6'-tetra-chloro-2,2'-[butane-1,4-diylbis(nitrilo-methanyl-yl-idene)]diphenolato}{µ(2)-4,4',6,6'-tetra-chloro-2,2'-[butane-1,4-diylbis(nitrilo-methanylyl-idene)]diphenolato}dicopper(II)].

The asymmetric unit of the title compound, [Cu(2)(C(18)H(14)Cl(4)N(2)O(2))(2)](n), contains two independent Cu(II) ions which are bridged by a pair of 4,4',6,6'-tetra-chloro-2,2'-[butane-1,4-diylbis(nitrilo-methanylyl-idene)]diphenolate ligands, forming a dinuclear unit. One of the Cu(II) ions is coordinated in a distorted square-planar environment and the other is coordinated in a distorted square-pyramidal environment. The long apical Cu-O bond of the square-pyramidal coordinated Cu(II) ion is formed by a symmetry-related O atom, creating a one-dimensional polymer along [010]. In addition, short inter-molecular Cl⋯Cl distances [3.444 (2) Å] and weak π-π inter-actions [centroid-centroid distances = 3.736 (2)-3.875 (3) Å] are observed. The crystal studied was an inversion twin with a refined twin component ratio of 0.60 (1):0.40 (1).

{4,4',6,6'-Tetra-iodo-2,2'-[propane-1,3-diylbis(nitrilo-methanylyl-idene)]diphenolato-κ(4)O,N,N',O'}nickel(II).

The asymmetric unit of the title compound, [Ni(C(17)H(12)I(4)N(2)O(2))], comprises half of a Schiff base complex. The Ni(II) and central C atom of the propyl chain are located on a twofold rotation axis. The geometry around the Ni(II) atom is square planar, supported by the N(2)O(2) donor atoms of the coordinated ligand. In the crystal, there are no significant inter-molecular inter-actions present. The crystal studied was a non-merohedral twin with a refined twin component ratio of 0.944 (1):0.056 (1).

4,4',6,6'-Tetra-chloro-2,2'-[(1E,1'E)-propane-1,3-diylbis(nitrilo-methanylyl-idene)]diphenol.

The title compound, C(17)H(14)Cl(4)N(2)O(2), is generated by crystallographic twofold symmetry. The two benzene rings are inclined to one another by 80.17 (10)°. There are two intra-molecular O-H⋯N hydrogen bonds, which make S(6) ring motifs. In the crystal, mol-ecules are linked by C-H⋯O and weak C-H⋯Cl inter-actions, forming a three-dimensional network.

4,4',6,6'-Tetra-bromo-2,2'-[(E,E)-ethane-1,2-diylbis(nitrilo-methanylyl-idene)]di-phenol.

The asymmetric unit of the title compound, C(16)H(12)Br(4)N(2)O(2), comprises half of a potential tetra-dentate Schiff base ligand. The whole mol-ecule is generated by an inversion center located in the middle of the C-C bond of the ethyl-ene segment. There are intra-molecular O-H⋯N hydrogen bonds making S(6) ring motifs. In the crystal, no significant inter-molecular inter-actions are observed.

2-[(Z)-(3-{[(Z)-2-Hy-droxy-3,5-diiodo-benzyl-idene]amino}-propyl-imino)-meth-yl]-4,6-diiodo-phenol.

In the title compound, C(17)H(14)I(4)N(2)O(2), there are two intra-molecular O-H⋯N hydrogen bonds, which make S(6) ring motifs. In the crystal, there are no significant inter-molecular inter-actions present.

(E)-1-(2-Hy-droxy-5-meth-oxy-benzyl-idene)thio-semicarbazide.

In the title mol-ecule, C(9)H(11)N(3)O(2)S, an intra-molecular O-H⋯N hydrogen bond generates an S(6) ring motif. In the crystal, mol-ecules are linked via pairs of N-H⋯S inter-actions, forming inversion dimers with R(2) (2)(8) ring motifs. These dimers are further linked via N-H⋯S and N-H⋯O hydrogen bonds, forming a two-dimensional network lying parallel to (100). The crystal structure is further stabilized by inter-molecular π-π inter-actions [centroid-centroid distance = 3.7972 (9) Å].

(E)-1-(3-Eth-oxy-2-hy-droxy-benzyl-idene)thio-semicarbazide.

The title compound, C(10)H(13)N(3)O(2)S, crystallizes with two independent mol-ecules (A and B) in the asymmetric unit. In the crystal, the A and B mol-ecules are linked via pairs of N-H⋯O and O-H⋯S hydrogen bonds, forming dimers with R(2) (2)(14) and R(2) (2)(6) ring motifs. These dimers are linked via a pair of N-H⋯S hydrogen bonds with an R(2) (2)(8) ring motif, forming chains propagating along the c-axis direction. The crystal was refined as an inversion twin with a final BASF ratio of 0.54 (11):0.46 (11).

4,6-Dichloro-2-[(E)-(2-{[(E)-3,5-dichloro-2-oxidobenzyl-idene]aza-nium-yl}eth-yl)iminiumylmeth-yl]phenolate.

The asymmetric unit of the title compound, C(16)H(12)Cl(4)N(2)O(2), comprises half of a potentially tetra-dentate Schiff base ligand, located about a twofold rotation axis which bis-ects the central C-C bond of the ethane-1,2-diamine group. In the solid state, the compound exists in the zwitterionic form. There are two intra-molecular N-H⋯O hydrogen bonds making S(6) ring motifs. In the crystal, mol-ecules are linked by C-H⋯O hydrogen bonds, forming two-dimensional frameworks which lie parallel to (100). There are also short Cl⋯Cl [3.4395 (9) Å] contacts present.

4,6-Dichloro-2-((E)-{4-[(E)-3,5-dichloro-2-hy-droxy-benzyl-idene-amino]-butyl-imino}-meth-yl)phenol.

The asymmetric unit of the title compound, C(18)H(16)Cl(4)N(2)O(2), comprises half of a potentially tetra-dentate Schiff base ligand. It is located about a twofold rotation axis that bis-ects the central C-C bond of the butane-1,4-diamine group. There are two intra-molecular O-H⋯N hydrogen bonds making S(6) ring motifs. In the crystal, mol-ecules are linked by pairs of weak C-H⋯Cl inter-actions, forming inversion dimers, which are further connected by C-H⋯O hydrogen bonds into two-dimensional frameworks that lie parallel to (001).

4,6-Dibromo-2-[(E)-(4-{[(E)-3,5-dibromo-2-hy-droxy-benzyl-idene]amino}-butyl)-imino-meth-yl]phenol.

The asymmetric unit of the title compound, C(18)H(16)Br(4)N(2)O(2), comprises half the molecule, which is located adjacent to an inversion centre at the mid-point of the central C-C bond of the butane-1,4-diamine segment. There are two intra-molecular O-H⋯N hydrogen bonds making S(6) ring motifs. In the crystal, mol-ecules are linked by pairs of weak C-H⋯Br inter-actions into chains along [101], which include R(2) (2)(8) ring motifs. These chains are further linked by C-H⋯O hydrogen bonds, forming a three-dimensional network.

Positive Margins Following Excision of Primary Bone & Soft Tissue Tumours in a Tertiary Centre and the Impact on Patient Outcomes.

Background Primary bone and soft tissue sarcoma treatment includes surgical resection, with or without peri-operative chemoradiotherapy. The aim of surgery is to achieve complete excision, to prevent localised recurrence and achieve cure. For various reasons, excision with adequate margins is not always possible. Our aim is to assess the occurrence of unexpected positive margins following primary excision within a tertiary centre and the impact on patient outcomes. Methods A retrospective analysis of 567 patients discussed at the Royal National Orthopaedic Hospital Multi-disciplinary team (MDT) meeting with positive margins between 1999-2020 was performed. Exclusion criteria included: excisions performed externally and lesions treated with curettage. Information gathering from electronic records highlighted 23 cases with unexpected positive margins following primary excision. Results All patients pre-operatively expected to achieve complete primary resection. The median age was 60 years (8-92), 10M:13F. Tumour location included lower limb (12), upper limb (six), pelvis (two) and trunk (three); eight bone tumours and 15 soft tissue. The overall recurrence rate was 30.4% (7/23). In those recommended for re-excision (n=16), the recurrence rate was 31.25% (5/16). Of the patients not initially recommended for re-excision (n=7), four proceeded to surveillance alone with 50% recurrence (2/4), both with metastatic disease not surviving to follow-up. A further three patients underwent post-operative radiotherapy alone with no recurrences at follow-up, one patient not surviving for further treatment due to stroke. The mean follow-up for patients was 3.1 years. Conclusion When positive margins do occur unexpectedly, the impact due to the need for further treatment and ultimately increased risk of recurrence can be significant. Results can be compared to those for unplanned excisions. Therefore, surgeons should be aware of the different circumstances in which positive margins occur to help guide treatment planning and managing patient expectations.

Soft tissue sarcoma: Recognizing a rare disease.

The recognition of a malignant soft tissue mass can be challenging, given the rarity of soft tissue sarcoma and the extensive overlap between benign and malignant presentations. Awareness of the signs and symptoms of soft tissue sarcoma in primary care practice ensures prompt referral to a sarcoma center for appropriate assessment and treatment to optimize outcomes.

Metastatic bone disease: Early referral for multidisciplinary care.

It is estimated that more than half of all cancers develop bony metastases, exacting a substantial cost in terms of patient quality of life and healthcare expenses. Prompt diagnosis and management have been shown to reduce morbidity and costs. When a patient with a history of cancer presents with musculoskeletal pain, heightened awareness of the risk of bone metastasis should prompt immediate referral to an orthopedic specialist. A multidisciplinary approach is needed to identify an appropriate treatment plan for the patient based on the prognosis, fracture status, and extent of skeletal disease.

4-Bromo-2-[(E)-(4-chloro-phen-yl)imino-meth-yl]phenol.

In the title compound, C(13)H(9)BrClNO, the dihedral angle between the substituted benzene rings is 43.90 (11)°. Strong intra-molecular O-H⋯N hydrogen bonds generate S(6) ring motifs. The crystal structure features short intemolecular Br⋯Br [3.554 (2) Å] and Cl⋯Cl [3.412 (2) Å] contacts. The crystal packing is further stabilized by inter-molecular C-H⋯O and C-H⋯π inter-actions.