Objetivo O tratamento cirúrgico de tumores ósseos é agressivo por natureza e frequentemente seguido por complicações relacionadas com a ferida (CRFs). Para minimizar esses eventos, diferentes estratégias foram empregadas e o penso de pressão negativa (closed-incision negative-pressure wound therapy, ciNPWT, em inglês) emergiu como possível adjuvante. Neste estudo, pretendemos avaliar o impacto dessa técnica na minimização de CRFs em pacientes com tumores de fêmur proximal e distal tratados com megapróteses. Métodos Este estudo retrospectivo observacional incluiu 41 participantes diagnosticados com tumores de fêmur proximal ou distal tratados com ressecção alargada e reconstrução com megaprótese. Os pacientes foram divididos em dois grupos com base no penso cirúrgico pós-operatório aplicado: grupo de encerramento assistido por vácuo (vacuum-assisted closure, VAC, em inglês), onde foi aplicado ciNPWT; e grupo não-VAC, que recebeu pensos convencionais. Dados sobre CRFs pós-operatórias e outras possíveis variáveis de interesse foram registados. A análise estatística foi realizada recorrendo ao programa IBM SPSS Statistics, versão 24.0. Resultados Foram 20 pacientes incluídos no grupo VAC e 21 no grupo não-VAC. A maioria dos pacientes não apresentou complicações e não houve diferenças entre os grupos em termos de CRFs, incluindo infecção. No entanto, deiscência da ferida e extravasamento persistente de fluido tiveram correlação positiva com o diagnóstico de infecção que, juntos, apresentaram correlação com a necessidade de revisão cirúrgica. Conclusão Apesar da ausência de significância estatística, a ciNPWT parece ajudar a minimizar a deiscência da ferida, o extravasamento persistente da ferida e as infecções da ferida operatória em pacientes com tumores ósseos do fêmur proximal e distal tratados com megaprótese. Além disso, a deiscência da ferida e o extravasamento persistente da ferida foram bem correlacionados com a infecção de ferida operatória, e os três parâmetros estão correlacionados com a necessidade de revisão cirúrgica.

INTRODUCTION: Metastatic bone disease decreases a patient’s function and increases morbidity being frequently found in patients with solid malignant tumors and multiple myeloma (MM). The effective treatment of these patients demands a multidisciplinary team approach to prevent catastrophic events such as pathologic fractures, especially in the proximal femur. This study aimed to evaluate oncologic outcomes, surgical complications, and associated healthcare costs in surgically treated patients with proximal femur bone metastases. METHODS: Retrospective study (2017-2021) of patients with proximal femur bone metastases secondary to carcinomas or MM, where surgical treatment of that anatomic location was performed. Epidemiologic data, histology, surgical management, presence of pathologic fracture, length of stay and overall survival were evaluated based on clinical records. Data analyses were performed using SPSS 23.0. RESULTS: Thirty-seven patients were identified, 20 male and 17 female. Nine patients had lung cancer metastases, eight had breast cancer metastases, seven had prostatic cancer secondary lesions, four presented uterine cancer secondary lesions, three cases were secondary to kidney cancer, and six patients had MM lesions. Twenty-nine patients presented pathologic fractures, while eight had an impending fracture. Twenty-six patients underwent osteosynthesis or conventional hemiarthroplasty/total hip arthroplasty, while an en bloc resection with megaprosthetic reconstruction was performed in the remaining 11 cases. Length of stay was longer for patients with pathologic fractures (p<0.05), with a better one-year overall survival (OS) for those with breast cancer metastases, those who underwent en bloc resection and those with impending fractures (p<0.05). CONCLUSION: OS for patients with proximal femoral metastases seems to be influenced by primary tumor histology, type of surgical management and the presence of pathologic fracture at diagnosis. This evidence should encourage thorough periodic follow-ups to prevent pathologic fractures and achieve optimized outcomes.

The purpose of this study was to compare the impact of postoperative closed-incision negative-pressure wound therapy (ciNPWT) and conventional dressings in wound-related complications after bone tumor resection and reconstruction. A total of 50 patients with bone tumors and clinical indication for wide resection and reconstruction were included and divided into two groups (A and B). Bone defect reconstructions were achieved with modular endoprosthesis or biologic techniques, mainly involving allografts with free vascularized fibula. Group A received ciNPWT, and Group B conventional dressings. Wound-related complications, including wound dehiscence, persistent wound leakage, surgical site infections (SSIs), and causes for surgical revision, were assessed. Nineteen patients were included in Group A and 31 in Group B. No significant differences were found between groups regarding epidemiologic and clinical presentation features, contrarily to reconstructive options, which were significantly different between both (Fisher = 10,100; p = 0.005). Additionally, Group A presented lower wound dehiscence rate (0 vs. 19.4

Bone marrow edema syndrome is a rare disease with an unknown etiology, self-limited and usually associated with an indolent course, which can also generate severe pain with tremendous functional impairment. The authors present a case of a 19-year-old female patient with a progressive, non-traumatic and unrelentless pain involving both knees, requiring persistently walking aids and analgesic drugs. The imaging studies showed a bilateral distal femur and proximal tibia bone marrow edema in the magnetic resonance imaging. Finally, and after an extensive investigation without any abnormal findings, a bone marrow edema syndrome diagnosis was established, with a spontaneous regression of the clinical and imaging presentation. One year after the initial complaints the patient is fully recovered, without pain or medication, presenting an MRI showing complete regression of the initial findings. Despite the rarity of this entity, being aware of its existance and clinical manifestations is crutial to allow a proper diagnosis. The case herein presented is, to our understanding, pragmatic regarding bone marrow edema syndrome presentation and clinical course.

We present the case of a 32-year-old man with a diagnosis of type-III osteogenesis imperfecta who developed a telangiectatic osteosarcoma in the proximal right tibia. An above-knee amputation was performed and after one-year follow-up, pulmonary metastatic lesions were detected on the thoracic CT scan. Palliative chemotherapy was proposed and to date the patient is still living and is under medical treatment. The association between osteogenesis imperfecta and osteosarcoma is rare. There are only ten confirmed reports of this unusual situation, but to our knowledge this is the first case reported with a telangiectatic osteosarcoma arising in this particular setting.

Giant cell tumour of bone (GCT) is a relatively rare, locally aggressive benign neoplasm observed in the long bone epiphyseal-metaphyseal regions of young adults. The optimal treatment strategy for these tumours remains controversial, and a huge amount of contradictory data regarding the functional and oncological outcomes can be found. Therefore, we performed a systematic review intended to investigate the functional and oncological outcomes after surgical treatment of GCTs arising around the knee, namely in the distal femur and proximal tibia. A trend towards better oncological control was found using wide resections, nonetheless, curettage-based techniques achieve a highly acceptable recurrence rate with overall better knee function. A slight advantage favouring proximal tibia GCTs regarding the Musculoskeletal Tumor Society (MSTS) score was also observed. Prospective studies comparing groups of more homogeneous patients, tumours, and treatment options should be developed to obtain more conclusive and definitive results regarding the optimal strategy for treating GCTs. Cite this article: EFORT Open Rev 2021;6:641-650. DOI: 10.1302/2058-5241.6.200154

Introduction: A primary malignant giant-cell tumor of bone (PMGCT) is an extremely rare disease and usually presents with a better prognosis than its secondary counterpart does (secondary malignant giant-cell tumor of bone or SMGCT). Case Report: We present a case of a highly atypical PMGCT of the proximal left tibia, with extremely fast progression, pathological fracture, fungation, and patient death. Conclusion: This clinical case is an example of the most extreme and aggressive biological behavior that could arise with a PMGCT. These usually have a better prognosis than most, among malignant giant-cell tumors. This case highlights the need for a low threshold of suspicion for malignant transformation when giant-cell tumors have an unusual presentation.

CASE:A 60-year-old man presented with left hip pain, and a radiograph showed reduced joint space. During the surgical procedure for a total hip replacement, a proximal femur mass was identified and biopsy was subsequently interpreted as grade 2 chondrosarcoma. A wide resection was needed, but he developed local recurrence after 2 years and was treated with an external hemipelvectomy.CONCLUSIONS:Chondrosarcoma does not always present with a classical clinical picture or imaging, and it can be misdiagnosed. Practitioners should be highly suspicious of malignant disease as a cause for hip pain even if there is no direct indication of a neoplasm such as chondrosarcoma.

INTRODUCTION:Pipkin fractures are rare events and usually occur as a consequence for high-energy trauma. Surgery to obtain anatomical reduction and fixation is the mainstay treatment for the majority of these injuries; nonetheless, controversy exists regarding the best surgical approach.DESCRIPTION OF THE CASE:We present the case of a 41-year-old male, which sustained a type II Pipkin fracture following a motorcycle accident. In the emergency department, an emergent closed reduction was performed, followed by surgery five days later. Using a surgical hip dislocation, a successful anatomical reduction and fixation was performed. After three years of follow-up, the patient presented with a normal range of motion, absent signs for avascular necrosis or posttraumatic arthritis, but with a grade II heterotopic ossification.DISCUSSION:Safe surgical hip dislocation allows full access to the femoral head and acetabulum, without increasing the risk for a femoral head avascular necrosis or posttraumatic arthritis. Simultaneously, this surgical approach gives the opportunity to repair associated acetabular or labral lesions, which explains the growing popularity with this technique.CONCLUSION:Although technically demanding, safe surgical hip dislocation represents an excellent option in the reduction and fixation for Pipkin fractures.

Introduction: Hip Surgical Dislocation (SHD) according the technique described by Ganz et al. is a safe and powerful tool to access intra-articular hip pathology in adults. Some indications may also arise in younger patients to correct slipped capital femoral epiphysis or femoral neck deformities Materials and Methods: From 2004 to 2008 we have selected 45 patients on whom the procedure was done to treat femoroacetabular impingement (FAI). The average follow up time is 3 years, and patient mean age 26 years. The indications for SHD were: mixed FAI in 26 cases, pure cam FAI in 6 cases and pure pincer FAI in 13 cases. 42 hips where graded as Tonnis 0 and 2 as Tonnis 1. All patients where evaluated according to the non arthritic hip score (NAHS – McCarthy et all) before and after the surgery at 3, 6, 12, 24 and 36 months. Osyrix ® software was used to measure radiographic parameters. The numeric variables where treated using SPSS for windows (paired t student test). Surgical Technique: In all 45 cases we did SHD, acetabular and/or femoral head neck junction trimming and labrum refixation. In half cases an anterior step trochanteric osteotomy was done and in 7 cases additional relative neck lengthening was performed. Results: The average alfa angle measured in the standard crosstable view x ray was 72° before surgery and 36° after surgery (p=0,0001). The NAHS before surgery was 40,8 average: 9,71 – pain; 6,9 – symptoms; 9 – function and 6,9 – activities and after surgery 76,38 average (p= 0,0001) 17,5 – pain (p= 0,0001); 12,9 – symptoms (p= 0,0001); 16 - function (p= 0,0001) and 14,9 - activities (p= 0,0001). All patients improved motion, specially flexion, internal rotation (p= 0,0001). The results did not differ significantly in the patients who had a trochanteric anterior step osteotomy. One patient had a total hip replacement for ongoing osteoartrithis We had no avascular necrosis so far and no neurovascular damage. Trochanteric screw removal was done in 3 cases for local irritation. We had 2 capsule adhesions, released shortly after using arthroscopy. Conclusions: SHD is a demanding technique with full access to femoral head and acetabular deformities as well as cartilage or labral tears. It can be done safely with a low complication rate. The best results are achieved in young patients without degenerative cartilage and significant labrum changes. Hip degenerative changes contraindicates this procedure. Modification of trochanteric osteotomy does not seem to influence results

Introduction: There are several complications associated with spinal cord injury. The authors propose to evaluate the complications developed during hospitalization of tetraplegic patients treated in our institution. Materials and Methods: The clinical and imaging records of 20 tetraplegic patients operated between 1995 and 2007 were evaluated (14 men and 6 women; mean age 31.5 years; 16 submitted to surgery using anterior cervical approach, 4 using posterior approach; 8 did steroids protocol during 24h and 12 during 48h; 9 patients were operated less than 48h after trauma and 11 patients after). Results: Mean hospitalization time was 47.4 days (men 48.9 d, women 23.4 d; anterior approach 50.25 d, posterior approach 39 d; corticosteroids during 24h 34.3 d, 55.3 d in those who did 48h; time until surgery 48h 54.5 d). 100% of patients developed respiratory tract infections. 56.3% of patients developed urinary tract infections (33% in patients doing corticosteroids during 24h, 70% in those who did 48h) Mean duration of mechanic ventilation was 20.3 days (anterior approach 19.3 d, posterior approach 19.8 d; steroids during 24h 16.7 d, steroids during 48h 21 d; time until surgery 48h 23 d) In 37.5% of patients a traqueostomy was performed (41.7% in patients submitted to anterior approach, 25% in posterior approach; 16.7% in patients doing steroids during 24h, 50% in those who did 48h; time until surgery 48h 50%) Discussion: This patients are associated with long hospitalization and mechanic ventilation periods. Respiratory tract infection was the most frequent complication. The surgical approach had no influence on mechanic ventilation periods. Those submitted to anterior approach had longer hospitalization periods and higher incidence of traqueostomy. Patients who did corticosteroids during 48h had higher incidence of urinary tract infections and traqueostomy, and longer mechanic ventilation periods. Those operated less than 48h after trauma had shorter hospitalization and mechanic ventilation periods and traqueostomy procedure. Conclusion: Steroids longer than 24h, anterior cervical approach and time to surgery > 48h tend to be associated with higher complication rates