Extra-osseous chondrosarcoma. Report of five cases and review of the literature.

In this paper we present five new cases and review sixty-one reported cases of extra-osseous chondrosarcoma. The lesion has a predilection for middle-aged men and for localization in the extremities. The mild and delayed nature of the symptoms contributes to delayed or inadequate treatment and an unusually high over-all recurrence rate of 50 per cent. En bloc resection is the treatment of choice. Amputation should be reserved for large tumors with extensive or intra-articular invasion, osseous erosion, or major neurovascular involvement. Pulmonary lobectomy appears to be effective in treating localized pulmonary metastasis. Chemotherapy and radiotherapy can also provide palliative benefits to patients with widespread metastases. Nearly all (77.8 per cent) of the known disease-related fatalities took place during the first year after operation on the primary tumor. The over-all five-year survival rate most likely is less than 81.2 per cent.

18F scintigraphy in the early diagnosis of osteonecrosis of the femoral head in chronic hemodialysis and transplantation.

Osteonecrosis of the femoral head results in an increased uptake of 18F due to a reparative reaction in the necrotic area and its surroundings. Twenty hemodialysis and twenty-seven post-transplant patients were studied serially. In the hemodialysis group, nine patients had positive scintigraphs and eleven had negative studies. All were asymptomatic. In the transplant group, twelve were positive and fifteen were negative. Four patients with positive scans later developed unequivocal clinical and radiographic evidence of osteonecrosis. Patients with negative scans have been asymptomatic and without radiological abnormalities. Age, sex, duration of dialysis, bone mineral densitometry, total steroid dose, duration of hospitalization after transplantation, and serum chemistries were not different in positive and negative patients. All patients on alternate-day steroids have negative scans. A positive 18F scintigraph antedates the occurrence of clinical and radiological findings of osteonecrosis.

Rotational ligamentous injuries to the ankle in football.

It is the author's belief that supination injuries with tear of the talofibular ligament are the most frequent ankle ligamentous injuries encountered on the football field (Figure 4). However, the author believes that the more significant injury is the rupture of the tibiofibular ligament and interosseous ligament incurred in pronation and external rotation. (Figure 5). Twenty time-loss injuries of significance, encountered over a five year period in one football team, are presented. The mechanism of injury and the force encountered at the ankle during an interruption of the normal sequence of running and turning on the football field are presented. It is the author's opinion that rigid immobilization of the more significant injury is necessary in order to return the participant to active athletics within a reasonable length of time. It is hoped that this report will stimulate others to closely evaluate ankle injuries occurring on the football field.

Infrapatellar tendon ruptures.

This is a retrospective study of 23 infrapatellar tendon ruptures in 22 patients seen at Henry Ford Hospital from 1969 to 1980. Two of the patients had a systemic disease known to predispose to tendon ruptures, while the remainder of the tendon ruptures occurred in otherwise normal individuals as the result of either repetitive or isolated trauma.

Chondrosarcoma of the foot: a report of three new cases plus a review of the medical literature.

Our paper presents three new cases of chondrosarcoma of the foot and a clinical analysis of all the known cases of similar tumors. We feel that surgery is still the treatment of choice and recurrence and metastases are uncommon following adequate surgical treatments.

Malignant hemangioendothelioma of bone: a clinical analysis of 11 cases treated at Henry ford hospital.

This article describes the clinical manifestations, roentgenographic appearance, gross and microscopic pathologic features, treatments, and long-term results of 11 cases of malignant hemangioendothelioma of bone. The authors recommend that surgery, radiotherapy, and chemotherapy be integrated carefully and tailored to meet the needs of each individual patient.

Synovial chondrosarcoma: a case report.

This paper reports a synovial chondrosarcoma in the knee of a thirty-four year old white male. An above-knee amputation produced a more than 12 year cure for this patient.

Ewing'S sarcoma: a clinical analysis of forty-six cases treated at Henry ford hospital.

Our paper describes the clinical features, roentgenographic manifestations, pathology and the results of various modalities of treatments of 46 cases of Ewing's sarcoma seen and treated at Henry Ford Hospital during the past 36 years. Surgery alone (4 cases) produced a 25% five-year survival rate, whereas radiotherapy alone (33 cases) yielded only a 3% five-year survival rate. Radiotherapy plus chemotherapy (9 cases) have proven to be far superior than radiotherapy alone. The overall five-year survival rate of our series is only 7%.

Extraosseous osteogenic sarcoma: a clinical analysis of ten cases.

This article describes the clinical manifestations, roentgenographic appearance, microscopic features and short- and long-term prognosis of ten cases of extraosseous osteosarcoma. The surgical technique of wedge biopsy and en bloc excision with interlocking sutures has also been illustrated. We feel that en bloc excision is the treatment of choice, and that amputation should be reserved for large tumors with major neurovascular involvement and unresectable recurrence. The overall five-year survival rate was 42.9%.

Pagetoid sarcomas: a clinical analysis of ten cases treated at Henry ford hospital.

The ten cases of Pagetoid sarcoma we studied included nine osteogenic sarcomas and one fibrosarcoma. Predominantly affected were the long tubular bones of older female patients. Pain and swelling were the most common chief complaints. Hyperphosphatasemia was invariably present. Early diagnosis and amputation combined with long-term systemic chemotherapy appear to be the treatment of choice. All ten patients died within 15 months after the appearance of this fatal disease.

Atlantoaxial arthrodesis: a clinical analysis of 22 cases treated at Henry ford hospital.

The indications for our 22 cases of atlantoaxial arthrodesis include rupture of transverse ligament, fracture of odontoid process, and absence of odontoid process. The surgical techniques of H-shaped unicortical and bicortical iliac grafts have been described. All our patients experienced satisfactory relief of their symptoms and reversal of their neurological deficits. In spite of the relatively minor postoperative complications, we feel that atlantoaxial fusion is a safe and effective method in treating various diseases of the atlantoaxial region.

Metastatic bronchogenic carcinoma to the finger simulating acute osteomyelitis.

A case of metastatic bronchogenic carcinoma to the distal phalanx of the ring finger was initially misdiagnosed as osteomyelitis. The presence of constitutional symptoms, past history of malignancy, the milder and relatively protracted clinical course, the negative culture and lack of response to surgical drainage and antibiotics should make the diagnosis of hand metastasis a distinct possibility. Amputation of the involved digit is an effective palliative treatment and the other foci of metastases should also be treated with systemic chemotherapy.

Pigmented villonodular synovitis: a clinical analysis of twenty-four cases treated at Henry ford hospital.

This article describes the clinical findings, roentgenographic manifestations, gross and microscopic pathology, treatment, and results of 24 cases of pigmented villonodular synovitis treated at Henry Ford Hospital over a period of 25 years. We conclude that synovectomy is the treatment of choice, and we have experienced a 16.7% recurrence rate.

The surgical technique for forequarter amputation: a clinical analysis of ten cases.

The surgical technique for forequarter amputation has been described in a step-by-step fashion. Our personal experience of ten cases has achieved a 40% overall cure rate. Soft somatic tissue sarcomas seem to have a much better five-year survival rate than the corresponding bone sarcoma (60% vs 0%). The disease-free state during the first postoperative year appears to be a very favorable indicator for long-term survival. We feel that surgery should be combined with prophylactic chemotherapy in order to prolong survival time and save lives.

Temporary occlusion of the common iliac artery during hemipelvectomy.

The surgical technique for temporarily occluding the common iliac artery during hemipelvectomy has been described. Not only can this technique significantly reduce the blood loss and operative time, but it may also minimize postoperative complications and increase the chances of a complete eradication of the primary malignant disease.

Osteochondroma of the atlas: a case report.

An extremely rare case of osteochondroma arising from the right lateral mass of an atlas was successfully treated by a complete removal through an oblique high cervical incision coupled with a transection of the underlying sternocleidomastoid muscle and careful freeing and retraction of the adjacent vital neurovascular structures.

Metastatic tumors of the hand: a report of six cases.

Six metastatic tumors of the hand of mammary, renal, pulmonary, colonic, and humeral origins are described. The areas involved were the distal phalanges, the metacarpal bones, a carpal bone, the nail bed, and the soft tissue of the dorsum of the hand. All six patients died within a few months after the metastatic lesions were diagnosed correctly. Metastases to the bone can cause destruction, pain, and swelling and may be misdiagnosed before operation as osteomyelitis. Metastases to the soft tissues tend to be asymptomatic and can closely mimic benign soft tissue tumors.

Metastatic tumors of the foot.

Four metastatic tumors of the foot, of colonic, renal and humeral origin, are described. They involved three calcanei and two tali. All four patients died within a few months after the appearance of metastasis to the foot. Bony destruction, pain, and swelling can closely resemble the clinical signs and symptoms of osteomyelitis. Diagnostic roentgenograms must be obtained to rule out the possibility of metastatic disease, and biopsies are usually required for accurate diagnosis.