[Osteoid osteoma of the spine. The experience of the Rizzoli Institute].

The authors report their experience at the Rizzoli Institute in treating osteoid osteomas localized to the spine (40 cases). This clinical study confirms that osteoid osteomas are tumors of adolescence, which are often diagnosed late due to their spinal localization. The role of additional investigations, dominated by bone scan and computed tomography is discussed.

Grosse-Kempf nailing in the elderly.

The authors report on 30 fractures of the femur and tibia treated with the Grosse-Kempf locked nail in patients aged more than 60 years. Neither nonunion nor severe complications were observed; surgical trauma was well sustained. Functional results were particularly satisfactory; most patients began walking within the first week after fixation.

The Gamma nail. A preliminary note.

The Gamma nail is a new device used in the treatment of pertrochanteric fractures in the elderly in which the principles of locked intramedullary nailing are applied. It is constituted by an intramedullary nail crossed in the proximal segment by a cervico-cephalic screw, by which compression of the fracture segments may be obtained. It is furthermore possible to obtain distal locking by means of two screws, such as for Grosse-Kempf nailing.

Vertebral histiocytosis.

Thirty-five cases of vertebral histiocytosis are examined for a total of 52 vertebrae affected. The study is conducted on the radiographic picture at the onset and at long-term follow-up in 32 cases (24-223 months, average 45). Diagnosis may be based on radiology only in typical cases, otherwise there may be errors in differential diagnosis with malignant neoplastic lesions.

Percutaneous transcatheter arterial embolization of bone and soft tissue tumors.

Arterial embolization was performed in 36 patients with tumors of bone and soft tissue. Embolization was the only treatment in seven patients with benign lesions. Fourteen patients underwent embolization before surgery to obtain hemostasis and/or reduce tumor size.

Soft tissue metastasis from carcinoma. A case report.

The authors report a case of a man who developed soft tissue metastasis to the thigh from pulmonary carcinoma. In the preoperative staging, computerized tomograms and magnetic resonance imaging allowed to identify and characterize the features of soft tissue masses; these studies, however, must be always completed with needle (tru-cut) or incisional biopsy.

Problems related to blocked nailing in fractures of the proximal femur.

The modern treatment of fractures of the proximal femur in the adult usually involves surgery. Open plating has proved to be reliable, but often involves a high percentage of complications: axial deformity, delayed union, breakage of the plate and/or screws (the risk of which increases in relation to the degree of comminution). At this site, in fact, the plate is submitted to strong flexion stress.

[Transcatheter embolization of expansive masses of the sacrum].

The authors report their 4-year (1984-1988) experience with TCE in the treatment of primary sacral benign/malignant and vascular bone tumors, after similar preliminary studies on aneurysmal bone cysts. Eleven patients were treated, for a total of 21 procedures: in 85% of the eight cases of palliative embolization, multiple instrumental approaches were needed for late revascularization, up to four consecutive embolizations in the same patients. Severe complications were observed in 19% of the procedures, due to arterial catheterization and/or instrumental maneuvers, but in none of them was surgery required.

Vertebral needle biopsy with CT scan monitoring.

The authors report the method used and the results obtained in 42 vertebral needle biopsies with CT scan monitoring. Material sufficient for a positive histological diagnosis was obtained in 67% of the cases. Indications for the use of this method are conditioned by a suitable clinical and instrumental evaluation, and limited to cases where a histological monomorphous lesion or when en bloc resection are predicted.

Breakage of the Grosse-Kempf nail: causes and remedies.

Eleven cases of breakage of the Grosse-Kempf nail were observed in a series of 297 operations performed at the Rizzoli Orthopaedic Institute in Bologna. Seven of the 9 femoral nails were not the latest available model, which is capable of supporting more stress because areas of less resistance have been eliminated. However, breakage is still a possibility as a result of errors of technique and incorrect planning of weightbearing.

Long-term results in 144 localized Ewing's sarcoma patients treated with combined therapy.

The results of 144 previously untreated cases of primary Ewing's sarcoma of bone are reported with a minimum follow-up of 5 years. This series was treated between 1972 and 1982 at Istituto Ortopedico Rizzoli with a combined therapy. The local control of the disease consisted of amputation (ten cases), resection followed by radiation therapy (35-45 Gy) (48 cases) and radiation therapy alone (40-60 Gy) (86 cases).

A comparison between delayed and immediate intramedullary nailing in the treatment of comminuted and open fractures (grade 1) of the tibia.

The authors studied a group of 215 comminuted or open (Grade 1) fractures of the tibial diaphysis in order to compare two methods successively adopted at the 1st Clinic and 3rd Division of the Rizzoli Orthopaedic Institute. We at first chose to delay nailing in these two types of fracture for 4 weeks (131 cases) and obtained good results in terms of consolidation, but only fair results in terms of functional recovery of ankle and subtalar movement and axial alignment of the tibia. Successively, we used immediate osteosynthesis with a screwed nail (84 cases), the results of which were better for all the parameters considered.

Radio-induced sarcomas in survivors of Ewing's sarcoma.

Of 255 cases of Ewing's sarcoma recorded at the Bone Tumor Center of the Rizzoli Orthopaedic Institute, 78 patients (irradiated and with a follow-up of longer than 3 years) were considered "at risk" for the development of a second radio-induced sarcoma (RIS). Three of the 78 patients developed an RIS in the irradiated field. Theoretical and statistical analyses were carried out considering different modalities of local treatment.

Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum.

The results of 131 cases of classic non-metastatic osteosarcoma of the extremities treated with preoperative chemotherapy, surgery and postoperative chemotherapy are reported. Preoperatively, the patients were given Methotrexate (MTX) intravenously (high and average doses) and Cisplatinum (CDP) intraarterially. For postoperative chemotherapy, the drugs and treatment protocols were based on the degree of necrosis observed (good, fair, poor).

[Value and limitations of computerized tomography in the study of benign tumors of the bone].

In order to stress the role of CT in the evaluation of benign tumors of the bone the authors studied by means of a high-resolution CT scanner 74 patients that later underwent surgery (70 cases) and histological examination (all cases). CT findings were compared with the surgical and histological data. The results prove that the diagnostic contributions of CT are less important in the evaluation of benign than in malignant bone tumors.

[Therapy of non-metastatic Ewing's sarcoma (pelvis excluded). Results obtained in 48 cases combining local therapy (radiation and/or surgical) and adjuvant chemotherapy with vincristine, adriamycin, dactinomycin and cyclophosphamide].

Combined therapy was used on a consecutive series of 48 patients with extrapelvic Ewing's sarcoma at the Rizzoli Orthopaedic Institute. The adjuvant chemotherapy protocol (VCR, ADM, D-ACT, EDX) was identical in all patients whereas local treatment consisted of amputation, resection and radiation treatment or radiation alone. At a mean follow-up of 58 months (39-78) 30 patients (60%) were free of the disease.

The Mazabraud syndrome: case report and review of the literature.

The authors report a case of Mazabraud's syndrome in a patient aged 57 years with a history of fibrous dysplasia of the skeletal system which had commenced at the age of 10. This became associated with myxomas of the soft tissues at the age of 42. This rare association was described by Mazabraud in 1957.

Giant-cell tumor of bone.

Of 327 patients who had a giant-cell tumor of bone and were seen at the Istituto Rizzoli, 293 were treated at the Institute, and 280 of these were followed for two to forty-four years. The distribution according to sex and age of the patient and site of the tumor was similar to the distributions in major reports of large series. The tumor usually involved the metaphysis and the epiphysis, but was occasionally limited to the metaphysis, and in only 2 per cent of the patients was it adjacent to an open growth plate.