Delay in Diagnosis and Treatment of Primary Bone Tumors.

BACKGROUND: Delay in the diagnosis and treatment of bone tumors continues to be a common problem. Prolonged diagnosis can significantly reduce the chances of successful treatment of the disease. Accordingly, the aim of this study was to assess the delay in the diagnosis of primary bone tumors, identify the most common symptoms and analyze the course of the diagnostic and therapeutic path. MATERIAL AND METHODS: Thirty-two (K=18; M=14) patients treated surgically for primary bone tumors were included in the retrospective study. Patient records were analyzed. Delay in diagnosis was defined as the time from the onset of symptoms to the initial diagnosis and referral to an orthopedic oncology center. RESULTS: The median delay in diagnosis was 7 (3-12) months. For tumors located in the pelvis, the delay was 10 months, compared to 5 months for the upper limb and 7 months for the lower limb (p=0.2312). The delay was 6 months In patients with osteosarcoma, and 8 months in chondrosarcoma patients (p=0.1786). At the first office visit, an x-ray was ordered in 19 cases (59.4%), of whom 9 patients (47.4%) were referred on to the oncology center. The most common symptoms were pain in the affected area (90.6%), limited mobility (28.1%) and pathological fracture (25%). After admission to an orthopedic department, a biopsy was performed after 5.5 (3-8.2) days. The histology results were ready after another 14 (8-18) days, and surgical treatment was performed after 95 (76-100) days. CONCLUSIONS: 1. Although patients show typical symptoms of bone tumors, only a small proportion are referred directly to an oncology center. After a primary bone tumor is suspected, further diagnostic and therapeutic activities proceed efficiently, in accordance with the current guidelines.

Computational Fracture Evolution Analysis of Steel-Fiber-Reinforced Concrete Using Concrete Continuous Damage and Fiber Progressive Models.

The process of concrete cracking is a common problem because the first micro-cracks due to the loss of moisture may appear even before the concrete is loaded. The application of fracture mechanics allows for a better understanding of this problem. Steel-fiber-reinforced concrete (SFRC) samples with a notch were subjected to a three-point bending test, and the results for crack energy were used to analyze the concrete's material properties. In this paper, an experimental and numerical analysis of SFRC with rapid changes in the force (F) crack mouth opening displacement (CMOD) curve (F-CMOD) is presented. In order to obtain the relevant F-CMOD diagrams, three-point bending tests were carried out with non-standard samples with a thickness equal to one-third of the width of standard samples. For analysis purposes, crimped steel fibers were adopted. A probabilistic analysis of the most important parameters describing the material in question, such as peak strength, post-cracking strength, crack mouth opening displacement (CMOD), fracture energy, and the post-cracking deformation modulus, was conducted. The tests and the analysis of their results show that the quasi-static numerical method can be applied to obtain suitable results. However, significant dynamic effects during experiments that influence the F-CMOD curves are hard to reflect well in numerical calculations.

Does the use of 3D-printed cones give a chance to postpone the use of megaprostheses in patients with large bone defects in the knee joint?

Revision procedures and the resulting bone loss are a big challenge for orthopedic surgeons. Therefore, we checked what functional outcomes that 3D-printed cone augments can offer to patients with bone defects (Anderson Orthopedic Research Institute [AORI] classification type 2B and 3) in the knee and whether the use of cones can delay the necessity to use a megaprotheses. Data from 64 patients (M = 22; W = 42) who underwent total knee arthroplasty (TKA) revision were included in the analysis. The Knee Society Clinical Rating System (KSS) and the range of motion in the knee joint were used for the functional assessment. The mean follow-up was 28 months (range: 18-44 months). The survival rate for aseptic loosening at follow-up was 100%. Infection occurred in two (3.1%) patients. The mean KSS score increased from 12.75 points preoperatively to 66.56 postoperatively (p < 0.001). The mean range of motion in the knee changed from 61.15° preoperatively to 115.93° postoperatively (p < 0.001). 3D-printed cone augments seem to be a good solution for patients requiring a TKA revision procedure. When used in patients with bone defects classified as 2B and 3 (AORI), they can be a good alternative, delaying the need for megaprotheses.

Suitability of Laser Engineered Net Shaping Technology for Inconel 625 Based Parts Repair Process.

In this paper, the Inconel 625 laser clads characterized by microstructural homogeneity due to the application of the Laser Engineered Net Shaping (LENS, Optomec, Albuquerque, NM, USA) technology were studied in detail. The optimized LENS process parameters (laser power of 550 W, powder flow rate of 19.9 g/min, and heating of the substrate to 300 °C) enabled to deposit defect-free laser cladding. Additionally, the laser clad was applied in at least three layers on the repairing place. The deposited laser clads were characterized by slightly higher mechanical properties in comparison to the Inconel 625 substrate material. Microscopic observations and X-ray Tomography (XRT, Nikon Corporation, Tokyo, Japan) confirmed, that the substrate and cladding interface zone exhibited a defect-free structure. Mechanical properties and flexural strength of the laser cladding were examined using microhardness and three-point bending tests. It was concluded, that the LENS technology could be successfully applied for the repair since a similar strain distribution was found after Digital Image Correlation measurements during three-point bending tests.

Microstructural Analysis of Fractured Orthopedic Implants.

In this paper, fracture behavior of four types of implants with different geometries (pure titanium locking plate, pure titanium femoral implant, Ti-6Al-4V titanium alloy pelvic implant, X2CrNiMo18 14-3 steel femoral implant) was studied in detail. Each implant fractured in the human body. The scanning electron microscopy (SEM) was used to determine the potential cause of implants fracture. It was found that the implants fracture mainly occurred in consequence of mechanical overloads resulting from repetitive, prohibited excessive limb loads or singular, un-intendent, secondary injures. Among many possible loading types, the implants were subjected to an excessive fatigue loads with additional interactions caused by screws that were mounted in their threaded holes. The results of this work enable to conclude that the design of orthopedic implants is not fully sufficient to transduce mechanical loads acting over them due to an increasing weight of treated patients and much higher their physical activity.

Mechanical and Non-Destructive Testing of Plasterboards Subjected to a Hydration Process.

The aim of this study was to investigate the effect of plasterboards' humidity absorption on their performance. Specimens' hydration procedure consisted of consecutive immersing in water and subsequent drying at room temperature. Such a procedure was performed to increase the content of moisture within the material volume. The microstructural observations of five different plasterboard types were performed through optical and scanning electron microscopy. The deterioration of their properties was evaluated by using a three-point bending test and a subsequent ultrasonic (ultrasound testing (UT)) longitudinal wave velocity measurement. Depending on the material porosity, a loss of UT wave velocity from 6% to 35% and a considerable decrease in material strength from 70% to 80% were observed. Four types of approximated formulae were proposed to describe the dependence of UT wave velocity on board moisture content. It was found that the proposed UT method could be successfully used for the on-site monitoring of plasterboards' hydration processes.