Evaluation of Bone and Soft Tissue Tumors of the Shoulder Girdle.

INTRODUCTION: The shoulder girdle comprises the scapula, clavicle, proximal humerus, and the soft tissues surrounding these structures. Bone and soft tissue tumors are notably more prevalent in the lower extremity than in the upper extremity. However, the shoulder ranks as the third most common site for primary tumors, following the hip-pelvis and knee. MATERIALS AND METHODS: This study conducted a retrospective examination of patients who presented with pain and swelling in the shoulder and its vicinity. The evaluation was carried out using a multidisciplinary approach by the Bone and Soft Tissue Tumors Council. RESULTS: The study included 224 patients diagnosed with a tumoral lesion in the shoulder girdle between 2004 and 2021. Among these patients, 22 were assessed to have lesions other than tumors, while 105 (51.98%) had benign lesions, and 97 had malignant lesions. The most prevalent benign lesions were cystic bone lesions (30) and soft tissue lipomas (10). The primary form of malignant lesion was metastatic tumors (49). CONCLUSION: Pathologies in the shoulder girdle may manifest through pain, palpable swelling, pathological fractures, or may be incidentally detected via radiological imaging. Notably, pain, hypercalcemia, and pathological fractures are significant indicators, especially in cases of bone metastases, which often follow a highly fatal course when involving long bones. The musculoskeletal system is the third most common site for metastasis, following the lungs and liver. Hence, particular attention should be directed toward metastatic concerns in the shoulder and its surrounding area.

Measuring the Whole Wall Thickness of the Common Femoral Vein as a Distinctive Diagnostic Tool to Distinguish Behçet's Disease Presenting with Oral Ulcers from Recurrent Aphthous Stomatitis.

Recurrent oral ulcers, which are the first and most common manifestation of Behçet's disease (BD), have several etiological causes but are often idiopathic and known as recurrent aphthous stomatitis (RAS). In recent years, publications have drawn attention to the fact that whole-wall thickness (WWT) and intima-media thickness (IMT) measurements of the common femoral vein (CFV) may be useful in the diagnosis of BD, which are independent of organ involvement. In this study, the usefulness of the WWT and IMT of the CFV measured by venous Doppler ultrasound (US) was investigated in differentiating BD presenting with oral ulcers from RAS. Patients with BD (n = 84), patients with RAS (n = 85), and healthy controls (HCs) (n = 70) were the three groups included. Both the right and left WWT of the CFV were significantly higher in the BD compared with the HCs and RAS groups (p < 0.001). The diagnostic cutoff values of ≥0.58 mm for the WWT of the CFV performed well against both the patients with RAS and HCs for the discrimination of BD (sensitivity = 79.8%, specificity = 64.7%). In patients with recurrent oral ulcers, the WWT of the CFV measurement may be a distinctive new diagnostic tool for the differential diagnosis of BD and RAS.

Momordica charantia enhances tendon healing in rats: An experimental study.

Momordica charantia (MC) is a traditional plant widely used since ancient times for wound healing. This study evaluated its potential effects on tendon healing. Adult Male Wistar albino rats (n=32, 8 rats in each group) were anesthetized, and their Achilles tendons were prepared for surgical procedures. Group 1 (Cont= control group) were not subjected to any surgery and were used as a control group for baseline values. Group 2 (PR= primary repair group) underwent primary repair (PR) with a monofilament suture after a full-thickness incision of the Achilles tendon. A full-thickness incision was also made to the Achilles tendon of Group 3 (CT=collagen tube administered group), followed by PR and collagen tube insertion. In Group 4 (MC= Momordica charantia-administered group), 1 ml of MC extract was applied locally on the collagen tube in addition to the surgical procedure applied to Group 3. The Achilles tendons were excised on the postoperative 40th day and examined stereologically, histologically, and bioinformatically. Data showed that the total volume of the collagen fibers was higher in MC and CT groups than in the PR group. The total volume of the tendon was decreased in MC and CT groups than in the Cont group. The ratios between the volumes of the collagen fibers and total tendon in the MC and CT groups were significantly different from PR; but not different from the Cont group. Additionally, MC improved tenoblastic activity, collagen production, and neovascularization. Bioinformatic interactions showed that the proteases of MC could trigger the signals playing a role on vasculogenesis, reducing inflammation, and contributing to tenoblast activation and collagen remodeling. MC extract ameliorates the healing of injured tendon and can provide satisfactory tendon repair. Further works are recommended to explore the healing capacity of MC.

The effect of adjuvant cryotherapy added to well-performed high-speed burr curettage on the long-term surgical outcomes of chondroblastoma cases.

OBJECTIVES: This study aims to investigate the effect of adjuvant cryotherapy added to well-performed high-speed burr curettage on the long-term surgical outcomes of chondroblastoma cases. PATIENTS AND METHODS: Between January 2004 and December 2020, a total of 30 chondroblastoma cases (19 males, 11 females; median age: 18.6 years; range, 9 to 53 years) who were surgically treated were retrospectively analyzed. The pressurized-spray technique was performed using liquid nitrogen. Data including age, sex, radiological appearance, treatment modality, duration of follow-up, skin problems, and recurrence were recorded. All patients received adjuvant liquid nitrogen cryotherapy after extended intralesional curettage with high-speed burr. The bone cavity was filled with an autologous iliac crest bone graft, allograft, or polymethylmethacrylate (PMMA). RESULTS: The median follow-up was 54 (range, 19 to 120) months. The lesion was located around the knee in 16 (53.3%), in the shoulder in seven (23.3%), around the hip in five (16.6%), and in the ankle in two (6.6%) cases. The defect was filled with an autologous iliac crest bone graft in 28 (93.3%), an additional allograft in eight (26.7%), and PMMA in two (6.7%) cases. Local recurrence was observed in only two (6.7%) patients during follow-up. Two (6.7%) patients developed physeal growth arrest. Osteoarthritic changes were observed in two (6.7%) patients (one knee and one hip) due to the periarticular location of the tumor. Three (10%) patients had skin complications. None of the cases had a pathological fracture. CONCLUSION: A well-performed extended intralesional curettage with high-speed burr is the first and essential step in treating chondroblastoma. Adding adjuvant liquid nitrogen cryotherapy with high-speed burr can improve treatment outcomes and significantly reduce the recurrence rate of this disease.

Gorham-Stout Disease: A Case Report and Review of the Literature.

Gorham-Stout disease causes gradual bone loss (osteolysis) due to an abnormal overgrowth of lymphatic vessels. This rare disease is usually seen in younger people. The etiopathology of Gorham-Stout disease remains unclear. The disease is pathologically characterized by the proliferation of the vascular or lymphatic vessels and, finally, bone matrix destruction. These pathological changes lead to the presence of massive osteolysis on plain radiographs. Thus, plain radiograph findings may lead physicians to consider tumoral conditions, especially metastasis. There are several other conditions on the differential diagnosis list of massive osteolysis, such as metabolic, infectious, malignant, and immunological conditions. After excluding all possible disorders, the disease can be considered in the differential diagnosis. The treatment of the disease is symptom-based, but there is no consensus. Pharmacological methods should be considered first-line treatment. If there is no regression in the course of the disease despite pharmacological treatment, radiotherapy and resection arthroplasty are the treatment of choice in the later stages. In this case report, we present a case of Gorham-Stout disease, which was treated by pharmacological methods. During the one and half year follow-up, the local control of the disease was achieved without any surgical intervention.

Buschke-Ollendorff Syndrome: A Rare Cause of Unilateral Genu Valgum.

Buschke-Ollendorff syndrome is a rare, often benign, autosomal dominant skin disorder. This syndrome commonly presents with non-tender connective tissue nevi and sclerotic bony lesions. Characteristic skeletal findings such as melorheostosis and hyperostosis are usually present. Most cases are detected incidentally. Skin lesions appear first and become less noticeable with age. Bone lesions occur in the later decades of life. Another rarely associated symptom, melorheostosis, is manifested by the appearance of wax running through the cortex of the bone. Plain radiographs usually show cortical hyperostosis. This study aims to present a case report of Buschke-Ollendorff syndrome from an orthopedic aspect and emphasize the importance of the disease since it can be easily assessed as a bone tumor. Second, to the best of our knowledge, this is the first case presented with a unilateral genu valgum deformity with a long-term follow-up in the relevant literature.

Osteosarcoma of the Proximal Fibula: A Case Report and Review of the Literature.

Osteosarcoma is the most common primary malignant bone tumor, especially in younger patients. Diagnosis is based on the combined evaluation of radiological, clinical, and pathological examinations. It is usually located in the distal femur, proximal tibia, and proximal humerus. The fibula is a rare localization for osteosarcoma. Surgery in this region is challenging due to the complex anatomic structures around the knee. Especially the peroneal nerve, lateral collateral ligament (LCL), and popliteal vessel branches are of critical importance. However, additional structures such as the arcuate ligament, biceps femoris, and iliotibial band play an essential role in the stabilization of the knee. Thus, these structures must be protected as much as possible. This case report aims to present the diagnosis and treatment process of conventional osteosarcoma in the proximal fibula, which was located close to the peroneal nerve and required LCL reconstruction after the resection.

Is the Thickness of the Margin Associated With Local Recurrence and Survival in Patients With Myxofibrosarcoma?

BACKGROUND: Myxofibrosarcoma (MFS) is a spectrum of aggressive soft tissue fibroblastic neoplasms characterized by variable myxoid stroma, pleomorphism, and a distinctive curved vascular pattern; these tumors are associated with a high likelihood of recurrence. Better local tumor control (a tumor-free margin) is believed to be important to minimize the risk of recurrence, but the effect of surgical resection margin status on local recurrence and survival in MFS is not as well-characterized as it might be. QUESTIONS/PURPOSES: (1) Is margin width associated with local recurrence? (2) Is there a relationship between greater margin thickness and improved overall and disease-free survival (DFS)? (3) Is worsening French Federation of Cancer Centers grade associated with local recurrence and poorer overall survival? METHODS: Using a database of patients with bone and soft tissue tumors at a tertiary university hospital, we retrospectively reviewed the medical records of 282 patients who had soft tissue sarcomas and who had been surgically treated by a multidisciplinary bone and soft tissue tumor care team between January 2010 and December 2021. Of these 282 patients, 38 were identified as having MFS. Patients who received surgical care for MFS outside our institution (unplanned resection) (four patients) and whose surgical margins were not reported as microscopic numerical data (10) were excluded from the analysis. We estimated survival and local recurrence and examined factors potentially influencing these outcomes. Patient demographics, tumor characteristics, surgical margin distance (in mm), and disease-related outcomes were recorded. The minimum follow-up was 3 months (median 41.5 months, range 3 to 128 months). RESULTS: Overall 1-year local recurrence-free rates were 66.7% (95% CI 50% to 88%). Patients with positive margins were more likely to have local recurrence than patients with negative margins (HR 10.91 [95% CI 2.61 to 45.66]; p = 0.001). Patients with an inadequate margin (positive margin or a negative margin of 1 mm or less) had a greater risk of local recurrence (HR 9.96 [95% CI 1.22 to 81.44]; p = 0.032). Patients with positive margins or margins less than or equal to 1 mm had worse 2-year local recurrence-free survival than did those with margins of greater than 1 mm (46.9% [95% CI 16% to 76%] versus 91.7% [95% CI 75% to 100%]; p = 0.005). The mean overall survival was 98 months (95% CI 77.2 to 118.8). The Kaplan-Meier overall 1-, 2- and 5-year estimated rates of survival were 88% (95% CI 75% to 100%), 79.2% (95% CI 64.5% to 97.2%), and 73.5% (95% CI 57.2 % to 94.5%), respectively. Positive surgical margins were associated with decreased overall survival (HR 6.96 [95% CI 1.39 to 34.89]; p = 0.018). There was a mean DFS time of 4.25 months (95% CI 0.92 to 7.59) in microscopically positive patients, 75.5 months (95% CI 37.47 to 113.53) in patients with margins 1 mm or less, and 118 months (95% CI 99.23 to 136.77) in patients with margins over 1 mm. There was a statistical difference between DFS times according to surgical margin classification (p < 0.001). With the numbers we had, we could not detect any difference between the histologic grades determined by the French Federation of Cancer Centers grading system in terms of local recurrence (HR 3.80 [95% CI 0.76 to 18.94]; p = 0.103) and overall survival (HR 6.91 [95% CI 0.79 to 60.13]; p = 0.080). Tumor size was the prognostic factor associated with a higher local recurrence rate among all factors analyzed as univariate (HR 1.18 [95% CI 1.05 to 1.32]; p = 0.004). CONCLUSION: A surgical procedure with a sufficient negative surgical margin distance appears to be associated with a lower proportion of patients who experience a local recurrence and is associated with overall patient survival. It is difficult to define what a sufficient margin is, but in our patients, it appears to be greater than 1 mm.Level of Evidence Level III, therapeutic study.

The Epidemiology and the Treatment of Fractures Due to Electric Scooters: A Comparison of Pediatric and Adult Age Groups.

AIM: Electric scooters (e-scooters) are widely used as alternative vehicles worldwide. These light vehicles do not need a license to drive, and it is also popular among vehicles under the age of 18 among users in Turkey. This is a new term in the literature since there is an increase in accidents resulting from this overuse. This study aims to reveal the patterns and severity of orthopedic injuries resulting from using an e-scooter, especially in the pediatric population. PATIENTS AND METHODS:  Patients who were admitted to the university hospital emergency department due to using an e-scooter and had fractures were retrospectively analyzed. Demographic data, admission times, injury mechanisms, and fracture patterns of the patients were documented. RESULTS: Forty-nine (49.4%) of 99 patients were under 18, and 50 (50.6%) were over 18. It is seen that 58.5% (58 patients) had an accident by falling spontaneously, 37.3% (37 patients) collided with vehicles in traffic, and 4.2% had an accident by colliding with a standing object. While 59.5% of the upper extremity fractures are seen, 27.2% are lower extremity fractures. Multiple fractures were observed in 13.3%. CONCLUSION: Pediatric population frequently uses these alternative means of transport. The pediatric group usually had upper extremity injuries, while adults mostly had lower extremity injuries. Care must be taken when children are drivers of e-scooters.

Silver Nanoparticles Enhance the Antibacterial Effect of Antibiotic-Loaded Bone Cement.

Purpose The goal of this study was to determine the antibacterial activity of bone cement in polymethyl methacrylate (PMMA) structures with varying amounts of silver nanoparticles (AgNPs) included. Additionally, we aimed to evaluate whether AgNPs affect the biomechanical properties of PMMA cement in our study. Materials and methods Between April 2020 and June 2020, we conducted a series of experiments to demonstrate the antibacterial characteristics by adding silver nanoparticles to PMMA bone cement. PMMA bone cement (Cemex, Tecres Company, Verona, Italy) was used as the base material. Seven different samples were prepared in order to evaluate the amount and presence of AgNPs. Cement samples containing AgNPs and teicoplanin at different concentrations and empty cement (control, without teicoplanin and AgNPs) were placed on Petri plates. The agar diffusion method was used to determine the antibacterial effect (Kirby-Bauer). Results Kirby-Bauer assays demonstrated that AgNPs added to bone cement increased the antimicrobial activity compared to antibiotic-free or only teicoplanin-loaded cement. It was observed that increasing the AgNPs ratio further increased the antimicrobial activity. Conclusion AgNPs in various combinations enhance antimicrobial activity synergistically while maintaining the mechanical strength of bone cement. Increasing the amount of AgNPs results in a significant increase in antimicrobial activity.

The Effect of Tourniquet Duration on Pain, Bleeding, and Functional Outcomes in Total Knee Arthroplasty.

Objective The aim of this study was to evaluate the effects of tourniquet use on perioperative blood loss, pain, and functional and clinical outcomes. Patients and methods This is a prospective study that included 80 knees who underwent total knee arthroplasty. The patients were separated into two groups: those with a tourniquet used throughout the entire surgical procedure and those where the tourniquet was only used during the cementation procedure. In the postoperative period, the pain levels of the patients were evaluated using a visual analog scale (VAS), and the functional results were evaluated with knee range of motion measurement, the Western Ontario and Mcmaster Universities Osteoarthritis (WOMAC) index, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Kujala Patellofemoral Scoring System, and the Oxford Knee Scoring system. The patients were examined in the early postoperative period and again in the 12th week, including possible complications that may develop postoperatively. Results In the early postoperative period, a greater hemoglobin decrease and calculated blood loss values, better functional clinical results, and better knee range of motion were determined in the group with a tourniquet applied only during the cementation, and the swelling in the knee was less (p<0.05). However, the difference between the two groups had disappeared by the postoperative 12th week. There was no significant difference in respect of complications. Conclusion Limiting the duration of tourniquet use during total knee arthroplasty has the significant advantage of providing better functional results with less pain in the early postoperative period.

Analysis of prognostic factors and histopathological response to neoadjuvant chemotherapy in osteosarcoma.

OBJECTIVES: This study aims to examine the clinical results of patients who underwent medical and surgical treatment for osteosarcoma, to determine the overall survival (OS) and disease-free survival (DFS) rates, and to examine the effects of prognostic factors on these rates. PATIENTS AND METHODS: Between January 2005 and January 2020, a total of 64 patients (38 males, 26 females; mean age: 20.9±11.5 years; range, 6 to 70 years) who received medical and surgical treatment for osteosarcoma were retrospectively analyzed. Demographic characteristics, follow-up period, tumor location and size, tumor stage and necrosis rate, metastatic disease, surgical treatments, postoperative complications, local recurrence, and metastasis were recorded. The relationship of these factors with the survival was examined. RESULTS: The median follow-up was 51.6 (range, 3 to 156) months. The most common tumor localization was in the distal femur with 42 (65.6%) patients and the most common histopathological subtypes were conventional osteosarcoma in 50 (78.1%) patients. The OS rates were 91.6% at one year, 65.9% at five years, and 51.6% at 10 years. With the exception of two patients who died during neoadjuvant chemotherapy, all patients underwent surgical treatment. The addition of chemotherapy + radiotherapy in the treatment did not provide any benefits in terms of survival and recurrence compared to the group that was not added, and the five-year OS rate was 79.3% compared to 20.7%, respectively. The overall 10-year survival rates were 83.9% and 37.2% in the group with a good response (≥90%) and poor response (<90%) to treatment (p=0.012). The mean survival time of three patients who presented with pathological fractures was shorter than the others (p>0.05). Surgical margin was ≤2 mm in 27 (42.2%) patients, >2 mm in 30 (46.9%) patients, and surgical margin was positive in five (7.8%) patients. The mean OS in the group with a surgical margin closure of >2 mm was 10.8±1.9 years and was longer than the other groups (p=0.047). CONCLUSION: Metastasis at the time of diagnosis, <90% tumor necrosis, a tumor size of ≥10 cm, and metastasis development were significantly associated with poor survival and were found to be independent prognostic factors. The OS rate in the patient group with Stage III-IV response after neoadjuvant chemotherapy given the cisplatin + doxorubicin protocol was found to be better than those given the European and American Osteosarcoma Studies (EURAMOS) protocol. More research is needed to determine the most optimal chemotherapy protocols in this patient population. In addition, a multidisciplinary approach in treatment is of utmost importance to improve oncological outcomes.

Domain-Specific Priors and Meta Learning for Few-Shot First-Person Action Recognition.

The lack of large-scale real datasets with annotations makes transfer learning a necessity for video activity understanding. We aim to develop an effective method for few-shot transfer learning for first-person action classification. We leverage independently trained local visual cues to learn representations that can be transferred from a source domain, which provides primitive action labels, to a different target domain - using only a handful of examples. Visual cues we employ include object-object interactions, hand grasps and motion within regions that are a function of hand locations. We employ a framework based on meta-learning to extract the distinctive and domain invariant components of the deployed visual cues. This enables transfer of action classification models across public datasets captured with diverse scene and action configurations. We present comparative results of our transfer learning methodology and report superior results over state-of-the-art action classification approaches for both inter-class and inter-dataset transfer.

Evaluation of prognostic factors and oncological outcomes in patients with limb-localized myxoid liposarcoma.

OBJECTIVES: This study aims to evaluate the prognostic factors and treatment outcomes of patients with extremity-localized myxoid liposarcoma (MLS). PATIENTS AND METHODS: Between January 2001 and October 2019, a total of 43 patients (29 males, 14 females; mean age: 56.3±11.4 years; range, 34 to 76 years) who were histopathologically diagnosed with MLS in our clinic were retrospectively analyzed. Data including demographic characteristics, tumor localization, tumor volume and length, histopathological characteristics, the surgery and chemotherapy (CT)/radiotherapy (RT) applied, survival rates, and complications such as local recurrence and metastasis were recorded. The treatment results and potential prognostic factors were identified. The overall survival (OS) and cancer-specific survival (CSS) rates were evaluated. RESULTS: The mean follow-up was 106.8±54.1 (range, 29 to 204) months. The mean tumor size was 11.4±6.5 (range, 4.7 to 36) cm. Tumor localization was determined as lower extremity in 76.7% of cases and upper extremity in 23.2%. The patients were divided into two groups according to the type of RT they received as follows: the patients who underwent neoadjuvant RT + wide surgical resection (n=14, 32.5%) and patients who underwent extensive surgical resection + adjuvant RT (n=29, 67.4%). To four patients who developed distant metastasis and to two who developed local recurrence, adjuvant CT was applied. In the whole cohort, the OS rate was 87.1% at five years and 73.2% at 10 years. The five and 10-year CSS rates were 83.5% and 66.4%, respectively. Local recurrence developed in 12 (27.9%) and distant metastasis in four (9%) patients. In the multivariate analysis, high tumor grade, R2 margins, and metastasis were found to be independent risk factors for OS. Although wide resection provided significantly good local control, neoadjuvant RT and adjuvant CT were not found to be prognostic factors for OS or CSS (p>0.05). CONCLUSION: High tumor grade, R2 margins, and metastasis are independent risk factors for increased OS and OSS. Surgery with CT and neo/adjuvant RT is not an independent risk factor for OS or CSS. Despite patients with a larger tumor size and neurovascular proximity, similar disease-free survival rates can be achieved in the patients receiving neoadjuvant RT. Neoadjuvant RT can be considered in lesions close to neurovascular structures or in large lesions, with a high risk of wound complications.

The Terrible Triad of the Elbow Accompanied by Capitellum and Humerus Shaft Fracture: A Rare Case Report.

The terrible triad of the elbow consists of radial head fracture and coronoid process fracture in addition to posterior dislocation of the elbow. It indicates high-risk complications such as instability, malunion, nonunion, and proximal radioulnar synostosis. We describe a rare case that was admitted to the emergency service with a terrible triad of the elbow with additional capitellum fracture, lateral collateral ligament (LCL) injury, and ipsilateral humeral shaft fracture. We treated the patient urgently by performing osteosynthesis of the humeral shaft fracture, radial head fracture, coronoid fracture, capitellum fractures, and repair of the LCL rupture. The terrible triad of the elbow also can be accompanied by adjacent column fractures, including the humeral shaft. In such complex cases, preoperative planning should be done well, and the entire anatomy should be demonstrated with additional imaging. Optimal treatment of all the fractured bones and ligaments is critical for early rehabilitation. The main aim of surgery is to acquire desired results by starting an early rehabilitation, including joint movement.

Evaluation of prognostic factors affecting survival in chondrosarcoma treatment and comparison with literature.

OBJECTIVES: The aim of this study was to identify the demographic characteristics of chondrosarcoma (CS) and prognostic factors affecting survival. PATIENTS AND METHODS: A total of 87 patients (45 males, 42 females; median age: 51.3 years; range, 19 to 77 years) with CS treated in our clinic between January 2007 and June 2020 were retrospectively analyzed. Demographic characteristics, whether it was primary/secondary, tumor location, histopathological features, tumor grade and stage, clinical follow-up period, surgical treatment methods, use of radiotherapy and chemotherapy, and the presence of local recurrence and metastasis in the postoperative period were recorded. The relationship of these factors with prognosis was analyzed and survival rates were compared. RESULTS: Histological subtype, tumor grade, pathological stage and presence of metastasis were defined as independent predictors in both overall survival and disease-free survival analysis of CS. Overall and disease-free five-year and 10-year survival rates were found to be the highest in the clear cell chondrosarcoma group. While mortality increased in the first five years in the patient groups with histological Grade 2 and 3, all groups were followed in a balanced manner over time. The mortality rate in the group with metastatic disease (M2) was approximately four times higher than the other groups at 10-year follow-up. According to the surgical margins, we found that the five-year survival rates of the R1 (marginal resection) and R2 (residual tumor) groups were similar, with the highest rate being in the R0 (wide resection) group with 78.3%. In multivariate analysis, only grade and stage had a significant association with disease-specific survival. Surgical resection combined with adjuvant radiotherapy was found to increase survival in both overall and disease-free survival of patients with dedifferentiated chondrosarcoma compared to other treatments. CONCLUSION: Histological subtype, grade, stage and presence of metastasis were the independent prognostic factors for survival in CS. However, marginal resection was a risk factor for local recurrence (LR), but there was no significant difference in overall survival in patients with or without LR. Although it is not significant, radiotherapy could increase survival in dedifferentiated CS variants.

Avascular Necrosis of the Type II Accessory Navicular Bone: A Rare Case Report.

The accessory navicular bone (ANB) is one of the most common accessory ossicles of the foot. Fewer than 1% of ANBs are symptomatic, and most of the symptomatic ANBs are type II ANBs. Avascular necrosis of the type II ANB is an uncommon cause of symptomatic accessory navicular syndrome and also a rarely reported condition in the podiatric medical literature. This rare disorder must be distinguished from other painful conditions of the ANB and should be considered in differential diagnoses. We present a case of avascular necrosis of the type II ANB with sclerosis on radiographs and magnetic resonance images in a 46-year-old woman.

Platelet Rich Plasma Versus Autologous Conditioned Serum in Osteoarthritis of the Knee: Clinical Results of a Five-Year Retrospective Study.

OBJECTIVES: There is no consensus on the effectiveness of platelet-rich plasma (PRP) and autologous conditioned serum (ACS) in the treatment of knee osteoarthritis (OA). Also, the group of patients who will benefit most from this treatment is not clear. This study aims to understand the effects of two treatment modalities: ACS and PRP on pain and clinical scores in the treatment of OA. For this reason, we compared the long-term (five-year follow up) clinical results of the patients to whom these two treatment methods were applied. MATERIALS AND METHODS: Eighty-two knee osteoarthritis cases, selected from a database prospectively maintained in our tertiary university hospital after institutional ethics committee approval, examined between January 2013 and September 2020 and treated with ACS and PRP by the same orthobiological treatment team, were retrospectively analyzed. The clinical results of group A (n=40) treated with ACS and group B (n=42) treated with PRP were statistically analyzed. Clinical evaluations were made pre-injection and at one, six, 12, 24 and 60 months post-treatment, using the knee injury and osteoarthritis result score (KOOS) for the evaluation of function and a visual analog scale (VAS) for the evaluation of pain. RESULTS: Side effects were noted in two patients (5%) in group A and 16 patients (38.1%) in group B. More side effects were seen in group B compared to group A (p<0.001). The better VAS scores in both groups were detected in the sixth and 12th months. When VAS scores were examined, better results were obtained in group A in the 12th and 24th months (p<0.05). When KOOS scores were examined, the superiority of ACS to PRP at 12 and 24 months was shown in KOOS.S, KOOS.P and KOOS.ADL scores (p<0.05). There was no statistically significant difference between the two groups in terms of all scores and baseline scores at 60 months. CONCLUSION: The effectiveness of ACS and PRP treatments can last up to two years. After two years, the effectiveness of both treatments decreases. Comparing the two treatments, ACS treatment showed better results on VAS and KOOS scores compared to PRP treatment.

Frequency of Hypoplasia of the Vertebral Body at L5, and Its Relationship with Degeneration in Patients with Low Back Pain.

AIM: To explain the association between vertebral body hypoplasia and degenerative changes in the discovertebral complex and facet joints, and to assess the incidence of hypoplasia of the vertebral body at the L5 level. MATERIAL AND METHODS: A retrospective analysis was made of 3,100 patients aged 20?50 years who underwent lumbar MRI with a complaint of back pain, of which 55 were identified with vertebral body hypoplasia. Intervertebral disc degeneration was evaluated in the study using the Pfirrmann and Modified Pfirrmann classification systems, while degenerative changes in the vertebrae endplate were assessed using the Modic classification system. Osteoarthritis of the facet joint was graded at the L4-5 level, and spondylolysis and spondylolisthesis rates were compared between the control group and the hypoplasic group. RESULTS: The incidence of hypoplasia of the vertebral body at the L5 level was found to be 1.8% in the population with back pain in the 20?50-year age group. In the hypoplasia group, disc degeneration was detected at a higher rate than in the control group (p < 0.001). The distribution of Modic signal changes in the superior and inferior endplates of the vertebrae differed significantly between the hypoplasia and control groups (p < 0.001).The rate of spondylolysis was 7.7% in the control group and 65.5% in the hypoplasia group (p < 0.001), and spondylolisthesis was significantly more common in the hypoplasia group (18.4%, p < 0.001). In addition, facet joint degeneration was identified more frequently in the hypoplasia group. Degenerative findings were detected in 74.5% of the right posterior intervertebral joints, and in 70.9% of the left posterior intervertebral joints in the hypoplasia group. CONCLUSION: Vertebral body hypoplasia is a predisposing factor for disc degeneration, facet osteoarthritis and degeneration in the vertebral endplates, and has also been associated with spondylolysis and spondylolisthesis.