Computed tomography-guided percutaneous radiofrequency and laser ablation for the treatment of osteoid osteoma - long-term follow-up from 5 to 10 years.

PURPOSE: The impact of computed tomography (CT)-guided, percutaneous radiofrequency ablation and interstitial laser ablation (ILA) on the management of patients with osteoid osteoma was studied. This was carried out by assessing immediate and long-term clinical outcomes, the complication rate, and repeat therapy effectiveness in recurrent patients who have already experienced percutaneous ablation. MATERIAL AND METHODS: Consecutive patients with osteoid osteoma were assessed before the interventional treatment in a single centre from 2010 to 2015. Patient demographics, complications, and recurrence were recorded. The pain was evaluated with Visual Analogue Scale (VAS). Percutaneous procedures were performed by means of radiofrequency thermoablation or ILA. Epidural or regional anaesthesia in the CT suite was applied in all procedures. Success, whether primary or secondary, was measured as complete pain relief without evidence of recurrence after the first or second procedure, respectively. Osteoid osteoma characteristics, procedure overview, and technical success were looked for in pre-procedural and procedural scans. RESULTS: Eighty-three per cent of osteoid osteomas were located in lower extremities, 56% of tumours were intracortical, and 83% of osteoid osteomas were extra-articular. The mean pre-procedure VAS score was 8.5 ± 0.8, while the overall primary success rate of radiofrequency thermoablation and ILA was 87.5%. No major complications were noted. The mean follow-up period for patients in was 7.5 years (5.0-10.2 years). CONCLUSIONS: Percutaneous, CT-guided thermoablation proved to be effective and should become the method of choice in osteoid osteoma treatment because of its minimal invasiveness. Our results show that there is no risk of very late recurrence after achieving primary and secondary treatment success.

How to increase the accuracy of the diagnosis of the accessory bone of the foot?

PURPOSE: The study was conducted to search for confident radiological signs in symptomatic cases of accessory bones. A normal accessory bone appearance on X-ray does not exclude that the accessory bone is the source of the discomfort; because of this, MRI examination can later be applied as part of the diagnosis. METHODS: We retrospectively analysed cases of 64 patients with recognized 70 symptomatic accessory bones of the foot. The average age was 29.2 (range 8-42) years. We included only patients with X-ray and MRI examinations. We investigated the following radiological features of the bone (structural and signal) in relation to soft tissue. RESULTS: The most constant symptoms identified in our study were bone marrow oedema (93%) and soft tissue oedema (77%). Changes in structures in which accessory bones were located or in adjacent structures to accessory bone were identified: tendon changes 51%, fluid adjacent to bone 51% and tenosynovitis 46%. MRI revealed changes in bone structure that are not seen on X-ray, including changes in contour (28%), sclerosis (3%) or osteonecrosis (3%). CONCLUSIONS: MRI plays an important role in determining whether accessory bones cause symptoms because it shows specific and accurate changes in accessory bone and/or in adjacent soft tissue.

Ischiofemoral Impingement Syndrome: A Case Report and a Review of Literature.

BACKGROUND: Ischiofemoral impingement syndrome is characterized by a hip pain associated with abnormalities in quadriceps femoris muscle and ipsilaterally reduced distance between the lesser trochanter and the ischium. Thus far, the congenital variant of this entity has been reported exclusively in women. CASE REPORT: We report a case of a 22-year old male with painful hips in whom on the basis of the imaging studies the constitutional variant of ischiofemoral impingement was diagnosed. CONCLUSIONS: Ischiofemoral conflict should be taken into consideration in the differential diagnosis of hip pain, particularly among women, but also in patients with valgus hip deformity and other abnormalities leading to reduction of the space between femoral and ischial bones independent of gender.

The results of the operative treatment of patellar instability in children with Down's syndrome.

Patellar instability can significantly influence the locomotor function in children with Down's syndrome. The aim of this study was to evaluate the mid-term results of the operative treatment of patellar instability in children with Down's syndrome. The study included eight children (10 operated knees) with Down's syndrome and associated patellar instability. The children's age ranged from 6 to 11 years (the mean age was 7 years 9 months). The operative treatment involved Green's quadricepsplasty in six cases (eight knees) and Green's quadricepsplasty augmented with a modified Galeazzi procedure - semitendinosus tenodesis - in two cases. The mean follow-up period was 3 years and 3 months. We achieved a stabilization of the patellofemoral joint and a correction of the position of the patella in seven knees (five of these were treated with Green's procedure and in two cases Green quadricepsplasty was combined with the Galeazzi procedure). We did not observe any recurrence of patellar dislocation in this group during the follow-up period. We noted two failures, defined as a recurrence of dislocation, during the mean of 9 months postoperatively. Green's quadricepsplasty provides satisfactory results in younger children with Down's syndrome. In older children, we recommend the modified Galeazzi procedure.

Treatment of solitary bone cysts with allogenic bone graft and platelet-rich plasma. A preliminary report.

The treatment of solitary bone cysts remains controversial. The high recurrence rate after operative treatment calls for the search of new effective treatment methods. The aim of this study was to evaluate the outcomes of treatment of solitary bone cysts with platelet-rich plasma (PRP) and allogenic bone grafts. The study group consisted of 9 patients (4 males and 5 females) with the diagnosis of solitary bone cyst. Their mean age was 12 years and 2 months (range: 6 to 17 years). All patients were symptomatic in routine daily activities. There was a coexisting fracture within the cyst wall in three patients. The operative procedure included removal of the cyst wall soft-tissue lining and filling of the cavity with deep frozen, gamma irradiated morselized allogenic bone grafts mixed with PRP. The PRP was prepared preoperatively with the GPS System (Gravitational Platelet Separation System, Biomet Merck). In six patients with an existing or impending fracture in particularly large cysts, fixation was used. For the cysts located close to the epiphysis (2 femurs, 1 humerus) we used an IM nail or DHS. For three cysts located in the diaphyseal region of the humerus we used an Ilizarov fixator. Three cysts with lower risk of impending fracture were left without fixation. The mean follow-up period was 19.5 months (range: 12 to 30). We noted no procedure-related complications and no refracture during the observation period. Bleeding from the wound was minimal, possibly as a result of PPP use. The wounds healed without swelling or excessive scar formation. After 12 months all the cysts were completely filled with new bone and were staged as Neer stage I. All the patients were asymptomatic. The use of PRP with allogenic bone grafts appears as a promising method for the treatment of solitary bone cysts. Further studies on larger patients series with longer follow-up will be necessary to answer the question whether this method will provide a lower recurrence rate compared to other forms of treatment.

Method of pectus excavatum measurement based on structured light technique.

We present an automatic method for assessment of pectus excavatum severity based on an optical 3-D markerless shape measurement. A four-directional measurement system based on a structured light projection method is built to capture the shape of the body surface of the patients. The system setup is described and typical measurement parameters are given. The automated data analysis path is explained. Their main steps are: normalization of trunk model orientation, cutting the model into slices, analysis of each slice shape, selecting the proper slice for the assessment of pectus excavatum of the patient, and calculating its shape parameter. We develop a new shape parameter (I(3ds)) that shows high correlation with the computed tomography (CT) Haller index widely used for assessment of pectus excavatum. Clinical results and the evaluation of developed indexes are presented.

Orthotic treatment of developmental hip dysplasia.

Summary. Abduction orthoses are used in the treatment of hip dysplasia in newborns and infants. These devices force ca. 1000-1100 flexion of the hips and 30-600 abduction. In this position, the femoral head assumed a concentric position in relation to the acetabulum, which is a basic precondition for normal hip development. This article presents the orthoses most commonly used id Poland to treat development hip dysplasia. Flexion-abduction orthoses are an excellent replacement for the plaster casts formerly used in these cases. The selection of orthosis depends on the attendant physician's experience and the type of defect. The treatment of developmental hip dysplasia is charged with the risk of nutritional defects of the femoral head, and thus requires caution. Orthotic treatment is suitable only for children to age 6 months, since at a later age it can disturb hip development. Lack of parent cooperation can cause complications or lack of treatment effect.