Outcomes of ilium and iliosacral Ewing's sarcoma resection reconstructed with tibial strut allograft.

Aims: Ilium is the most common site of pelvic Ewing's sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients' outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft. Methods: Medical files of 43 patients with ilium and iliosacral ES who underwent surgical resection and reconstruction with a tibial strut allograft between January 2010 and October 2021 were reviewed. The lesions were classified into four resection zones: I1, I2, I3, and I4, based on the extent of resection. Functional outcomes, oncological outcomes, and surgical complications for each resection zone were of interest. Functional outcomes were assessed using a Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Results: The mean age of the patients was 17 years (SD 9.1). At a mean follow-up of 70.8 months (SD 50), the mean functional outcomes were 24.2 points (SD 6.3) for MSTS and 81 points (SD 11) for TESS. The mean MSTS and TESS scores were associated with the iliac resection zone (< 0.001). Nine patients (20.9%) had local recurrence. The recurrence was not associated with the zone of iliac resection (p = 0.324). The two-year disease-free survival of the patients was 69.4%. The mean time to graft union was longer in patients with the I4 resection zone (p < 0.001). The complication rate was 34.9%, and nerve palsy (11.6%) was the most common. The rate of surgical complications was not associated with the resection zone. Conclusion: Reconstruction using tibial strut allograft is an efficient procedure after the resection of the ilium and iliosacral ES. Functional outcomes and complications of iliac ES depend on the resection zone, and inferior outcomes could be generally expected when more segments of the pelvic ring are resected, even if it is reconstructed.

Outcomes of Megaprosthesis Reconstruction for the Salvage of Failed Osteoarticular Allograft Around the Knee implanted before Skeletal Maturity in Primary Bone Sarcoma: A Case-Series.

Objectives: Functional expectations following the salvage of a failed osteoarticular allograft are poorly described. In this study, we aim to evaluate functional outcomes, implant survival, and complications of the megaprosthesis in salvaging a failed osteoarticular allograft around the knee. Methods: We retrospectively reviewed the medical profiles of 21 skeletally mature patients who underwent megaprosthesis reconstruction to salvage a failed osteoarticular allograft around the knee implanted before skeletal maturity. The location of reconstruction was the proximal tibia in 13 patients and the distal femur in eight patients. Knee function was evaluated by the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Results: The mean age of patients was 16±1.7 years. The mean interval between the primary (allograft) and secondary (megaprosthesis) reconstructions was 59.4±23.6 months. At an average follow-up of 51.2 months, the mean knee range of motion was 101.2±15.6°. The mean MSTS score and TESS were 83.6±7 and 86.6±7.9, respectively. The mean limb length discrepancy was 2.5±1 cm before and 0.36±0.74 cm after the operation (P<0.001). Six postoperative complications (28.6%) occurred in this series, including one wound dehiscence, one periprosthetic fracture, two acute infections, one aseptic loosening, and one delayed periprosthetic infection. Only the last two complications required revision. Accordingly, the two- and five-year implant survivals were 95.7% and 90%, respectively. Conclusion: Megaprosthesis is a viable option for salvaging failed osteoarticular allografts around the knee. It also provides the opportunity to correct the limb length discrepancy.

Does the intercondylar approach provide a better outcome for chondroblastoma of the distal femur in skeletally immature patients?

Aims: The epiphyseal approach to a chondroblastoma of the intercondylar notch of a child's distal femur does not provide adequate exposure, thereby necessitating the removal of a substantial amount of unaffected bone to expose the lesion. In this study, we compared the functional outcomes, local recurrence, and surgical complications of treating a chondroblastoma of the distal femoral epiphysis by either an intercondylar or an epiphyseal approach. Methods: A total of 30 children with a chondroblastoma of the distal femur who had been treated by intraregional curettage and bone grafting were retrospectively reviewed. An intercondylar approach was used in 16 patients (group A) and an epiphyseal approach in 14 (group B). Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and Sailhan's functional criteria. Results: At final follow-up, the mean MSTS score was 29.1 (SD 0.9) in group A and 26.7 (SD 1.5) in group B (p = 0.006). According to Sailhan's criteria, the knee function was good and fair in 14 (87.5%) and two (12.5%) patients of group A, and eight (57.1%) and six (42.9%) patients of group B, respectively (p = 0.062). The lesion had recurred in one patient (6.2%) in group A and four patients (28.6%) in group B. Limb shortening > 1 cm was recorded in one patient (6.2%) from group A and six patients (42.8%) from group B. Joint degeneration was noted in one patient from group A and three patients from group B. Conclusion: An intercondylar approach to a chondroblastoma of the middle two-quarters of the distal femoral epiphysis results in better outcomes than a medial or lateral epiphyseal approach: specifically, better limb function, a lower rate of recurrence, and a lower rate of physeal damage and joint degeneration.

Using action research to evaluate a nursing orientation program in a multicultural acute healthcare setting.

OBJECTIVES: Competence motivates newly employed nurses to provide high-quality care, which leads to appropriate patient care and satisfaction. A nursing orientation program can have a positive impact on new nurses who are joining healthcare organizations. The research examined the orientation program for new nurses in a multicultural setting to redesign the program. METHODS: The study was carried out in a multicultural tertiary setting. Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. Seventy nurses were part of the orientation program. The competence of the nurses was assessed using the Nurse Competence Scale. Focus-group discussions were also conducted to find the views of the beneficiaries about the program. RESULTS: The study revealed that the overall competence was high, and there was an overall gain in the competence score (5.48%) among the nurses. Among their competence in different dimensions, new nurses had a maximum gain in competence for the dimension of ensuring quality. However, they showed low competence gain in teaching coaching. The results show that the difference in the overall pre- and post-test scores was statistically significant (P < 0.05) in all dimensions except teaching coaching and managing situations, and the program was effective. However, a few challenges were identified in the program. CONCLUSIONS: New nurses were found to be competent, and the orientation program had a significant impact on the competence of the nurses. The findings emphasized the need for modification of some content and strategy for future programs. The strategies developed from the findings were presented. This helps hospitals to consider examining specific aspects of the orientation program and redesigning it so it can enrich the experiences of new nurses.