Periosteal ganglion cyst of tibia: A rare case report.

INTRODUCTION AND IMPORTANCE: Periosteal ganglion cyst is a rare disorder, found only in 55 out of 100,000 people annually. Periosteal ganglion location may cause partial external cortical destruction with irregular saucerization and erosion. This report presents a rare case of periosteal ganglion cyst that occurred of the cruris sinistra. CASE PRESENTATION: A male patient, 68 years old, came with complaint of a lump in the left cruris since one year ago. Nine months later, the lump has increased in size like a chicken egg and still felt painless. MRI result revealed a well-circumscribed multilocular cystic lesion in the peri-osseous soft tissue of the tibia. We performed directly excisional biopsy within the mass, and the histopathology result was periosteal ganglion cyst. CLINICAL DISCUSSION: The exact pathogenesis of periosteal ganglion is unclear. Synovial herniation and mucoid degeneration of the connective tissue of the periosteum are two suggested mechanisms. In some cases, ganglion cysts may compress nearby nerves. Surgical treatment is recommended for patients who still experience symptoms after non-surgical management has failed. Complete resection of the cyst and surrounding periosteum is recommended to prevent recurrence. After 6 months post-operative follow up clinical examination, no recurrence symptoms founded on the patient. CONCLUSION: Periosteal ganglion is a rare lesion and may mimic other bone surface lesions. Resection of the periosteal ganglion cyst with surrounding periosteum is important to prevent recurrence.

The Outcome of Orthopedics Treatment of Lombok Earthquake Victim 2018: A Cohort of One-Year Follow-Up Study-Lesson Learned After Lombok Earthquake.

Introduction: There was a magnitude 7 on the Richter scale earthquake on Lombok Island in 2018, causing more than 500 deaths. In the event of earthquakes, there is often an imbalance between overcrowding in hospitals and inadequate resources. The initial management of earthquake victims with musculoskeletal injuries is controversial, arguing over whether to utilize debridement, external or internal fixation, or conservative or operative treatment in an acute onset disaster situation. This study aims to determine the outcome of initial management after the 2018 Lombok earthquake, between immediate open-reduction and internal fixation (ORIF) and Non-ORIF procedures after one year follow-up. Methods: This is a cohort study to evaluate radiological and clinical outcomes one year after orthopedic treatment in the Lombok earthquake 2018. The subjects were recruited from eight public health center and one hospital in Lombok in September 2019. We evaluate radiological outcomes (non/malunion and union) and clinical outcomes (infection and SF-36 score). Results: Based on 73 subjects, the ORIF group has a higher union rate than the non-ORIF group (31.1% vs. 68.9%; p = 0.021). Incidence of infection only appeared in the ORIF group (23.5%). Clinical outcome as measured by SF36 showed the ORIF group had a lower mean of general health (p = 0.042) and health change (p = 0.039) clinical outcomes than the non-ORIF group. Discussion: The most affected public group is the productive age with significant impact on social-economy. ORIF procedure is a major risk factor of infection in initial treatment after earthquake. Therefore, definitive operation with internal fixation is not recommended in the initial phase of a disaster. Damage Control Orthopedic (DCO) surgery protocol is the treatment of choice in acute disaster setting. Conclusion: The ORIF group had better radiological outcomes than the non-ORIF group. However the ORIF group had higher cases of infection and lower SF-36 than the non-ORIF group. Definitive treatment in acute onset disaster setting should be prevented.

Surgical techniques for medial clavicular tumors: A report of 3 cases.

INTRODUCTION AND IMPORTANCE: Clavicular tumors are rare, consisting of <1 % of all skeletal tumors. In this series, we described our experience of treating medial clavicular tumors. CASE PRESENTATION: We treated three patients with medial clavicle tumors at a national tertiary referral hospital in Jakarta, Indonesia. The patients were treated with wide excision following bony reconstruction from fibular bone and one patient was treated by marginal excision. Each patient was treated by surgery and one patient underwent reconstruction using non-vascularized fibular graft and composite using bone cement. CLINICAL DISCUSSION: All patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. Based on these cases above and the extension of tumor, we recommend medial clavicle tumor resection classification divided into three type to decide which type of surgical procedure that should be performed. In our report, all patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. CONCLUSION: Clavicle resection in management of medial third clavicle tumor is technically demanding. We proposed three types of clavicular resection based on tumor extension. The surgical technique of medial end clavicle in this patient resulted in tumor free margin of medial clavicular, medial scapula, and lateral scapular incision. Reconstruction surgery following clavicle resection can be done in order to restore symmetry of the lower neck and upper chest, protect nearby neurovascular bundle, and rarely associated with significant shoulder function loss.

The association of the COVID-19 outbreak with in-hospital mortality: A single-centre study from Indonesia.

Objective: The early outbreak period of Coronavirus Disease (COVID-19) has affected the emergency department (ED) and hospital services in many countries. This study aimed to investigate the association between COVID-19 outbreak and in-hospital mortality in Jakarta, Indonesia. Methods: This retrospective cohort study was conducted in a single-centre referral hospital in Jakarta, Indonesia. Data were collected between May and October 2020. All patients who visited the ED and required inpatient care during the early COVID-19 outbreak period at the study location (March to April 2020) were included in the exposure group. All patients who visited the ED and required inpatient care during the non-outbreak period (March to April 2019) were included in the non-exposure group. In-hospital mortality was the primary outcome, whereas other variables, such as sex, age, triage categories, trauma cases, referral cases, and ED length of stay (LOS), were measured to identify confounding and effect modifications. Multivariate logistic regression analysis was performed to assess this association. Results: A total of 2,808 patients during the outbreak period and 2,423 patients during the non-outbreak period participated in the study. The odds of in-hospital mortality increased during the outbreak period compared to that during the non-outbreak period (odds ratio [OR], 1.41; 95%CI 1.04-1.91; p = 0.01) after adjusting for age, sex, triage categories, trauma case, ED LOS, and interaction between the outbreak period and ED LOS. Conclusion: COVID-19 outbreaks have been associated with an increased risk of in-hospital mortality in referral hospitals in Jakarta, Indonesia.

Post COVID-19 Syndrome Monitoring in Confirmed COVID-19 Patients with Telemedicine at Cipto Mangunkusumo Hospital.

BACKGROUND: The incidence of post-covid-19 syndrome is quite high and requires further monitoring after the patient is discharged from treatment. So we need a proper monitoring method and description of the Covid-19 syndrome in Indonesia.  Methods: This retrospective cohort study with total sampling method uses data from medical records and telemedicine observations of confirmed COVID-19 patients who received treatment in the Kiara room at Cipto Mangunkusumo. The data were then analyzed using chi-squared and multinomial logistic regression techniques. RESULTS: A total of 133 samples were used, including 44.4% male and 55.6% female, with an average age Standard Deviation (SD) of 40.36 (17.94). The severity levels of Covid-19 were mild (66.9%). The most common post-Covid-19 symptom manifestations was cough expressed at the first follow-up (first week after recovery) and second follow-up (the fourth week after recovery). Furthermore, the significant relationship between severity levels and post-Covid-19 symptomatic syndrome outcomes is the critical headache or vertigo symptoms with an RR of 8.70 (95% CI, 1.10-68.69,). In comparison, the telemedicine quality assessment was declared good, as shown by 98.7% of an examined sample. CONCLUSION: The most manifestation shown in the first and fourth week of follow-up is cough. Other symptoms tend to decrease in the second follow-up. The severity level associated with post-Covid-19 manifestations are severe-critical with headache or vertigo as a risk factor and mild with symptoms of headache or vertigo as a preventative. Meanwhile, the quality of telemedicine services was recognized as good by the majority of the sample.

Acetabular reconstruction with total hip replacement and femoral head autograft following pelvic resection of malignant bone tumour: A case report.

INTRODUCTION: Pelvic tumors greatly impact survival and quality of life of the patient. Reconstruction following resection of neoplasms involving the acetabulum remains one of the most challenging procedures for orthopaedic surgeons. We reported an 18-year-old female with Hodgkin's lymphoma of the left iliac wing. PRESENTATION OF CASE: A 18-year-old female presented left hip pain since one year before admission. Pelvis X-ray demonstrated lytic lesion on the left iliac crest with moth-eaten pattern. However, the contrast-enhanced MRI showed the true extent of the tumour which engulfed the iliac crest and extended to the anterior border of the acetabulum. The acetabulum was reconstructed using femoral head autograft and total hip replacement. At six months of follow-up, CT scan of the pelvis demonstrated no tumour. No complications occurred during 14 months of follow-up. However, the patient died 28 months post surgery. DISCUSSION: In pelvic sarcomas, the utilization of this technique remains limited, as the complex anatomy and the bulk of tumour growth often limits the choice of what procedure can be conducted. Reconstruction techniques have also advanced, albeit difficult and laden with complications, especially when the lesion involves the acetabulum. CONCLUSIONS: The choice of implant for pelvic resection in the developing country remains challenging due to the high cost of implants. However, in cases of pelvic sarcomas, the utilization of this technique remains limited, as the complex anatomy and the bulk of tumour growth often limits the choice of what procedure can be conducted. Reconstruction techniques have also advanced, albeit difficult and laden with complications, especially when the lesion involves the acetabulum.

Correlation between Prognostic Factors and the Histopathological Response to Neoadjuvant Chemotherapy in Osteosarcoma: A Retrospective Study.

BACKGROUND: Multimodality treatment, incorporating neoadjuvant chemotherapy and adjuvant chemotherapy, is the standard management plan for osteosarcoma that increases the overall survival (OS) rate. However, data regarding prognostic factors affecting the histopathological response following neoadjuvant chemotherapy is limited. Patients and Methods. We retrospectively reviewed patients diagnosed with osteosarcoma in our center between 2008 and 2018. We classified patient characteristics according to gender, age, tumor size, site and stage at diagnosis, site of metastasis, type of surgery, necrosis rate based on the Huvos grading system, and the number of neoadjuvant chemotherapy cycles. We divided response to neoadjuvant chemotherapy into poor responder for patients with Huvos grades 1 and 2 and good responder for patients with Huvos grades 3 and 4. We also documented patients' survival and follow-up information. RESULTS: We reviewed 64 patients within 5-65 years of age, dominated by men (62.5%). The distal femur (53.1%) was the most common site of osteosarcoma. Fifteen (23.4%) patients had a good response while 49 (76.6%) patients were poor responders to neoadjuvant chemotherapy based on the Huvos grading system. Based on multivariate analysis, gender (p = 0.012), age (p = 0.029), symptom duration (p = 0.004), and tumor enlargement after neoadjuvant chemotherapy (p < 0.001) were significantly associated with histopathological response. A scoring system was proposed integrating these significant variables (age > 20 years = 1 point, female gender = 1 point, symptom duration > 12 weeks = 1 point, and increased tumor size after neoadjuvant chemotherapy = 2 points). This scoring system divides patients into two groups with a total score of more than two predicting a poor responder to neoadjuvant chemotherapy. CONCLUSIONS: Age, gender, symptoms duration, and tumor size after neoadjuvant chemotherapy are the prognostic features that affect the histopathological response to neoadjuvant chemotherapy in patients with osteosarcoma.

Pedicle screw system reconstruction in shoulder resection type IV-total scapulectomy: A case report and short term follow up.

INTRODUCTION: Shoulder resection remains a challenging procedure after scapulectomy for tumour resection. The results have various functional outcome, wound coverage, and cosmetic aspect. In this case report, we reported the outcome of pedicle screw application after scapulectomy procedure within 1 month follow up after surgical tumour excision. CASE PRESENTATION: A 74-year-old female presented with a painful lump on the left shoulder since nine months before admission. We performed physical examination, radiological evaluation using x-ray and MRI. We performed limb salvage surgery with shoulder girdle resection of tumour procedure using Malawer technique type IVB and applied pedicle and screw in proximal end clavicula and proximal end of humerus. We performed histopathological examination to ensure the tumour. We evaluated the patient one month after surgery using DASH score. DISCUSSION: MRI examination revealed that there was a solid mass with malignant characteristic destructing left scapular bone with the acromioclavicular and glenohumeral joint involvement. We used pedicle and screw to reconstruct the patient with efficient cost spending consideration. Clinical valuation showed there was no pain left and hand-free movement except the limitation of shoulder abduction. DASH score evaluation pre operative and post operative showed improvement from 70.8 to 45.0. CONCLUSION: Limb salvage procedure using pedicle screw system may be one of treatment of choice for treating tumour of the shoulder affecting glenohumeral joint with excellent result of evaluation both clinical and functional outcome.

Five-Year Cancer Epidemiology at the National Referral Hospital: Hospital-Based Cancer Registry Data in Indonesia.

PURPOSE: In 2016, there were 1,308,061 cases of cancer being treated in Indonesia, with 2.2 trillion rupiahs spent, amounting to $486,960,633 in US dollars (purchasing power parity 2016). The high burden of cancers in Indonesia requires a valid data collection to inform future cancer-related policies. The purpose of this study is to report cancer epidemiological data from 2008 to 2012 based on Hospital-Based Cancer Registry (HBCR) data from Cipto Mangunkusumo Hospital, Indonesia. METHODS: This was a descriptive study with cross-sectional design. Data were collected from Cipto Mangunkusumo Hospital HBCR 2008-2012. Demographical, diagnostic, stages of cancer, and histopathological types of cancer data were extracted. RESULTS: After screening, 18,216 cases were included. A total of 12,438 patients were older than 39 years of age (68.3%), with a female-to-male ratio of 9:5. Most patients have cancers at advanced stages (stages III and IV, 10.2%). The most common sites of cancer were cervix uteri (2,878 cases, 15.8%), breast (2,459 cases, 13.5%), hematopoietic and reticuloendothelial systems (1,422 cases, 7.8%), nasopharynx (1,338 cases, 7.4%), and lymph nodes (1,104 cases, 6.1%). CONCLUSION: From this HBCR, cancer incidence in female was almost twice the incidence in male, largely because of the burden of cervical and breast cancers. The cervix uteri as one of the top five cancer sites based on this HBCR, 2008-2012, are still approximately consistent with Global Cancer Incidence, Mortality and Prevalence 2018, which portrayed that Indonesia has been severely afflicted by cervical cancer cases more than any other Association of Southeast Asian Nations countries. The HBCR could serve as a robust database of epidemiological data for cancer cases in Indonesia.

Emergency orthopaedic surgery in the pandemic era: A case series at Cipto Mangunkusumo national tertiary hospital in Jakarta, Indonesia.

INTRODUCTION: Every emergency surgery performed is aimed at saving lives; however, during COVID-19 pandemic, surgeries are often postponed. Many existing recommendations take into account postponing surgery during a pandemic. How these surgeries can lead to increasing infection rates has not been widely published. This study aims to investigate the relationship of emergency orthopaedic surgery and the incidence rate of COVID-19. PRESENTATION OF CASE: This was a case series of 14 patients. The study was performed at the emergency department unit at a national tertiary hospital in Jakarta, Indonesia. A total of 14 patients underwent orthopaedic surgery in the emergency room of our institution. The mean age of the subjects was 40.07 ± 20.5 years. Twelve (85.7%) were male patients and 2 (14.3%) were female patients. The average duration of surgery was 125 minutes. The most used type of anaesthesia was general anaesthesia for 6 operations (50%). Patients were hospitalized for an average length of 4 days. Three patients had infiltrates found on plain x-ray examination, which required further examination to determine whether the cause was COVID-19 infection or not. There was no ground glass appearance (GGO) in the three patients in further follow-up examination. CONCLUSIONS: We found that emergency orthopaedic surgery was not associated with increasing number of COVID-19 cases. Factors including duration of surgery, length of stay, types of anaesthesia and comorbidities were also not associated with COVID-19 cases in this study.

A modified technique of mega prosthesis revision on non-neoplastic patient: Case report.

INTRODUCTION: Mega prosthesis is mainly used for the treatment of the oncologic patient whose limb underwent salvage surgery that caused the limb to lose significant bone or soft tissue. In recent years, mega prosthesis can also be used to treat non-oncologic patients. PRESENTATION OF CASE: We presented a case of a 40-year-old male with chief complain of pain on the right knee 5 months before admission. Four years previously, the patient sustained motor vehicle accident that fractured his head of femur dan distal femur. He underwent 2-staged surgery for his femoral head and distal femur. However, he presented a year later with signs of non-union and finally underwent mega prosthesis surgery on his distal femur. During his follow up, he experienced a fracture on his prosthesis 3 years later and was referred to our institution. Physical examination shows deformity and slight varus on the right knee, and limited range of motion. The patient then underwent implant revisions. DISCUSSION: After 12 months of post revision surgery follow-up, the patient was able to walk independently. Our patient has not had any sign or episode of failure after the follow up for 12 months. According to literature, the incidence of failure is mostly at 48-72 months post implantation. CONCLUSION: The problem for this patient maybe caused by the mechanical fatigue of the implant due to stress addressed to the implant. Our current technique of revisions procedure hopefully will enhance the power of the mega prosthesis for further usage.

Management of synovial chondromatosis of the hip by open arthrotomy debridement only VS total hip replacement: A case report.

INTRODUCTION: Synovial chondromatosis is an unusual nonneoplastic condition of joints. Clinical symptoms usually insidious, and the patient often came in the late stage of the disease. Treatment generally include arthroscopy debridement, open arthrotomy debridement to evacuate loose bodies, or in a very late stage with a collapsing joint, it might need a joint replacement arthroplasty. METHODS: We report two cases of a 55-year old and a 22-year-old man with synovial chondromatosis of the hip. Both patients came with hip pain, but the former presents at a late stage with osteoarthritis of the hip. The former underwent open arthrotomy debridement to evacuate loose bodies, synovectomy then followed by a total hip replacement. The latter underwent open arthrotomy debridement only to evacuate loose bodies and synovectomy without performing dislocation of the hip. Postoperative outcome was evaluated using plain hip x-ray, pain scale with VAS, and functional score with Harris Hip Score (HHS). RESULTS: At 1-year follow up, both subjects demonstrate an improving functional outcome. The former patient had an improved HHS from 39 to 91 while the latter had an improved HHS from 68 to 93. With complete removal of the metaplastic tissue and synovectomy, the recurrence of the chondromatosis is not apparent yet until now. DISCUSSION: Arthrotomy debridement only or arthrotomy debridement followed by total hip replacement can be considered as an option in treating synovial chondromatosis of the hip as both show a successful outcome. A selective method of treatment must be considered in our decision making for each individual.

Parosteal Osteosarcoma: A Benign-Looking Tumour, Amenable to a Variety of Surgical Reconstruction.

Osteosarcoma arising from cortical surface is classified into parosteal, periosteal and high-grade surface osteosarcoma. Along the spectrum, parosteal osteosarcoma occupies the well-differentiated end. It is a relatively rare disease entity, comprised only 4% of all osteosarcomas and barely reported in the literature. The objective of this study is to describe cases of parosteal osteosarcoma as well as a variety of treatment options amenable to such entity. Six cases of parosteal osteosarcoma were identified based on histopathological reports in a tertiary referral hospital in Jakarta, Indonesia between January 2001 and December 2019. The mean age was 29.8 years old; four of them (66.7%) were male. Distal end of femur was the most commonly involved bone (five cases, 83.3%). The patients were treated with wide excision followed by several different reconstruction methods: replacement with endoprosthesis, extracorporeal irradiation, knee arthrodesis, or prophylactic fixation. One of our patients presented with dedifferentiated component, and therefore was treated by limb ablation. While two cases died of pulmonary metastasis, other patients reported fair to excellent functional outcome.

Reconstruction of osteosarcoma of the proximal tibia using bone on polyethylene hemiarthroplasty knee joint system: A case report.

INTRODUCTION: Current treatment in treating patient with osteosarcoma is combination of chemotherapy and surgery, either limb-sparing or limb-ablation surgery. One challenge in limb-sparing technique in children is how to deal with the remaining growth of the bone. We created a limb-sparing reconstruction technique that can be fitted in many types of hospital and have a good functional outcome. CASE PRESENTATION: We reported a case of 13-years-old female with left knee pain since 8 months prior hospital admission with previous treatment to a bone setter and open biopsy at previous hospital. Histopathological findings demonstrated osteosarcoma. The patient had a neoadjuvant chemotherapy and followed with limb-sparing surgery. We performed wide excision of proximal tibia and reconstruction using a bone on polyethylene hemiarthroplasty system of the knee joint. Patient then continued on adjuvant chemotherapy. Later on, local recurrence occurred and we performed excision again. Within one year, the patient could walk full weight bearing, perform daily activities with no limitation and no pain, and she had MSTS score of 21. DISCUSSION: Limb-sparing surgery remains a challenging procedure in skeletally immature patients. This bone on polyethylene technique would be functional due to high adaptability in paediatric patients in order to decrease the number of surgeries until the final goal of limb equalization. CONCLUSION: Bone on polyethylene hemiarthroplasty system enables good and reliable functional outcome while maintaining the knee joint for daily activity. It can be chosen as one of viable options in treating osteosarcoma around the knee joint in children.

Functional outcome of operative treatment for pelvic metastatic bone disease from primary thyroid cancer: A case series.

BACKGROUND: Metastatic bone disease (MBD) is the most common malignancy of bone. It is estimated that 70 % of all malignant bone tumors are due to metastasis. The functional outcome from pelvic MBD surgical management has been rarely described in the literature contrary to that of the long bones. METHOD: We reported three patients that underwent pelvic resection surgery due to pelvic MBD. All of the primary tumors were thyroid cancer. We measure the functional outcome using SF-36 and MSTS (musculoskeletal tumor society) scores after a one-year follow-up. RESULT: The SF-36 scoring result was that all of the patients had a remarkable improvement in terms of pain (77.5 %, 100 %, and 100 %). All of the patients also still had proper social functioning (75 %, 100 %, and 100 %) and good emotional well-being (72 %, 92 %, and 88 %). According to the MSTS, the second and third case had an excellent functional outcome; however the first case had poor functional outcome CONCLUSION: Surgery remains the choice of therapy for pelvic MBD that results in alleviation of pain and quality of life improvement.

Modified total humeral replacement on unusual osteosarcoma of the humerus: A case report.

INTRODUCTION: Osteosarcoma of the humerus is an unusual case. In order to salvage the limb, resection followed with total humeral replacement is preferred. In situations where those prostheses are not available, a technique of modified total humeral replacement could be used. CASE PRESENTATION: A 20-year-old female patient came with osteosarcoma of the right humerus accompanied by pathological humeral shaft fracture, with the onset of six months. The lesion extended along the proximal to distal part of humerus. The patient underwent a neoadjuvant chemotherapy before surgery and a limb salvage surgery by wide excision of the humerus and reconstruction using modified total humeral replacement was performed. Modifications to the shoulder hemiarthoplasty and total elbow prostheses were made, so both prostheses could join as one unit. DISCUSSION: After the surgery, no disturbances of hand function were seen, and functional outcome was evaluated by using Musculoskeletal Tumour Society Score (MSTS) score with score of 83% (excellent). After 3 years of follow up, patient could work and resume daily activity with improved MSTS score. There were neither sign of tumor recurrence nor distant metastasis on follow up. CONCLUSION: Total Humeral Replacement for the treatment of humerus malignancy was feasible by using this modification. This procedure yielded good functional outcome.

Reconstruction giant cell tumor of the right proximal humerus Campanacci 3 with pedicle and rod system: A case report.

INTRODUCTION: Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. Although considered to be benign tumors of bone, GCT has a relatively high recurrence rate. Tumor often extends to the articular subchondral bone or even abuts the cartilage. The joint and/or its capsule are rarely invaded. Surgical resection is the universal standard of care for the treatment of bone GCT. The key ensuring an adequate surgical treatment with complete removal of tumor is by obtaining adequate exposure of the lesion. PRESENTATION OF CASE: We reported a case of 24-years-old male with Giant cell tumor (GCT) of the right proximal humerus. Patient presented with chief complaint of pain on the right shoulder and had a history of fell on the right elbow. Radiographic examination showed a primary bone tumor of the proximal humerus. MRI provided excellent depiction in suggesting the diagnosis of cutaneous GCT Campanacci 3, which was later, affirmed by biopsy. Patient underwent successful wide excision and reconstruction. The limb salvage procedure consisted of shoulder resection type 1B and reconstruction with pedicle screw and rod system. During 5 days post-operative period, there was no major event observed. Patient could do shoulder flexion forward 0-30, shoulder extension 0-20, elbow extension - Flexion, wrist flexion extension, and fingers flexion. DISCUSSION: GCT of bone typically shown as an epiphyseal, eccentric, expansive lytic lesion with a 'soap-bubble appearance'. MRI is useful to assess extracortical spread and intramedullary extension. Surgery is the treatment of choice. Curettage is usually combined with cementing or bone grafting. Hemi-articular and total elbow allografts have been used for reconstruction of the defects following tumor excision, but the complication rates are high, and these techniques are reserved as salvage procedures following failed total elbow arthroplasty. CONCLUSION: Wide resection and total elbow arthroplasty enables good functional outcome and lower risk for recurrence. Pedicle and rod system for shoulder reconstruction is a viable option, as it provides good pain relief and functional improvement with lower complication rates.

Correlation between survival and tumour characteristics in patients with chondrosarcoma.

PURPOSE: To evaluate the correlation between survival and tumour characteristics in 23 patients with chondrosarcoma. METHODS: Records of 15 men and 8 women aged 14 to 66 (mean, 37) years who were diagnosed with primary (n=19) or secondary (n=4) chondrosarcoma of the axial skeleton (n=8), proximal extremity (n=9), or distal extremity (n=6) were reviewed. The tumour diameter was <10 cm in 4 patients, 10-19 cm in 12, and 20-30 cm in 7. The tumour involved the intramedullary in 17 and the periosteum in 6 patients; tumour extension was intracompartmental in 5 and extracompartmental in 18 patients. The Evans histological grade for the tumours was grade 1 in 6 patients, grade 2 in 10, and grade 3 in 7. The mean tumour size was 12.3 cm for grade 1 tumours, 18.2 cm for grade 2 tumours, and 18.3 cm for grade 3 tumours. 13 patients had no metastasis and 3 of 10 patients with grade 2 tumours and all 7 patients with grade 3 tumours had metastasis to the lung at presentation. 17 patients underwent surgery, one underwent adjuvant treatment only, and 5 declined treatment. RESULTS: The mean follow-up period for the 23 patients was 3.1 years (range, 3 weeks to 9 years). The 5-year survival rate was 43% overall, 83.3% for grade 1 tumours, 50% for grade 2 tumours, and 0% for grade 3 tumours. The median survival duration was 20 (95% confidence interval, 11-29) months. Two patients had local recurrence and 16 did not, and the 5 patients who declined treatment died. Survival correlated with Evans histological grading (p=0.004), the presence of metastasis at presentation (p=0.026) and local recurrence (p=0.004). CONCLUSION: The survival rate was lower in patients with higher Evan grading, metastasis, or local recurrence.

Bilateral iliopsoas haemophilic "soft tissue pseudotumours": A case report.

Haemophilic soft tissue pseudotumour is one of the rarest complications of haemophilia that caused by repetitive bleeding resulting in an encapsulated mass of clotted blood and necrotic tissue. Soft tissue pseudotumour may not only cause flexion contracture but also chronic pain and femoral nerve compression that cause severe disability. Thus, surgical excision is the treatment of choice. It should only be carried out in a major haemophilic center by an integrated multidisciplinary surgical team.

Fibrodysplasia Ossificans Progressiva: Difficulty in Diagnosis and Management A case report and literature review.

INTRODUCTION: Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant genetic disorder and characterized by postnatal progressive heterotopic ossification of the connective tissue. There are difficulties in diagnosing FOP, thus delayed or misdiagnosis and mismanagement is common. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. CASE REPORT: We present the diagnosis and surgical management of a 9-year old Indonesian girl with FOP. She presented with extensive involvement of cervical spine and both shoulders. Total excision of occipito-cervico-lumbar and paravertebral ossification and also exostoses at bilateral shoulder was done. At three years follow up, she had local recurrence with similar range of movement of the shoulder and cervical spine. CONCLUSION: FOP is an extremely rare case. It is difficult to diagnose and manage FOP, therefore delayed or misdiagnosis and also inappropriate management is common.