Infantile Myofibromatosis of the Femoral Neck: A Case Report.

CASE: A 15-month-old boy who was being followed for developmental dysplasia of the hip because of breech presentation was discovered to have a solitary infantile myofibroma in the left femoral neck. The patient was avoiding weight-bearing on the affected extremity; thus, stabilization of the femoral neck was performed using a proximal femur locking plate. Postoperatively, he achieved all gross motor developmental milestones. CONCLUSION: This report is the first to describe a solitary infantile myofibroma in the femoral neck and demonstrates the utility of operative stabilization of these lesions.

Thermal necrosis in orthopedic bone tumors: experimental research.

Introduction: The extent of surgical resection in orthopedic oncology differs according to tumor biology. While malignant bone tumors are operatively managed with wide resection, benign bone tumors and metastatic carcinomas are often treated through intralesional excision and adjuvant modalities, including the elimination of residual neoplastic cells through thermal necrosis. This study investigates in vitro temperature thresholds for thermal necrosis in common orthopedic bone tumors. Methodology: Eleven cell lines, including metastatic carcinomas to bone (A549, A498, FU-UR-1, PC3, MDA-MB-231, TT, MCF7, and K1), giant cell tumor of bone, osteosarcoma (HG-63), and control non-neoplastic cells (HEK293) were cultured. Cells were exposed to thermal stress at varying times and temperatures and evaluated for survival and viability with crystal violet and MTT assays. Results: Both the MTT and crystal violet assay demonstrated statistically superior rates of viability and survival for A549 (lung carcinoma), FU-UR-1 (renal carcinoma), K1 (thyroid carcinoma), and MG-63 (osteosarcoma) cell lines compared to control (HEK293 cells) at 60°C. Additionally, the MTT assay demonstrated superior viability for PC3 (prostate carcinoma), MCF7 (breast carcinoma), and A498 (renal carcinoma) compared to control. All cell lines demonstrated significantly decreased survival and viability in temperatures more than 90°C. Conclusion: This study demonstrated in vitro thresholds for thermal necrosis for cell lines of common orthopedic tumors of bone. The A549 (lung carcinoma), K1 (thyroid carcinoma), and FU-UR-1 (renal carcinoma) cell lines demonstrated greater resistance to heat stress compared to non-neoplastic control cells. Temperatures in excess of 90°C are necessary to reliably reduce cell survival and viability to less than 10%.

Does a Career in Orthopaedic Surgery Affect a Woman's Fertility?

BACKGROUND: Orthopaedic surgery lags behind other specialties in the recruitment of women. Concerns about fertility, pregnancy, and childbearing may be a deterrent to women when considering orthopaedic surgery as a specialty. METHODS: An anonymous 168-item survey was distributed to the members of Ruth Jackson Orthopedic Society and the Women in Orthopaedics, an online group exclusive to female orthopaedic surgeons. Respondents were queried regarding family planning, contraceptive length of use, fertility, perinatal work habits, age and stage at each pregnancy, pregnancy complications, and miscarriages. RESULTS: Eight hundred one surveys were collected. Seven hundred fifty (94%) expressed interest in having children of their own, with 60% having at least one child at the time of the survey. The average maternal age at birth of the first child was 33.6 ± 3.6 years. Voluntary childlessness was reported by 6% (49/801) of survey respondents. Eighteen percent of this group stated that their choice as an orthopaedic surgeon served as a barrier to having children. Among those with children, childbearing was intentionally delayed by 53% because of their career choice (425/801). Fifty-two percent did not conceive their first child until the end of their training. Complications during pregnancy were reported among 24%. A total of 853 children were conceived by this cohort with assisted reproductive technology being used 106 times. Miscarriages were reported by 38% (304/801). Of those who miscarried, only 28% informed their employer and 8% took time off during or immediately after their miscarriage. CONCLUSION: Most respondents desire to have children but two-thirds delay doing so because of their career choice and its demands. Having a family is an important part of life for many orthopaedic surgeons, and our study provides an updated description of the fertility and pregnancy characteristics of female orthopaedic surgeons to help guide present and future surgeons in their family planning.

Free tibia and fibula-fillet-of-leg flap for pelvic ring reconstruction: A case report.

Pelvic sarcoma resections present large and complex defects, which are a challenge to reconstruct. At times, these cancers are treated with external hemipelvectomy, and both the soft tissue and bony framework of the pelvic ring must be addressed. The purpose of this case report is to describe the use of a free tibia and fibula-fillet-of-leg flap for pelvic ring reconstruction, performed to enhance the quality of life of a patient following hemipelvectomy. A 50-year-old female with advanced stage undifferentiated pleomorphic sarcoma of the left thigh and pelvis underwent free vascularized tibia and fibula-fillet-of-leg flap, including 21 cm of bone length and 21 cm long and full circumferential soft tissues of the leg, accompanying the bone, for the reconstruction of the bony pelvis and soft tissue. Postoperatively, the patient had no surgical complications, was followed for 6 months and went on to have bony healing, and was able to sit prior to disease progression and eventual death from metastatic disease. In the reported case, we have shown that composite tibia-fibula free flap with lower leg soft tissues may be a viable option for the reconstruction of massive external hemipelvectomy defects.

Side Variations of Anterior Cruciate Ligament Coronal Angles: Implications for ACL Reconstruction.

Current literature has shown a biomechanical advantage of recreating the native coronal obliquity of the anterior cruciate ligament (ACL) during grating procedures; however, the majority of studies on ACL morphological variation have been performed unilaterally. This cadaveric study aimed to evaluate sided ACL coronal angle of inclination variation including trend analysis with sex, age, height, and femoral condyle width. The ACLs of 57 embalmed cadaveric specimens were evaluated bilaterally for a total of 114 ACLs. The knees were flexed to 110°. A 0.70-mm wire measured coronal angulation through the lateral tibial plateau and the medial ACL border. An image taken of the wire allowed digital measurement with the ImageJ software. IBM SPSS was utilized for statistical analysis. Bilateral measurements demonstrated a difference in an individual's sided ACL angulation (P < 0.001). Right-sided angulation was greater in 61.4% (35/57). In cadavers with greater right-side angulation, right ACLs averaged 66.2° versus left ACLs averaged 60.9° (P < 0.001). Cadavers with greater left-sided ACL angles demonstrated average left ACLs measuring 65.5° versus right ACLs measuring 60.6° (P < 0.001). Right-sided angles were greater in 69.7% of females. Understanding the anatomy of the ACL's native coronal angle and variations between a patient's knees is imperative during reconstruction surgery to aid in anatomic tunnel placement for improved knee motion and rotational knee kinematics following surgery. A statistically significant difference exists between an individual's right and left ACL coronal angles of inclination. Clin. Anat. 32:1102-1106, 2019. © 2019 Wiley Periodicals, Inc.