Odds of Metastatic Disease at Diagnosis of Primary Bone and Soft-Tissue Sarcomas of the Extremity and Pelvis Based on Preferred Language and Socioeconomic Factors.

Introduction: The odds of metastatic disease at diagnosis of bone (BS) and soft-tissue sarcomas (STS) of the extremities and pelvis may vary among patients due to several factors. There is limited research comparing the rates of metastatic disease at diagnosis in patients from different demographic and socioeconomic backgrounds.

Methods: Patients with a primary BS or STS of the extremity or pelvis were identified using International Classification of Diseases codes.

Socioeconomic disparities in reception of limb-sparing surgery versus amputation for lower extremity sarcoma.

Background: In lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery.

Methods: Patients with lower extremity bone or soft tissue sarcoma who received either limb-sparing surgery or amputation from 2007 to 2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database.

The Emerging Role of Three-dimensional Technologies in Orthoplastic Surgery.

Three-dimensional (3D) planning and manufacturing technologies have become integral to head and neck reconstruction following tumor resection. These technologies facilitate the prototyping of patient-specific solutions in both digital and physical form. Three-dimensional tumor models and cutting guides help conceptualize and verify the surgical approach, as well as serve as a blueprint for reconstruction.

Optimizing Total Hip and Knee Arthroplasty Among an Underserved Population: Lessons Learned From a Quality-Improvement Initiative.

Background: Under-represented minorities and those with noncommercial insurance have higher medical comorbidities and complications following elective total joint arthroplasty (TJA). In an effort to bridge this gap, our center implemented a preoperative optimization protocol for TJA in a Medicaid Clinic (Clinic). The purpose of this study is to assess the effectiveness of that protocol and highlight challenges associated with caring for this patient population.

Antecubital Burn Resulting From Antenna Coupling: A Case Report.

Case: We present the case of a 54-year-old man who underwent elective hip disarticulation complicated by third-degree burn of the left antecubital fossa requiring skin graft. After careful review, it was determined that "antenna coupling" as a result of electrosurgery was the likely cause. We present an experiment demonstrating this phenomenon.

A Systematic Review of the Orthoplastic Approach in Adult Lower Extremity Soft Tissue Sarcoma Flap Reconstruction.

Background: The orthoplastic approach to patient care has changed the way patients with a wide variety of lower extremity pathology are treated. Through a systematic review, we aim to analyze outcomes in adult patients with lower extremity soft tissue sarcomas who undergo an orthoplastic flap management approach to their care.

Methods: A systematic review of adult lower extremity soft tissue sarcoma excision with plastic surgery flap reconstruction was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching the Pubmed, Embase, and Web of Science databases from inception to April 2023.

Is There an Implicit Racial Bias in the Case Order of Elective Total Joint Arthroplasty?

Introduction: Identifying ways to improve equitable access to healthcare is of the utmost important. In this study, we analyzed whether patient race was negatively associated with surgical start times for total joint arthroplasties (TJA).

Methods: The surgical case order and start times of all primary TJAs performed at a large academic medical center between May 2014 and May 2018 were retrospectively reviewed.

Effect of Insurance Status on Mortality in Adults With Sarcoma of the Extremities and Pelvis: A SEER-Medicare Study.

Introduction: Previous studies have highlighted the association between insurance status and poor outcomes after surgical treatment of sarcomas in the United States.1-3 It is unclear how much of this disparity is mediated by confounding factors such as medical comorbidities and socioeconomic status and how much can be explained by barriers to care caused by insurance status.

Methods: Surveillance, Epidemiology, and End Results-Medicare linkage data were procured for 7,056 patients undergoing treatment for bone and soft-tissue sarcomas in the extremities diagnosed between 2006 and 2013.

Effect of Resident and Fellow Involvement on Outcomes of Sarcoma Surgery: A NSQIP Database Cross-Sectional Study.

Background: The complexity of sarcoma surgery often justifies surgical assistants of higher levels of academic training: senior residents, fellows, or co-surgeons. The association between the level of training of assistants and outcomes of these procedures has yet to be studied.

Methods: The Current Procedural Terminology (CPT) codes comprising the "core" procedures for musculoskeletal oncology fellowships were gathered.

Statistical Fragility of Surgical Clinical Trials in Orthopaedic Trauma.

Introduction: The Fragility Index (FI) and the Fragility Quotient (FQ) are powerful statistical tools that can aid clinicians in assessing clinical trial results. The purpose of this study was to use the FI and FQ to evaluate the statistical robustness of widely cited surgical clinical trials in orthopaedic trauma.

Methods: We performed a PubMed search for orthopaedic trauma clinical trials in high-impact orthopaedics-focused journals and calculated the FI and FQ for all identified dichotomous, categorical outcomes.

Postoperative COVID-19 Pneumonia following Resection of a Large Thoracic Chondrosarcoma.

Case: A 57-year-old man presenting with two months of insidious shoulder pain was found to have a large thoracic chondrosarcoma invading the spinal canal. The patient's orthopedic oncologist organized an interdisciplinary team including interventional radiology, thoracic surgery, neurosurgery, and plastic surgery. This allowed safe, en bloc tumor resection.

Recurrent Giant Apocrine Hidrocystoma of the Leg: A Case Report.

Case: A 26-year-old woman developed a painful enlarging mass in her left leg over the course of 4 years. Marginal resection and local adjuvant therapy was undertaken, and pathology confirmed the mass to be an apocrine hidrocystoma.

Conclusion: Giant apocrine hidrocystomas with osseous involvement outside of the head and neck are extremely rare.

Statistical Fragility of Surgical and Procedural Clinical Trials in Orthopaedic Oncology.

Unlabelled: The fragility index (FI) is a powerful tool that can be used to assess the statistical strength of a study outcome. This metric is defined as the number of patients who would need to have an alternative outcome to convert a clinical trial result from statistically significant to not statistically significant, or vice versa. No studies to date have used the FI to evaluate surgical and procedural clinical trials in the orthopaedic oncology literature.

Treatment of an Acromial Stress Fracture After Reverse Total Shoulder Arthroplasty With Teriparatide: A Case Report.

Case: A 78-year-old woman who underwent reverse total shoulder arthroplasty (RTSA) for proximal humerus fracture developed a Type-3 acromial stress fracture, resulting in increased pain and decreased function 9 months post-op. She was managed nonoperatively with adjunctive teriparatide (FORTEO), and after a 4-month course, she had regained excellent motion and achieved union.

Conclusion: Teriparatide is a viable adjunct in treating patients nonoperatively with acromial stress fractures after RTSA.

Risk Factors for Surgical Site Infection in Orthopaedic Oncology.

Introduction: Surgical site infections (SSIs) are common complications after surgeries involving musculoskeletal tumors, but we know little about SSI risk factors unique to orthopaedic oncology. A greater understanding of these factors will help risk-stratify patients and guide surgical decision-making.

Methods: A retrospective review at a single-institution identified 757 procedures done on 624 over 6 years.

Sarcoma Surveillance: A Review of Current Evidence and Guidelines.

After initial treatment of sarcoma, disease progression may occur in the form of local recurrence, pulmonary metastases, or extrapulmonary metastases. As such, surveillance is an important aspect of management, but no universally accepted practice standards are found. In the absence of strong evidence, and to allow for individualized care, existing guidelines contain flexibility in terms of both the frequency and modality of surveillance.

Is There an Association Between Insurance Status and Survival and Treatment of Primary Bone and Extremity Soft-tissue Sarcomas? A SEER Database Study.

Background: Several recently published population-based studies have highlighted the association between insurance status and survival in patients with various cancers such as breast, head and neck, testicular, and lymphoma [22, 24, 38, 41]. Generally, these studies demonstrate that uninsured patients or those with Medicaid insurance had poorer survival than did those who had non-Medicaid insurance. However, this discrepancy has not been studied in patients with primary bone and extremity soft-tissue sarcomas, a unique oncological population that typically presents late in the disease course and often requires referral and complex treatment at tertiary care centers-issues that health insurance coverage disparities could aggravate.

A Peculiar Primary Paraganglioma of the Distal Thumb.

A paraganglioma is a highly vascularized neuroendocrine tumor most commonly found within the adrenal gland as a pheochromocytoma. Extra-adrenal paragangliomas are frequently located in the head, neck, thorax, and abdomen. We report the first documented case of a primary paraganglioma found within the appendicular skeleton.

Increased Insulin mRNA Binding Protein-3 Expression Correlates with Vascular Enhancement of Renal Cell Carcinoma by Intravenous Contrast-CT and is Associated with Bone Metastasis.

Purpose: To: 1) assess the correlation between CT vascularity and a candidate molecular marker of RCC metastasis (insulin-like mRNA binding protein-3 (IMP3)); and 2) demonstrate the differential expression of IMP3 in high vs. low vascular tumors.

Experimental Design: Retrospectively obtained contrast CT from 72 patients with primary RCC were used to establish threshold values for Low, Intermediate and High tumor vascularity.

The AOA-JOA 2014 exchange traveling fellowship: Banzai and beyond.

The American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) traveling fellowship was established in 1992 as a method for creating collaboration between the American and Japanese orthopaedic communities and providing a friendly exchange of current practices and scientific endeavors. The fellowship is designed to allow early-career orthopaedic surgeons the opportunity to participate in international travel and scholarship. This year's traveling fellows (Hassan Mir, Wakenda Tyler, Leo Kroonen, and Dan Zlotolow) all hail from different parts of the United States and have a variety of practice subspecialties.

A highly curable lymphoma occurs preferentially in the proximal tibia of young patients.

The presentation of two 19-year-old male subjects with stage I non-Hodgkin lymphoma in the proximal tibia prompted an extensive review of institutional and national databases to assess whether there is any statistical evidence that these reflected a previously overlooked syndromic pattern of presentation. The institutional records of a single institution were reviewed for presentation of non-Hodgkin lymphoma in the bone. The records of two additional institutions were reviewed for all reports of non-Hodgkin lymphoma in the tibia.

Atypical femur fractures.

Atypical femur fractures were first reported in 2007 and are now recognized as a unique clinical entity. They occur along the shaft of the femur extending from the subtrochanteric region proximally to the distal femoral metaphysis. These fractures have an increased incidence in patients taking bisphosphonates for osteoporosis and develop as stress reactions in the lateral cortex of the femoral shaft.

Proximal humerus fractures with associated axillary artery injury.

Proximal humerus fractures have rarely been associated with injuries to the axillary artery. Most of the fractures described have been Neer 2-part surgical neck fractures with medialization of the shaft fragment and resultant laceration or thrombosis of the axillary artery. No intraoperative deaths have been reported.