Orthopedic oncology residency education, how broad and how deep?

Orthopedic residency training has long been an area of active research and discussion, and as the knowledge and concepts in subspecialties evolve, it is crucial to investigate the implications of these advancements in the musculoskeletal oncology field. It is important to note that the acquisition of surgical skills and scientific knowledge from orthopedic texts alone is not sufficient in this area. Orthopedic residents must also acquire multidisciplinary communication and leadership skills, as well as the mental capacity to make sound clinical decisions. Therefore, this commentary highlights the importance of assessing whether the current curriculum provides adequate preparation for residents' future careers, despite the fact that the expansion of subspecialties in orthopedic education has undoubtedly enhanced the depth of knowledge and concepts in the field. In addition, orthopedic residents must adopt an open-minded and scientific approach toward orthopedic oncology, which has unique principles. Moreover, it is crucial that general orthopedic surgeons have the necessary skills to manage patients and know when to refer them. By exploring these issues, we hope to continually contribute to ongoing discussions about how to improve orthopedic residency education.

Gorham-Stout syndrome, the challenge in diagnosis and unique in treatment: a case report.

BACKGROUND: Gorham-Stout disease is a rare condition with fewer than 400 reported cases in the literature. The presentation of Gorham-Stout disease varies on the basis of location, extent, fracture, and accompanying symptoms. It lacks a specific histopathological appearance but is characterized by vascular changes and the absence of cellular atypia. CASE PRESENTATION: This article presents a case study of a 16-year-old Persian boy with an entire femur with Gorham-Stout disease, highlighting the difficulties in managing this condition. The lack of a clear diagnosis resulted in prolonged procedures, delayed medical treatments, and ultimately required total femoral replacement with an endoprosthesis. CONCLUSION: It is important to note that raising awareness of this disease and its potential complications can facilitate timely and appropriate treatment for patients presenting in the early stages of the disease.

Talus osteohondroma with syndesmosis problem; case report.

INTRODUCTION AND IMPORTANCE: Osteochondroma, commonly known as exostosis, is a benign osteocartilaginous mass lesion frequently encountered in orthopaedic clinics. While its benign nature is of little concern, the impact on surrounding tissues can be significant, especially in the case of exostosis located in the distal tibia and fibula, which can damage the syndesmosis. CASE PRESENTATION: This report presents a rare case of exostosis of the talus that has progressed into the syndesmosis, causing distinct clinical and radiographic symptoms. The patient underwent excision of the lesion through the posterolateral ankle approach, and our main concern was about the approach to the syndesmosis. Ultimately, open reduction and screw fixation were performed for the patient. CLINICAL DISCUSSION: Exostosis in the talus area is generally uncommon in the literature review, and the presence of the lesion in the posteromedial surface area, as well as its entry and damage to the syndesmosis area, is even less common. Diagnosing the lesion through appropriate methods and a multidisciplinary team approach is crucial for correct diagnosis and treatment. Different approaches to managing syndesmosis have been reported, and suitable treatment for these cases is required. CONCLUSION: In conclusion, correct diagnosis and excision of the exostosis lesion are essential, but it is also necessary to appropriately identify and manage its adverse effects. The selection of an appropriate treatment strategy for managing these lesions is crucial.

Guided growth in the correction of knee deformity in patients with congenital insensitivity to pain.

BACKGROUND: Orthopedic manifestations of congenital insensitivity to pain (CIP) can be devastating if left untreated. Knee deformities are common in patients with CIP and might lead to joint destruction and loss of walking ability. The purpose of the present study was to report the results and complications of guided growth procedures around the knee in patients with CIP. METHODS: In a retrospective review, all patients with CIP who underwent guided growth procedures around the knee from 2009 to 2017 at a tertiary referral hospital were evaluated. Patients with secondary insensitivity to pain (e.g., syringomyelia), as well as patients with incomplete records, were excluded. Demographic data, clinical findings, correction rate, and complications were recorded. RESULTS: Ten knees in six patients fulfilled the inclusion criteria. The median age was 10 (range, 5-12), with a mean follow-up of 31 months (range, 16-56). Distal femoral tension-band hemiepiphysiodesis was the most common procedure, followed by proximal tibial hemiepiphysiodesis. The mean correction rate was 0.28°/month for femoral deformity. Staples were removed prematurely in one patient due to extrusion. No cases of infection or skin dehiscence were observed. None of the patients needed a reconstructive knee procedure during the study period. CONCLUSIONS: The findings of this study suggest that guided growth procedures might have a role in the correction of knee deformities in patients with CIP. However, the correction rate is lower than that of typically developing children, patients should be closely followed to prevent complications, and stringent patient selection criteria should be followed to ensure success.

Collapsed membranes within pelvic cyst: What is the diagnosis?

Collapsed membranes and daughter cysts are pathognomonic for hydatid cysts on imaging. The comma-shaped lesions, visible within the hydatid cyst in sagittal view of MRI, are collapsed membranes. Although primary hydatid cyst of pelvic cavity is rare, clinicians should remember to include hydatid cysts in differential diagnosis of pelvic cysts.

Interfragmentary motion assessment for three different fixation techniques of femoral neck fractures in young adults.

BACKGROUND: Vertical femoral neck fractures in the youth could be happened in high-energy accidents, and because of dominant shearing forces, this fracture is considered as a troublesome injury with a controversy regarding selection of the best fixation method. OBJECTIVE: The long term goal of this quasi-experimental study was to find the more stable fixation method among cannulated screws (CSs), proximal femoral locking plate (PFLP), and dynamic hip screw with derotational screw (DHS+DS) for this kind of fracture. METHODS: Twelve fresh-frozen cadaveric femurs were assigned to three groups that were matched for mean bone mineral density and stiffness of intact bone. Vertical fractures were artificially mimicked in the specimens and fixed using three different implants, i.e. CSs, PFLP, and DHS+DS. Then, the samples were tested under incremental, cyclic, and failure loading phases. RESULTS: The differences in all biomechanical parameters were statistically significant among tested groups (p<0.05). All biomechanical parameters for the DHS+DS method of fixation are significantly different from those corresponding to CSs (p<0.05). There were no significant differences in failure load and failure energy between the PFLP and CSs techniques (p>0.05). Also, there were no significant differences in relative stiffness and femoral head displacement between the PFLP and DHS+DS groups (p>0.05). CONCLUSIONS: Based on the clinical assumption that restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the results of this study suggest that the priority order of selection for the stable fixation implant of vertical femoral neck fracture in young patients is DHS+DS, then PFLP, and finally CSs.

Lunate Osteochondral Fracture Treated by Excision: A Case Report and Literature Review.

INTRODUCTION: Lunate fracture is a rare injury. Most reports are associated with other wrist injuries such as perilunate dislocation and distal radius fracture. Isolated lunate fracture has been reported even more rarely. The choice of treatment and outcomes are consequently undetermined. CASE PRESENTATION: In this case report we will describe a lunate avulsion fracture as an isolated injury after a fall from nine meters treated operatively by excision of the comminuted avulsed fragment. After 33 months of follow-up radiographs showed no sign of degenerative joint disorder on simple X-ray, but slight Volar Intercalated Segment Instability (VISI) by a capitolunate angle of 26 degrees was noted. Clinically, the patient was pain free near full wrist and forearm range of motion and could perform his previous vocational and recreational tasks without any limitations. CONCLUSIONS: Despite apparently good short and mid-term clinical outcome, slight volar intercalated segment instability after 33 months of follow-up revealed that lunotriquetral ligament function was probably lost, which led to static instability. This ligament injury may be missed primarily. Excision of the avulsed osteochondral fragment should be the last option of treatment and most attempts should be tried to fix and/or restore the normal anatomy of ligamentous structure.

Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations.

Femoral neck fractures in young patients are usually caused by a high-energy trauma, which results in a perpendicular fracture. Although efforts are focused on preserving the femoral head in young patients, vertical femoral neck fracture is a problematic orthopedic injury due to the domination of shear forces. Due to controversy regarding which fixation method is the best choice, the purpose of this study was to find the most stable fixation method for this kind of fracture. This study includes experimental testing on cadaveric bone samples and finite element analysis (FEA) for three fracture fixation techniques, namely cannulated screws (CSs), dynamic hip screw with derotational screw (DHS + DS), and proximal femoral locking plate (PFLP). Experimental results of bone-implant stiffness, average femoral head displacement, failure load, failure energy, and relative position of the fractured fragments indicate that DHS + DS offers the strongest structure for stabilizing a vertical femoral neck fracture. Experimental data and FEA results both indicate that under static loading, the DHS + DS method of fixation produces the lowest femoral head displacement and interfragmentary movement, followed by PFLP and then CSs. The results of this research suggest that, based on the clinical assumption that a restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the DHS + DS method of fixation is a better choice compared to CSs and PFLP for a vertical femoral neck fracture fixation in young adults.

Combining Concentrated Autologous Bone Marrow Stem Cells Injection With Core Decompression Improves Outcome for Patients with Early-Stage Osteonecrosis of the Femoral Head: A Comparative Study.

The management of early-stage osteonecrosis of the femoral head (ONFH) remains challenging. This study aimed to evaluate the effects of core decompression and concentrated bone marrow implantation on ONFH. The study recruited 28 hips with early ONFH randomly assigned into two groups of core decompression with (group A) and without (group B) bone marrow injection. Patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Visual Analogue Scale (VAS) pain index, and MRI. The mean WOMAC and VAS scores in all patients improved significantly (P<0.001). MRI showed a significant improvement in group A (P=0.046) and significant worsening in group B (P<0.001). Bone marrow stem cell injection with core decompression can be effective in early ONFH.

Late sequelae of hip septic arthritis in children.

Septic arthritis of the hip in children has multiple sequelae and may result in severe disability. Significant morbidity can be prevented by early recognition and treatment. The authors reviewed 13 children with 14 hips with sequelae of septic arthritis of the hip. All of children had history of hip septic arthritis before age of 4 years. Six were male subjects, and 7 were female subjects. We evaluated the history, clinical findings and radiographs of all children who had been treated at the Imam Khomeini hospital between 1986 and 2001 for septic arthritis of the hip. Final results of operations in patients include range of motion, presence or absence pain, joint stability, limb-length discrepancy were assessed. Three hips had mild pain in usual daily activities and one patient with cerebral palsy experienced hip instability. Most of patients (80%) had flexion contracture about 10-15 degrees .Final results showed average limb length discrepancy was about 2.8 cm. Septic arthritis of the hip in children may result in a spectrum of residual problems and the significant complications can be averted by early detection and treatment. Treatment in younger age cause better outcome.

Periosteal osteoblastoma: report of a case with a rare histopathologic presentation and review of the literature.

Osteoblastoma is an uncommon benign bone tumor most commonly located in the vertebral column or metaphysis of a long bone. Periosteal location is rare. We report a periosteal-based osteoblastoma, arising from the proximal tibia, in a 20-year-old woman who presented with knee swelling and pain of 2-year duration. Imaging studies showed a metaphyseal surface-based lesion with patchy radiodensities. The cortico-medullary junction was intact. The lesion was totally excised. Histopathologic evaluation disclosed immature bone and osteoid deposition in a vascularized stroma, associated with numerous osteoblasts and osteoclasts rimming the bony trabeculae. Plate-like arrangements of cartilage in the margin of the neoplastic tissue were also identified. At 16 months postoperatively, the patient was well without recurrence. Although extremely unusual, the presence of cartilage does not necessarily exclude the diagnosis of osteoblastoma.