A New Approach for Complex Upper Limb Revisions Utilizing the Clavicula Pro Humero Technique: A Case Report.

Case: A complex case is described involving limb salvage using a combination of the clavicula pro humero technique with a free vascularized fibular graft to span the defect following a failed megaprosthetic reconstruction. This is believed to be the first description of this approach for a very difficult problem.

Conclusion: In the setting of infection and minimal bone stock, conventional reconstruction options for the proximal aspect of the humerus were unsatisfactory.

XI-006 induces potent p53-independent apoptosis in Ewing sarcoma.

There is an imperious need for the development of novel therapeutics for the treatment of Ewing sarcoma, the second most prevalent solid bone tumour observed in children and young adolescents. Recently, a 4-nitrobenzofuroxan derivative, XI-006 (NSC207895) was shown to diminish MDM4 promoter activity in breast cancer cell lines. As amplification of MDM4 is frequently observed in sarcomas, this study examined the therapeutic potential of XI-006 for the treatment of Ewing and osteosarcoma.

Primary osteosarcoma of the clavicle and the perils of bone biopsy.

We present a rare case of delayed diagnosis of osteosarcoma of the medial clavicle in a young man. He presented following a pathological fracture with a falsely reassuring core and fine-needle aspiration biopsy. The initial biopsy was suggestive of an aneurysmal bone cyst and was therefore treated conservatively without further follow-up.

Multicentric myofibroblastic sarcoma.

We report a case of synchronous, multicentric low-grade myofibroblastic sarcoma presenting in a 62-year-old man. He initially presented with inflammatory symmetric polyarthritis and adhesive capsulitis of his shoulder and hips bilaterally and did not respond to a trial of disease modifying antirheumatic drugs. Over a period of several years he developed progressive restriction of both knees and nodules on his hands, both knees and back.

Many faces of osteosarcoma on plain radiographs.

Osteosarcoma is the most common primary malignancy of bone. It is a very rare form of cancer with an annual incidence of 3:1,000,000 and so will not be seen by many surgeons. Coupled with this are the many different subtypes of this cancer that can have different appearances on imaging ranging from densely sclerotic to lytic or even cystic.

A modified ulnar translocation reconstruction technique for Campanacci grade 3 giant cell tumors of the distal radius using a clover leaf plate.

Background: Campanacci grade 3 giant cell tumors of the distal radius are locally aggressive and in close proximity to the median nerve, articular cartilage, flexor and extensor tendons, and the radial artery. Although several reconstructive techniques have been described, it is unclear to what degree these procedures restore function.

Description Of Technique: We present a modified ipsilateral ulna translocation technique using a clover leaf plate, for reconstruction of en bloc resected distal radius.

Nutlin-3a efficacy in sarcoma predicted by transcriptomic and epigenetic profiling.

Nutlin-3a is a small-molecule antagonist of p53/MDM2 that is being explored as a treatment for sarcoma. In this study, we examined the molecular mechanisms underlying the sensitivity of sarcomas to Nutlin-3a. In an ex vivo tissue explant system, we found that TP53 pathway alterations (TP53 status, MDM2/MDM4 genomic amplification/mRNA overexpression, MDM2 SNP309, and TP53 SNP72) did not confer apoptotic or cytostatic responses in sarcoma tissue biopsies (n = 24).

Pre-activation of the p53 pathway through Nutlin-3a sensitises sarcomas to drozitumab therapy.

The present study evaluated the efficacy of drozitumab, a human monoclonal agonistic antibody directed against death receptor 5 (DR5), as a new therapeutic avenue for the targeted treatment of bone and soft-tissue sarcomas. The antitumour activity of drozitumab as a monotherapy or in combination with Nutlin-3a was evaluated in a panel of sarcoma cell lines in vitro and human sarcoma patient samples ex vivo. Knockdown experiments were used to investigate the central role of p53 as a regulator of drozitumab cytotoxicity.

The toronto extremity salvage score in unoperated controls: an age, gender, and country comparison.

The Toronto Extremity Salvage Score (TESS) is widely used for the functional assessment of patients following surgery for musculoskeletal tumours. The aim of this study was to determine if there are gender and/or age-specific changes, unrelated to surgery, that may influence this score and the appropriateness of the questions. The TESS for lower limb was carried out in two different countries to see if there was variation between them.

Aqueous calcium sulphate as bone graft for voids following open curettage of bone tumours.

Introduction: Reported strategies for void filling in bone include autograft, allograft, synthetic bone substitutes or various combinations of these materials, but poor response rates and donor morbidity have created a desire to find a better option. Calcium sulphate as a stand-alone graft material reconstruct bone following curettage has not been previously reported. The purpose of this study was to assess the efficacy and radiological quality of healing, the time to healing, the functional outcomes and the complications following curettage and grafting using an injectable aqueous calcium sulphate (BonePlast; Biomet, Warsaw, IN, USA) as the sole grafting strategy.

Can the Toronto Extremity Salvage Score produce reliable results when used online?

Background: Web-based questionnaires have become popular, however, access to the Internet can be biased regarding age, gender, and education, among other factors. Therefore, it is unknown whether this is a reasonable avenue to administer a questionnaire to patients or whether Web-based can be a reliable alternative to paper-based.

Questions/purposes: We determined whether the Internet version of the Toronto Extremity Salvage Score is reproducible compared with the paper-based version and the compliance and completion rates.

Open incisional biopsy is a safe and accurate technique for soft tissue tumours.

Background: Accurate diagnosis of musculoskeletal tumours is important for successful treatment. Studies have reported a high risk of complications following open biopsy and have advocated core biopsy as a safer alternative; however, accuracy may be reduced with the smaller sample. The aims of this study were to determine the accuracy of open incisional biopsy, the complications (overall and those that affected subsequent management) including local recurrence and the need for further surgery.

The survivorship of protrusio cages for metastatic disease involving the acetabulum.

Background: Metastatic disease commonly affects the proximal femur and occasionally the acetabulum. Surgical options include the use of a protrusio cage with a THA. However, the complications and survivorship of these cages for this indication is unknown.

Vascular reconstruction in lower limb musculoskeletal tumours.

Background: Individual experience in the investigative, planning and operative aspects of lower limb musculoskeletal tumours is often small, making comparison between results difficult. The aim of the study was to describe the recent experience of a single tertiary referral unit performing limb salvage surgery, to identify areas of concern that are amenable to intervention and to provide clinicians an understanding of the surgical options.

Methods: Nine patients with peripheral limb musculoskeletal tumours are described.

Protecting a patellar ligament reconstruction after proximal tibial resection: a simplified approach.

Unlabelled: Limb salvage in tumor surgery has encouraged the development of megaprostheses. However, reattaching the ligamentum patellae poses a particular problem: avulsion and/or extensor lag may lead to poor function. We describe a new technique of patellar ligament reconstruction.

Injectable form of calcium sulphate as treatment of aneurysmal bone cysts.

Background: Aneurysmal bone cysts (ABC) are a rare condition in adolescents and teenagers but may result in pain, fracture and growth abnormalities. The gold standard of open curettage carries the risk of surgical complications and still a local recurrence rate of 20-30%. Percutaneous treatment of ABC have rarely been reported and a poor response the usual outcome.

Low risk of cardiac events during intramedullary instrumentation of lung cancer metastases.

Background: Instrumentation, particularly reaming, of the long bones carries the risk of embolic phenomenon. Emboli may result in pulmonary injury, which is usually manifested by desaturation. This pulmonary injury may be particularly relevant if there is diminished pulmonary reserve due to pre-existing lung disease such as lung carcinoma.

Lytic bone lesions in an Australian population: the results of 100 consecutive biopsies.

Background: The identification of a lytic bone lesion is often perceived as a harbinger of malignancy, especially in an older patient. This study reviews the results of 100 consecutive biopsies of patients who presented with either a solitary lesion or multiple lytic bone lesions in the absence of a history of malignancy.

Methods: Following preoperative planning, including plain radiographs, bone scan and computed tomography scanning, an open biopsy was carried out.

Importance of biopsy of new bone lesions in patients with previous carcinoma.

Development of destructive bone lesions in a patient with a history of visceral carcinoma may be assumed to be meta-static disease. However, this assumption may lead to inappropriate treatment. We prospectively enrolled 50 patients (54 previous malignancies) from the South Australian Musculoskeletal Tumour Service with new metastases to bone after a previous diagnosis of localized visceral carcinoma.