Microsurgical reconstruction in limb salvage due to a giant cell tumor of the distal radius. Case report.

The giant cell tumor of bone is one of the most controversial neoplasms due to growth patterns that may present. The case reported shows a very aggressive tumor in a classic location, but key to hand function. Rather than treat with radical surgery, was planned and performed a wide resection with an ulnar-carpus arthrodesis and microsurgical reconstruction of the defect throught an anterolateral thigh flap. The multidisciplinary approach of bone neoplasms produce a positive impact on patients.

El tumor óseo de células gigantes es una de las neoplasias más controversiales debido a los patrones de crecimiento que pueden presentar. El caso reportado muestra un tumor muy agresivo en una localización clásica, pero clave para la función de la mano. En lugar de tratarla mediante cirugía radical, se planeó y realizó una resección amplia con artrodesis cúbito-carpiana y la reconstrucción microquirúrgica del defecto mediante un colgajo anterolateral de muslo. El abordaje multidisciplinario de las neoplasias óseas repercute positivamente en los pacientes.

[Origin of surgical metastatic bone disease]. / Origen de la enfermedad ósea metastática quirúrgica.

BACKGROUND: Metastatic bone disease should be considered as a public health problem. The alterations it may cause include pain that is refractory to medical treatment, metabolic instability, pathologic fractures and spinal disorders. MATERIAL AND METHODS: The primary tumor site that led to the need for surgery was investigated in a series of patients with a diagnosis of metastatic bone disease. The bone involved and the histology of the lesions were also studied. RESULTS: Kidney cancer was the one that most frequently required a surgical procedure; it was followed by breast and prostate cancer. The primary tumor was not found in 6.36% of cases. The bones affected by the lesions studied were as follows in order of occurrence: femur, spine, humerus and pelvis. Adenocarcinoma was the most frequent histological diagnosis. DISCUSSION: The diagnosis of metastatic bone disease should always be considered in patients over forty years of age with skeletal lesions, preferably lytic. CONCLUSIONS: In this study, kidney cancer, the proximal limbs and adenocarcinomas were the variables that most frequently produced metastatic bone lesions that warranted a surgical procedure.

[The art of diagnosing bone tumors]. / El arte de diagnosticar tumores oseos.

Bone tumors are infrequent and at times difficult to diagnose, especially when the medical team is not familiar enough with this type of pathology. A close relationship between the surgeon, the radiologist and the pathologist is necessary to diagnose bone neoplasias. A thorough case history and physical exam are mandatory to get the first clinical impression. After the former aspects, conventional radiology offers a powerful tool for the characterization and differential diagnosis of bone tumors and seudotumor lesions. Patient age and radiologic findings are very important to reach a diagnosis. Supplementary studies contribute to stage the lesion and guide the biopsy and they are necessary to plan the definitive surgery. Biopsy is a very important procedure that should be performed at the hospital by the surgeon who will later perform the definitive surgery. When the pathologist gets the tissue specimen, regardless of the type of biopsy, the entire patient history should be considered before making the final diagnosis.

[Massive allograft and wrist arthrodesis for a giant cell tumor of the distal radius. Report of two cases and literature review]. / Aloinjerto masivo y artrodesis de la muñieca para un tumor de células gigantes del radio distal. Reporte de dos casos y revisión de la literatura.

INTRODUCTION: The giant cell tumor represents 5% of all the primary bone tumors and 20% of the benign bone neoplasias. The most common locations are the distal femur and the proximal tibia (50%) as well as the distal radius (10%). Treatment methods include the intralesional resection of the latent and active tumors, and broad resection for the aggressive lesions. The wrist reconstruction after broad resection of the distal radius represents a challenge for the orthopedic surgeon. OBJECTIVE: To present 2 clinical cases of patients diagnosed with giant cell tumor of the distal radius who were treated with broad resection and placement of a massive allograft with wrist arthrodesis. To perform a bibliographic review and the analysis of the different treatment methods described. MATERIAL AND METHODS: Description of the treatment and course of each case, as well as a bibliographic review and the analysis of the treatments found. RESULTS: Radiologic data of the allograft integration at 11 months and a functionality which was compatible with all the activities of daily living. DISCUSSION: The massive allograft of the distal radius with wrist arthrodesis represents a very safe and appropriate option for the reconstruction of this anatomic segment after broad resection.

[Complications of oncologic hemipelvectomy]. / Complicaciones en hemipelvectomía oncológica.

INTRODUCTION: The treatment of bone pelvic tumors is associated with high compli cation rates. The surgeon usually has to decide between external and internal hemipelvectomy. OBJECTIVE: To describe the frequency of infectious and wound-related complications in a group of patients undergoing hemipelvectomy for different types of musculoskeletal tumors. MATERIAL AND METHODS: This is an observational, descriptive, retrospective study with a single measurement. We observed the complications that occurred in eight patients treated with different modalities of hemipelvectomy without reconstruction. Infectious and wound-related complications were described as follows: a) no complications, b) seroma, c) hematoma, d) mild infectious process, e) moderate infectious process, f) severe infectious process, and g) flap necrosis. Internal hemipelvectomies were classified usin Enneking and Dunham's criteria. RESULTS: Eight patients were assessed. Five patients underwent external hemipelvectomy and three internal hemipelvectomy. Two patients had no complications (25%), three had seromas (37.5%), one patient wa treated for a mild infectious process (12.5%) and two for severe infectious processes (25%). 75% of the patients had complications. No cases of flap necrosis were observed. DISCUSSION: The surgeon decides which the best procedure in each case is. Different types of complications of hemipelvectomy have been reported; the most common ones are infectious processes and flap necrosis, and our results are similar to those reported by other authors. CONCLUSIONS: Pelvic bone tumors are usually large masses that hinder the achievement of tumor-free surgical margins. There is a high likelihood of postoperative wound complications.