The Gritti-Stokes Amputation: Is It Still a Reliable Technique in the 21st Century? A Narrative Review.

Lower limb amputation is a common surgical procedure performed worldwide. Many individuals require amputation due to various circumstances, with amputations occurring above or below the knee. Surgeons rely on published research to determine the most appropriate technique based on intraoperative and postoperative outcomes. The Gritti-Stokes amputation (GSA) procedure, introduced in 1857, has shown positive results in terms of primary wound healing, reduced mortality rates during and after surgery, and accelerated healing and mobility. However, due to the need for highly trained surgeons and limitations in functional and cosmetic prosthesis fitting, concerns have been raised regarding its utility. Additionally, the procedure is underutilized in cases where it could potentially yield better results. This article provides a comprehensive review of the documented benefits of GSA, suitable candidate selection, limitations, various modifications, and a comparison with traditional approaches to lower limb amputation. The review is focused on evidence published in the last 100 years.

Functional, clinical, and radiological outcomes of split anterior tibial tendon transfers in patients with sequelae of congenital talipes equinovarus.

OBJECTIVE: This retrospective analysis aimed to assess the effectiveness of Split Tibialis Anterior Tendon Transfer (Split TATT) in treating residual idiopathic congenital talipes equinovarus (CTEV) deformities. METHODS: 15 patients (20 feet) with CTEV, with a mean age of 6.4 ± 3.2 years, initially treated with Ponseti casting, underwent Split TATT. Clinical and radiological evaluations, including Diméglio and Garceau scores, dorsiflexion, and X-ray measurements, were conducted preoperatively and post-operatively at a minimum 2-year follow-up. RESULTS: Significant improvements were observed in Diméglio and Garceau scores. Dorsiflexion increased by an average of 3°, and radiological analysis revealed nuanced changes. Despite a weak Kappa coefficient, positive trends in dorsiflexion and Garceau scores were noted. Preoperative Garceau scores did not reliably predict postoperative results. CONCLUSION: Split TATT demonstrates promising results in improving muscular balance and functional outcomes in CTEV. While radiological changes are subtle, positive trends in clinical scores indicate meaningful outcomes. LEVEL OF EVIDENCE: IV Retrospective study.

Efficacy of the pridie drilling technique in knee osteochondritis dissecans among children and young adults: follow-up of 41 cases.

PURPOSE: This study aims to examine whether Pridie drilling, a form of bone marrow stimulation, can expedite the healing process and enable a faster return to sports activity in patients with knee Osteochondritis dissecans (OCD). The primary objective is to assess the effectiveness of Pridie drilling in stable OCD lesions that do not respond to non-operative treatment, by evaluating the absence of painful symptoms 6 months after the procedure. Secondary objectives include evaluating radiographic reconstruction 6 months post-surgery and determining the time it takes to resume sports participation. MATERIALS AND METHODS: This single-center retrospective study included all cases of stable OCD in the knee that underwent anterograde chondral drilling between 2008 and 2020. Diagnosis of OCD was established using knee radiographs, and the surgical technique involved multiple multidirectional subchondral drilling. Treatment efficacy was defined by the absence of painful symptoms for 6 months postoperatively. RESULTS: A total of 41 knees were included in the study, and no complications were observed before or after surgery. At 6 months postoperatively, 32 knees (78%) showed complete resolution of symptoms. Complete radiographic reconstruction was observed in 66% of cases. Asymptomatic patients at 6 months returned to sports activity of similar intensity to that practiced previously in an average time of 7.9 months; while, patients who were symptomatic at 6 months returned in an average time of 16.5 months. CONCLUSION: This study provides evidence supporting the short-term efficacy of anterograde chondral drilling in stable lesion of OCD in children and adolescents after failed functional treatment. LEVEL OF EVIDENCE: Level III (retrospective cohort study).

Biomechanical characteristics of the meniscocapsular junction of the posterior segment of the medial meniscus.

PURPOSE: Despite extensive literature available on the mechanical properties of knee ligaments and menisci, research on the mechanical properties of the meniscus-capsular junction (MCJ) is lacking. This study aims to investigate the biomechanical behavior of the MCJ of the medial meniscus using a tensile failure test. MATERIALS AND METHODS: Seven dissected cadaveric knees were used for biomechanical analysis. Tensile failure tests were performed using an INSTRON ElectroPuls E1000 stress system to measure stress/strain curves, maximum load at failure, elastic limit load, elongation at break, elongation at the elastic limit, and linear stiffness, were collected and analyzed. RESULTS: All ruptures occurred at the MCJ. The MCJ displayed similar mechanical properties to knee ligaments. Average values were: maximum load at failure (63.9 ± 3.2 N), yield load (52.9 N ± 2.6 N), elongation at break (2.5 mm ± 0.3 mm), elongation at the elastic limit (1.25 mm ± 0.15 mm), strain at break (47.0% ± 3.5%), strain at yield (23.2% ± 2.3%), and stiffness (56.6 ± 9. N/mm-1). CONCLUSION: The meniscus-capsular junction's mechanical properties are similar to other knee ligaments and may play a role in knee stability. The findings provide insights into the the behavior of the meniscus-capsular junction could have clinical implications for diagnosing and surgical treatment of meniscocapsular lesions.

"Tomydesis" might be a reliable technique for lesions of the long head of the biceps tendon associated with rotator cuff tears: a minimum 6-month prospective clinical follow-up study.

PURPOSE: To compare the clinical outcomes of self-locking T-tenotomy called "tomydesis" to three different techniques of tenodesis for lesions of the long head of the biceps tendon (LHBT) associated with rotator cuff tears. HYPOTHESIS: Tomydesis could provide similar clinical outcomes than the other LHBT tenodesis techniques. METHODS: This prospective multicentre study included 77 patients who underwent rotator cuff repair concomitant with one of four surgical techniques on the LHBT. All patients had a minimum of 6-month follow-up post-operatively. Outcomes were evaluated based on the Constant score, SSV, pain on visual analogue scale, biceps-specific pain and Popeye deformity on photographs. RESULTS: There was no difference for the pain at the biceps muscle belly (p = 0.58), the bicipital groove (p = 0.69) and during resisted supination (p = 0.53), as well as for muscle cramps (p = 0.09), VAS for pain (p = 0.12) and Popeye deformity (p = 0.18). There was more pain in resisted flexion in the tomydesis group (p = 0.032), and significantly better Constant scores and SSV (< 0.001) in the patients who underwent the double lasso loop technique, but non-repairable cuff tears were most frequent in the tomydesis group. CONCLUSIONS: Tomydesis might be a reliable alternative that combines advantages of tenodesis and tenotomy. It should be considered in cases of rotator cuff tears, whose repair and healing are the key for good functional outcomes. LEVEL OF EVIDENCE: II.

Etiology, pathogenesis, and management of angiosarcoma associated with implants and foreign body: Clinical cases and research updates.

Angiosarcomas are rare and highly malignant soft tissue sarcomas originating from endothelial cells lining the lymphatic or vascular system. While they predominantly emerge from (sub)cutaneous regions, occurrences have been reported throughout the body. The etiology of angiosarcoma remains elusive in most clinical cases. Nevertheless, several prognosis risk factors play a pivotal role, including chronic lymphedema, therapeutic irradiation, environmental carcinogens, familial syndromes, and the presence of foreign materials like metallic objects and biomedical implants. Despite evidence implicating retained foreign material in angiosarcoma development, understanding its prognosis and pathogenesis remains limited. The pathogenesis of angiosarcoma appears to involve a complex interplay of chronic inflammation, tissue remodeling, and genetic factors that create a conducive microenvironment for malignant transformation. Management of these sarcomas remains challenging due to their infiltrative nature owing to the high chance of metastasis and local recurrence. The primary treatment modalities currently include surgery, radiotherapy, and chemotherapy, but recent advances in targeted immunotherapy and gene therapy hold promise for more effective approaches. This comprehensive review delves into the potential etiological and pathogenic roles of foreign materials, such as metallic objects, biomedical implants, and biomaterials, in the development of angiosarcoma. Further research into the underlying molecular mechanisms could provide valuable insights for tailored management and developing novel targeted therapeutic strategies.

A Simple Intraoperative Technique for Restoring Rotational and Length Alignment After Distal Femur Resection and Endoprosthesis Reconstruction: A Technical Note.

Restoring femoral rotation alignment and limb length after distal femur resection and endoprosthetic reconstruction is crucial to avoid poor outcomes. This technical note presents a simple and reliable intraoperative technique for restoring femoral rotation and length during distal femur resection and endoprosthetic reconstruction without the need for extensive preoperative planning or complex perioperative modalities. The method utilizes an external fixator frame as a guiding device to assess and restore the native alignment. This approach provides a practical alternative to relying solely on the position of the linea aspera, which has been shown to be an unreliable landmark for rotational alignment. Implementing this technique can contribute to improved functional outcomes in patients undergoing distal femur endoprosthetic reconstruction.

Comprehensive Insights into Chondroblastoma Metastasis: Metastatic Patterns and Therapeutic Approaches.

Chondroblastoma metastasis, though rare, represents a clinically significant and notably important aspect of bone tumors. Understanding its epidemiological characteristics, pathological features, and treatment modalities, despite its infrequency, is imperative for comprehensive patient management. This review aims to elucidate the epidemiology, molecular mechanisms, diagnostic challenges, and therapeutic strategies associated with chondroblastoma metastasis. The patterns, prognostic factors, and treatment outcomes were explored through an analysis of case studies and clinical reports. Notably, we highlighted emerging therapeutic perspectives aimed at improving patient outcomes. To the best of our knowledge, there has been no previous review addressing these matters cumulatively, highlighting a significant gap in the existing scholarly literature. By shedding light on the nuances of chondroblastoma metastasis, this review contributes to the advancement of knowledge in this field and informs clinical decision-making for improved patient care.

Response of Recurrent Aggressive Aneurysmal Bone Cyst of Distal Tibia to Denosumab Treatment.

Introduction: Aneurysmal bone cysts (ABCs) are aggressive and benign tumors that primarily affect children and adolescents. The standard course of treatment for ABCs involves surgical excision or curettage with a bone transplant or cement to repair the deficiency. Denosumab, a monoclonal antibody that inhibits receptor activator of nuclear kappa B ligand, is used to treat osteoporosis, skeletal metastasis, and giant cell tumors of the bones. Case Report: This case study details the therapeutic treatment of a female patient, age 22, who had a recurring aggressive ABC of the distal tibia. The patient was initially treated using curettage and lesion filling. However, recurrence of the osteolysis was observed 9 months later that led to subsequent interventions involving absolute alcohol sclerotherapy in multiple sessions. However, these interventions failed to achieve ossification. Following unsuccessful surgical and sclerotherapy treatments, the patient was administered denosumab, which led to a positive response. Regular radiographic and clinical follow-up demonstrated significant improvements in ossification and pain reduction. During the course of the 12-month treatment, the frequency of visits was gradually reduced. Further, follow-up and monitoring revealed the effectiveness of the local control and long-term treatment. Conclusion: This case report highlights the ability of denosumab to manage recurrent aggressive ABCs after surgical or sclerotherapy failure.

Efficacy of denosumab treatment for lung metastasis secondary to proximal humerus chondroblastoma.

Chondroblastoma is a rare benign cartilaginous tumor that accounts for approximately 1% of bone tumors, but it can be associated with lung metastasis in extremely rare cases, leading to a poor prognosis and death. Herein, we report the case of a 19-year-old male patient who presented with an aggressive chondroblastoma of the proximal humerus and bilateral lung metastasis. The patient was treated with wide local resection, partial metastasectomy, and denosumab. Denosumab treatment was effective in controlling metastatic progression and preventing local recurrence.

Minimally Invasive Treatment of Benign Osteolytic Bone Lesions with a Hartmann Ear Speculum: A Surgical Technique.

This study introduces a novel and simple minimally invasive technique for treating benign osteolytic bone lesions. The standard treatment involves lesion removal and cavity filling with various materials. Minimally invasive approaches, including arthroscopy and CT-guided injection, have been described, but they pose challenges such as X-ray exposure and expansiveness. In this study, a new minimally invasive technique using a Hartmann ear speculum is presented. The technique was successfully applied in 10 patients with various benign tumors, demonstrating full healing and no recurrence at one-year follow-up. The presented approach combines simplicity, cost-effectiveness, and minimal invasiveness, making it a promising alternative option for treating benign bone lesions with low complication rates and surgical site morbidity. Level of evidence: IV.

Patellar osteoblastoma: A case report and literature review.

An osteoblastoma is a benign bone tumor characterized by osteoblast proliferation that is more commonly diagnosed in young men during adolescence and youth. The condition mainly occurs in the posterior regions of the spine and sacrum, but in rare cases, the patella as well. We present a case of patellar osteoblastoma successfully managed through intralesional curettage and grafting, highlighting the need for comprehensive imaging and pathological studies to ensure an accurate diagnosis. A 26-year-old male with a history of knee plica excision presented with persistent knee pain over 1 year. Radiographic and CT evaluations revealed an osteolytic lesion in the patella, further characterized by MRI. An incisional biopsy confirmed the diagnosis of osteoblastoma. Intralesional curettage and grafting were performed. Later, subsequent follow-up demonstrated complete pain relief, restoration of knee function, and optimal graft incorporation. As shown in this case, precise diagnosis and effective management are key to improving the quality of life of patients. Furthermore, it illustrates that intralesional curettage and grafting are effective treatments for patellar osteoblastomas. Given the rarity of this condition, further research and comprehensive case studies are imperative to establish standardized guidelines for improved healthcare and patient outcomes. In summary, while the clinical characteristics of patellar osteoblastoma resemble those of osteoblastomas in general, its unique presentation warrants specific attention. Individualized consideration of adjuvant measures, graft selection, and preventive fixation is vital to ensure optimal outcomes in patellar osteoblastoma management.

Angioleiomyoma: An Update with a 142-Case Series.

Angioleiomyomas are uncommon, noncancerous, smooth muscle tumors that primarily arise from blood vessels. Previous studies have yielded limited data due to the lack of interdisciplinary approaches or restricted patient pools. This study aims to provide a comprehensive analysis of angioleiomyomas, including the demographic, clinical, radiological, and histopathological features, with a large number of patients. Conducted as a retrospective investigation at a single center from January 2005 to June 2023, this study involved 142 patients. Relevant information was extracted from electronic medical records, covering clinical, radiological, histological, and demographic details. Angioleiomyomas mostly occurred at age 59 (1-87), predominately affect females (53%) and commonly arise in subcutaneous tissue (85%) and the lower limbs (76%). MRI findings revealed characteristic signals, with a high prevalence of the solid histologic type (65%), often displaying a reticular sign. Smooth muscle Actin was universally present (n = 95/95), while Desmin and Caldesmon showed positive expression in 83% (n = 71/85) and 98% (n = 92/94) of cases, respectively. This study presents an updated and comprehensive analysis of angioleiomyomas. Typically appearing as well-defined nodules in the extremities, these tumors can be effectively diagnosed using MRI, though histopathological analysis is generally essential for confirmation. Treatment primarily involves straightforward excision, with notable low complication and recurrence rates.

Cobalt-chromium toxicity following revision of total hip replacement.

Systemic cobalt-chromium (Co-Cr) toxicity following a total hip replacement is a rare complication that may sometimes lead to fatal consequences. We report a case of a 64-year-old woman, who presented with Co-Cr toxicity after revision of fractured ceramic components with metal-on-polyethylene. Systemic toxicity occurred a year after surgery and was expressed brutally with mostly central neurological symptoms. Revision surgery allowed rapid regression of all symptoms. Prosthetic revision with a metal bearing surface after a history of fracture of the ceramic bearing component should be avoided. Orthopedic surgeons and the different medical actors should be aware of this rare but serious complication to allow earlier management. Above all, multidisciplinary management is primordial to allow correct diagnosis and appropriate treatment.

Restoration of internal rotation after reverse shoulder arthroplasty may vary depending on etiology in patients younger than 60 ​years of age: a multicenter retrospective study.

BACKGROUND: Reverse shoulder arthroplasty (RSA) offers promising functional outcomes for young patients, yet challenges persist in restoring internal rotation (IR). This study aimed to assess the restoration of IR after RSA in patients younger than 60 years of age and analyze the factors affecting IR recovery. METHODS: A retrospective multicenter study was conducted, examining the functional outcome of patients who underwent RSA, with a minimum follow-up period of 2 years. Two subgroups of patients who underwent primary RSA were analyzed separately with respect to active internal rotation with the elbow at the side (AIR1): "difficult AIR1" and "easy AIR1." RESULTS: The study included 136 patients (overall series) with a mean age of 51.6 years. The overall series showed statistically significant improvement in active range of motion (RoM), pain, and Constant scores, especially with active IR (p â€‹< â€‹0.01). According to etiology, statistically significant improvement (p â€‹< â€‹0.05) in active IR was observed for fracture sequelae, primary osteoarthritis, and rheumatoid arthritis, whereas no statistically significant improvement in IR was observed for tumor, revision, and cuff-tear arthropathy (p â€‹> â€‹0.05). In subgroup analysis, patients with easy AIR1 displayed a statistically significant lower body mass index and better Constant score mobility, as well as improved motion in forward elevation and active IR (p â€‹< â€‹0.05). No statistically significant associations were found between improved IR and prosthetic design or subscapularis repair. Scapular notch, lysis of the graft, and teres minor atrophy were significantly associated with better active IR (p â€‹< â€‹0.05). CONCLUSION: RSA improves active RoM, pain, and functional outcomes in patients aged under 60. However, the degree of improvement in IR may vary depending on several factors and the underlying etiologies. These insights are crucial for patient selection and counseling, guiding RSA optimization efforts. LEVEL OF EVIDENCE: IV.

A Rare Coexistence of Hybrid Tumor Low-grade Fibromyxoid Sarcoma/Sclerosing Epithelioid Fibrosarcoma and Hibernoma in the Same Thigh: A Case Report.

Introduction: We encountered a unique case of a patient with two distinct tumors coexisting in the same thigh. To the best of our knowledge, this combination of tumors in the same anatomical region has not been previously described in the literature. Case Report: This case report describes a 38-year-old Caucasian male with a painless mass in his right thigh, which was later diagnosed as a hybrid tumor composed of low-grade fibromyxoid sarcoma and sclerosing epithelioid fibrosarcoma, as well as a second tumor, which was diagnosed as a hibernoma. The patient underwent neoadjuvant chemotherapy and surgical excision, followed by adjuvant radiotherapy and treatment for metastatic recurrence. Conclusion: The rarity of this case highlights the need for interdisciplinary collaboration and further investigations into the behavior and management of hybrid tumors. This case also underscores the importance of an accurate histological diagnosis aided by immunohistochemistry and molecular analyses.

Integra® Dermal Regeneration Matrix: A Versatile Solution for Complex Soft Tissue Sarcoma Reconstruction in the Hand.

This case report describes the successful use of Integra® (Integra LifeSciences Corporation, Plainsboro, New Jersey, United States), an artificial skin substitute, for the reconstruction of soft tissue defects following soft tissue sarcoma resection. We present a case of a 75-year-old female presented with a progressively enlarging lesion on her right hand. Imaging revealed tumor involvement in the extensor tendons and adjacent to the index finger tendon. A percutaneous biopsy confirmed an undifferentiated pleomorphic sarcoma. The patient underwent neoadjuvant radiotherapy followed by wide excision of the tumor. Integra® dermal regeneration matrix was utilized to cover the exposed bone during the surgical procedure. This allowed for wound closure and provided a favorable environment for tissue regeneration and subsequent split-thickness skin graft. Complete wound healing was obtained. Regular follow-up examinations showed no evidence of local recurrence or secondary lesions after one year. The successful use of Integra®, in this case, demonstrates its efficacy as a reconstructive option for complex hand sarcomas. It offers immediate wound coverage and promotes tissue regeneration, thereby avoiding the need for more extensive treatment modalities with associated donor-site morbidity. The utilization of Integra® resulted in high patient satisfaction and excellent recovery. This case highlights the importance of utilizing innovative techniques and materials in achieving optimal outcomes in challenging hand sarcoma reconstructions.

Unusual Site of a Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) Involving the Scapula: First Case Report and Review of the Literature.

Bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora's lesion, is a rare benign surface lesion of bone that typically occurs in the hands and feet. We report herein the first case of BPOP occurring in an unusual location, specifically the scapula of a 29-year-old male patient. The lesion exhibited features mimicking those of a peripheral chondrosarcoma because of its atypical location in the axial skeleton and the presence of calcification, which indicates the presence of cartilaginous matrix. Treatment involved a wide surgical resection, and histopathological examination confirmed the diagnosis of BPOP of the bone. At a five-year follow-up, there was no evidence of local recurrence.

Unusual Presentation of Extraskeletal Mesenchymal Chondrosarcoma: A Case Report.

Mesenchymal chondrosarcomas are extremely rare and aggressive tumors that primarily affect patients between the ages of 20 and 30. These neoplasms are typically found in the lower limbs and cranial region. Their occurrence within soft tissues is exceedingly rare, and the initial presentation often includes immediate metastatic dissemination. Given the extraordinarily low prevalence of extraskeletal mesenchymal chondrosarcoma, treatment approaches remain non-standardized. Surgical resection combined with neoadjuvant chemotherapy or radiotherapy is the most commonly favored strategy by medical teams. In this case report, we present the case of a 72-year-old patient with no specific medical history, who presented with a non-metastatic extraskeletal mesenchymal chondrosarcoma located in the popliteal fossa. The therapeutic intervention encompassed surgical resection followed by adjuvant radiotherapy. After 18 months of follow-up period, there was no evidence of local recurrence or distant metastases. The disparity between the patient's clinical characteristics and the existing medical literature may provide new insights into understanding this neoplastic entity.

Teaching Potential of Multidisciplinary Tumor Board Meetings for Orthopedic Residents: Insights From a French Sarcoma Reference Center.

Multidisciplinary tumor board meetings (MTBMs) have been established in oncology to improve patient care. While their benefits for patients have been well-documented, there are no previous studies on the teaching opportunities they provide for residents and medical students. This study aimed to examine the teaching provided to residents during MTBM and identify areas for improvement. The study hypothesized that although the primary objective of MTBM is not teaching, they could still contribute to residents' learning. The study focused on the tumors board meeting for bone metastasis and musculoskeletal tumors/sarcoma in a French reference center for musculoskeletal oncology. The composition of the MTBM included specialists from various disciplines, and it convened on a weekly basis to discuss cases. The orthopedic oncology residents (OORs) actively participated in the MTBM as part of their training. A questionnaire was distributed to OORs who had served between 2014 and 2021, and their responses were analyzed. The results showed that the OOR perceived MTBM as interesting, beneficial for their training, and challenging. While opinions were divided on whether MTBM was a suitable place for education, the majority believed it improved their knowledge of different specialties and provided valuable elements applicable to daily practice. They also felt it facilitated future access to MTBs if needed. OORs recommended the rotation as an orthopedic oncology resident to younger residents. Recommendations for improvement included incorporating more dedicated teaching time, active involvement of residents in the learning process, availability of learning materials, and post-MTBM debriefing sessions. The study highlighted the importance of case presentations, public speaking skills, interdisciplinary collaboration, and clinical reasoning observed during MTBM. In conclusion, while not primarily designed for teaching, MTBM offers valuable learning opportunities for residents. Enhancing the teaching experience through dedicated debriefing sessions, resident involvement, and improved support can further optimize their educational impact. Future evaluations are needed to assess the effectiveness of these improvements. This study provides insights into the teaching potential within MTBM and can guide educational initiatives in the field of oncology.