Foot and Ankle Giant Cell Tumors Are Not so Aggressive After All: A Retrospective Study.

Giant cell tumors are most commonly seen around the knee and rarely around the foot and ankle. Therefore there is a paucity of data regarding the options of surgery, outcomes and recurrence of Giant cell tumors involving the foot and ankle. We retrospectively studied patients with Giant cell tumors of the foot and ankle from January 2009 to December 2017. We identified 19 (N = 19) patients with a minimum of 1-year follow-up. Their data was retrieved from the electronic database and analyzed. The mean follow-up period was 36.2 (range 12-96) months. On an average, the patients underwent 1.6 surgeries. The surgeries performed were extended curettage and bone graft/cement in 8 (42.1%) patients, excision and bone graft in 8 (42.1%) patients and excision and mega prosthesis in 3 (15.79%) patients. The most common complication was wound infection seen in 3 (15.79%) patients. None of the patients who underwent index procedure in our center (biopsy and surgery) had local recurrence. There were 9 (47.36%) patients with primary procedure elsewhere - 7 of them had no recurrence after surgery in our center. One (5.26%) amputation was eventually performed due to complications and not as a primary surgery. At the final review, all 19 (100%) patients with >1 year follow up were in remission. Local recurrence and wound infection were exclusively found in patients who presented to us after invasive procedures done elsewhere. With good surgical clearance, the uncommon presentations of foot and ankle Giant cell tumors can be treated to attain complete remission.

Grade 3 Proximal Humerus Giant Cell Tumour: Is Resection and Reconstruction with Prosthesis a Valuable Option?

Grade 3 proximal humerus giant cell tumours are uncommon and the results of their surgical management with prosthetic replacement are not well established. We retrospectively studied patients with grade 3 giant cell tumours of proximal humerus treated with excision and prosthetic replacement from January 2009 and December 2018. We identified 13 patients who underwent tumour excision and prosthetic replacement. There were 7 (53.8%) men and 6 (46.2%) women. The mean age at diagnosis was 30.4 years (range 16-48 years). The mean follow-up period was 72.2 months (range 24-132). Margins were positive in 4 (30.8%) patients, ≤ 1 mm in 8 (61.5%) patients, and negative in 1 (7.7%) patient. Local recurrence was seen in 2 (15.4%) patients. 1 out of 2 (50%) patients with local recurrence had pathological fracture at presentation and margins were positive in both (100%) patients. There were 3 (23.1%) complications-1 patient with joint subluxation, 1 patient with fracture post trauma, and 1 patient with surgical site infection. The mean overall Musculoskeletal Tumour Society score was 24 out of 30 (range 21-29). Resection of grade 3 proximal humerus giant cell tumour and reconstruction with prosthesis results in low recurrence rate and good functional outcome and is a valuable treatment option for such tumours.

Long-term outcome of high-energy open Lisfranc injuries: a retrospective study.

BACKGROUND: The outcome of open Lisfranc injuries has been reported infrequently. Should these injuries be managed as closed injuries and is their outcome different? METHODS: We undertook a retrospective study of high-energy, open Lisfranc injuries treated between 1999 and 2005. The types of dislocation, the associated injuries to the same foot, the radiologic and functional outcome, and the complications were studied. There were 22 patients. Five patients died. One had amputation. Of the remaining 16 patients, 13 men were followed up at a mean of 56 months (range, 29-88 months). The average age was 36 years (range, 7-55 years). RESULTS: According to the modified Hardcastle classification, type B2 injury was the commonest. Ten patients had additional forefoot or midfoot injury. All patients were treated with debridement, open reduction, and multiple Kirschner (K) wire fixation. All injuries were Gustilo Anderson type IIIa or IIIb. Nine patients had split skin graft for soft tissue cover. Mean time taken for wound healing was 16 days (range, 10-30 days). Ten patients (77%) had fracture comminution. Eight patients had anatomic reduction, whereas five had nonanatomic reduction. Ten of 13 (77%) patients had at least one spontaneous tarsometatarsal joint fusion. The mean American Orthopaedic Foot and Ankle Society score was 82 (range, 59-100). Nonanatomic reduction, osteomyelitis, deformity of toes, planus foot, and mild discomfort on prolonged walking were the unfavorable outcomes present. CONCLUSION: In open Lisfranc injuries, multiple K wire fixation should be considered especially in the presence of comminution and soft tissue loss. Although anatomic reduction is always not obtained, the treatment principles should include adequate debridement, maintaining alignment with multiple K wires, and obtaining early soft tissue cover. There is a high incidence of fusion across tarsometatarsal joints.

Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy.

OBJECTIVES: To evaluate preoperative neck resorption and postoperative valgus orientation as predictors of union and functional outcome after valgus intertrochanteric osteotomy for treatment of neglected femoral neck fractures and nonunions. DESIGN: Retrospective cohort study. SETTING: Tertiary care center. PATIENTS/PARTICIPANTS: Forty consecutive patients with neglected femoral neck fracture and nonunions were treated with valgus intertrochanteric osteotomy, and follow-up was available in 32 patients (average age, 43 years; range, 14-60 years; average nonunion duration, 6 ± 7 months; range, 1-36 months). INTERVENTION: Valgus intertrochanteric osteotomy. MAIN OUTCOME MEASUREMENTS: Clinical outcome was assessed with Harris hip score. Plain radiographs were evaluated for union, avascular necrosis, preoperative bone deficiency (neck resorption ratio), and postoperative femoral head fragment alignment (head-shaft angle). RESULTS: Follow-up at 5 ± 3 years (range, 2-12 years) after surgery showed union in 29 patients (91%), and Harris hip score was 82 ± 13 points (range, 63-100 points). The 3 patients with persistent nonunion at the neck of femur had neck resorption ratio <0.52. Increased postoperative head-shaft angle was associated with lower follow-up Harris hip score; postoperative valgus alignment >15 degrees compared with the contralateral side was associated with poor functional outcome. The presence of avascular necrosis did not affect the outcome. CONCLUSIONS: Valgus intertrochanteric osteotomy resulted in union and satisfactory functional outcome in most patients who had neglected femoral neck fractures and nonunions. Preoperative neck resorption ratio <0.5 was a risk factor for nonunion, and excessive valgus alignment was a risk factor for poor functional outcome after osteotomy. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Successful repair of chronic instability of anterior chest wall following right parasternal approach for closure of atrial septal defect in a young female.

Chronic instability of anterior chest wall is a known complication following the minimally invasive right parasternal approach for valvular heart operations. The exact incidence of this condition, as well as the need for reoperation, has not been well documented. We report the first case of successful correction of unstable anterior chest wall in a 33-year-old lady after she underwent atrial septal defect closure through right paramedian approach eight years ago. The repair consisted of interposing iliac crest bone graft in the defect created by deficiency of the 3rd and 4th costal cartilages and anchoring the graft using steel wires.