RESUMO
BACKGROUND: Schwannoma is a benign, encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system. Typical symptoms are soreness, radiating pain and sensory loss combined with a soft tissue mass. AIM: To evaluate pre- and postoperative symptoms in patients operated for schwannomas in the extremities and investigate the rate of malignant transformation. METHODS: In this single center retrospective study design, all patients who had surgery for a benign schwannoma in the extremities from May 1997 to January 2018 were included. The location of the tumor in the extremities was divided into five groups; forearm, arm, shoulder, thigh and leg including foot. The locations of the tumor in the nerves were also categorized as either; proximal, distal, minor or major nerve. During the pre- and postoperative clinical evaluation, symptoms were classified as paresthesia, local pain, radiating pain, swelling, impairment of mobility/strength and asymptomatic tumors that were found incidentally (with magnetic resonance imaging). The patients were evaluated after surgery using the following categories: Asymptomatic or symptomatic patients (radiating and/or local pain) and those with complications. The follow up period was from the time of surgery until last examination of the particular physician. Multivariate logistic regression analysis was performed to identify independent prognostic factors for postoperative significant symptoms at follow-up. RESULTS: We identified 858 cases from the institutional pathology register. We excluded cases with duplicate diagnoses (n = 407), pathology not including schwannomas (n = 157), lesions involving the torso, spine and neck (n = 150) leaving 144 patients for further analysis. In this group 99 patients underwent surgery and there were five complications recorded: 2 infections (treated with antibiotics) and 3 nerve palsies (2 involving the radial nerve and one involving the median nerve) that recovered spontaneously. At the end of follow-up, 1.4 mo (range 0.5-76) postoperatively, we recorded a post-operative decrease in clinical symptoms: Local pain 76% (6/25), radiating pain 97% (2/45), swelling 20% (8/10). Symptoms of paresthesia increased by 2.8% (37/36) and there was no change in motor weakness before and after surgery 1% (1/1). Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves (odds ratio: 2.63; confidence intervals: 1.22-6.42, P = 0.029). One patient with schwannoma diagnosed by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor. No local recurrences were reported. CONCLUSION: Surgery of schwannomas can be conducted with low risk of postoperative complications, acceptable decrease in clinical symptoms and risk of malignant transformation is low.
RESUMO
INTRODUCTION: Implant-related discomfort (soft-tissue irritation, pain and cosmetics) is often seen in patients with surgically treated clavicle fracture. The aim of this study was to investigate indications, complications, functionality and patient satisfaction following implant removal of surgically treated clavicle fractures. METHODS: A total of 97 patients (73 males, mean age 43 years) had a clavicle plate removed at our department between 2007 and 2014. A purpose-made questionnaire was used to assess self-perception of cause of implant removal, remission, complications and overall satisfaction. Functionality was assessed using the Quick DASH score. RESULTS: Two patients died before follow-up and were excluded. Five different indications for implant removal were found. A total of 65/95 of the patients answered the purpose-made questionnaire; 50/65 reported satisfaction and 14/65 had a complication following the removal of their implant. The mean QuickDASH score was 7 (range: 0-91). Only 18/36 of those with pain and soft tissue irritation due to a clavicle plate had complete remission after implant removal. CONCLUSIONS: The indications for clavicle plate removal are many and mainly subjective. Implant removal in patients following surgically treated clavicle fractures generally causes very few complications, and most patients seem to experience a positive effect. However, it is important to inform the patient of the risk of no remission or even a worsening, which is not an uncommon occurrence. FUNDING: none. TRIAL REGISTRATION: not relevant.