Purpose: Chondroblastomas are a lesion of immature cartilage found in a typically epiphyseal location. The peak incidence is in teenagers. Current surgical treatment is a balance between complete excision, with potential for physeal and articular cartilage damage, and local recurrence. A minimally invasive technique with a low complication rate providing effective treatment may be provided by radiofrequency (RF) thermocoagulation. Already the treatment of choice for Osteoid Osteoma – another lesion that can occur in the epiphysis. 1. ,. 2. ,. 3. Literature to date on clinical use of RF thermocoagulation in chondroblastoma is scarce. 4. The high water content of chondroblastoma should ensure its sensitivity to RF ablation. Our units experience in osteoid osteoma has been extended to RF thermocoagulation of chondroblastoma. Patients: Four patients were treated with RF thermocoagulation for a chondroblastoma. Minimum follow up one year. Methods: A RITA Starburst probe thermocoagulates the lesion for at least 5 minutes at 90 degrees centigrade. Overnight stay and outpatient follow up until skeletal mature, or two years following treatment. Results: Two chondroblastomas were in the proximal tibia, one in the distal femur and one in the proximal humerus. One patient had surgery previously and one patient presented with collapse of the proximal tibial plateau. All patients were treated successfully and are pain free. All patients, accepting the one with pre-existing collapse, have a full range of movement. There has been no local recurrence at one year. Conclusion & Discussion: Our experience suggests that radiofrequency thermocoagulation is a safe and effective treatment method for patients with chondroblastoma

Aims: To evaluate the outcome of surgical treatment of benign and aggressive chondroblastoma in the Prague bone tumours register. Methods: Between 1969–2001 57 patients (38 men and 19 women) with chondroblastoma have been registered. The age ranged from 7 to 52 years – in average 19 years. The most frequent localizations were epiphyses of long bones (13 proximal humerus, 10 proximal femur, distal femur and proximal tibia each 11). We also observed atypical localizations (3 patella, 2 pelvis and 1 each in, fibula, talus, 5th metatarsal). All patients had available x-rays for evaluation and some arteriography or CT. All had histological verification. The treatment of choice was intralesional curetting and filling with auto or allografts. The femoral head lesions were treated through an original femoral neck approach to prevent hip luxation. We registered 5 aggressive variants with a different clinical course. They recur after intralesional surgery, are purely osteolytic and richly vascularized. One patient even developed lung metastasis. Results: In the usual type of benign chondroblastoma all patients were healed after intralesional surgery and graft filling with well-preserved function. In the aggressive form we performed a limb saving reconstructive surgery (knee arthrodesis, total knee or hip endoprosthesis). Conclusions: For benign chondroblastoma intra-lesional surgery brings excellent results. The aggressive form should be differentiated and resected at least marginally without delay to prevent larger skeletal defects

This is a retrospective study of 70 patients with chondroblastoma treated between 1973 to 2000. Of these 70 patients, 53 had their primary procedure performed at our unit in the form of an intralesional curettage. The purpose of this study was to determine the rates of recurrence and the functional outcomes following this technique. Factors associated with aggressive tumour behaviour were also analysed. The patients were followed up for at least 22 months, up to a maximum of 27 years. 6 out of these 53 cases (11. 3%) had a histologically proven local recurrence. Three patients underwent a second intralesional curettage procedure and had no further recurrences. Two patients had endoprosthetic replacement of the proximal humerus and one patient underwent a below knee amputation following aggressive local recurrences. One patient had the rare malignant metastatic chondroblastoma and died eventually. The mean MSTS score was 94. 1%. We conclude that meticulous primary intralesional curettage without any additional procedure can achieve low rates of local recurrence and excellent long-term functional results

Percutaneos radiofrequency (RF) ablation of osteoid osteoma has been proved as an effective treatment. However, there is limited data regarding other tumors. It also has been described in the treatment of other benign and malignant tumors like chondroblastoma and metastasis. In fact, one of the reported cases of chondroblastoma that were treated with RF was radiological small lesion erroneously diagnosed prior to treatment as osteoid osteomas. It was diagnosed as chondroblastoma only retrospectively. The aim of this study is to describe the success of RF as a definitive treatment and as an alternative to traditional surgery for the treatment of large chondroblastoma and chondromyxoid-fibroma which were diagnosed as such prior to ablation. From April 2006 to April 2007, 3 patients with chondroblastoma and 1 patient with chondromyxoid-fibroma were treated with RF ablation using cool-tip probe. Three procedures were done in the CT suit and one in the operating room. There were 3 girls and 1 boy. Mean age was 12 y 9 m (range 11 y 6 m – 14 y 6 m). Clinical and radiological follow-up was performed to assess outcome. The mean follow-up was 23.25 months (range 20–32 months). Three patients healed after single treatment and one needed repeated treatment. No immediate or delayed complications were observed. Follow up MRI showed no enhancement in the lesion and an extra-lesional sclerotic ream signifying RF effect beyond the lesion area. All patients returned to complete normal painless function. In spite of the small number of patients, percutaneous RF ablation was shown to be an effective and safe minimally invasive procedure for the treatment of chondroblastoma and chondromyxoid-fibroma, avoiding the morbidity of commonly used wide excision surgeries

Abstract: Dealing with peri-articular pathology in the skeletally immature is challenging. Where the process is benign the emphasis rests on preservation of the joint while minimising the risk of recurrence. However when dealing with lesions of the femoral head this may lead to avascular necrosis (AVN), negating the effects of conservative surgery, and potentially subjecting a child to a prolonged period of fruitless treatment, increased hospital stay, reduced mobility and significant time out of education and social interaction. Case & Method: A 13 year-old Caucasian female presented with a six-month history of pain in her right hip, initially in the groin, and a limp necessitating the use of crutches. Radiographs revealed a lytic lesion in the femoral head with a thinned but intact articular surface. This was biopsied, and a diagnosis of chondroblastoma reached. The operative alternatives of arthrodesis and arthroplasty were discarded in preference for hip salvage. An anterior approach to the hip, with dislocation of the femoral head allowed identification of the fragile cortical margin of the chondroblastoma. This was opened with a scalpel and curetted. Corticocancellous strips of bone graft were placed into the defect as struts around cancellous graft. An autogenous fascia lata graft was sutured over the articular defect in the femoral head. The capsule was repaired. Results: One year post-operatively she is pain free and has returned to normal activities. Radiographs show good incorporation of the bone graft. Conclusion: Femoral head preservation is effective with benefits outweighing the risk of AVN

Purpose of the study: Chondroblastoma is a rare benign cartilage tumor usually observed in secondary ossification centers of long bone in subjects aged 10 to 20 years. We report a multicentric series of 63 cases of chondro-blastoma in children and attempt to identify particular pediatric epidemiological features and identify factors of risk of recurrence. Material and methods: Clinical data an pre and postoperative imaging were analyzed as well as the histological findings reported by one observer. Files were collected from ten pediatric orthopedic units in France (two in Lyon, three in Paris, Rennes, Strasbourg, Toulouse, Saint-Etienne, Nice). Data were stored in a single database. The series included 35 boys, and 29 girls (sex ratio 1.25=. Mean age at diagnosis was 12 years (18 months to 17 years), 13 years for boys and 11 years for girls. Tumors were located in the epiphysis of the proximal tibia (n=17), the proximal femur (n=16), proximal the humerus (n=16), the distal femur (n=4), tarsal bones (n=4), the distal tibia (n=2), the fibula (n=2), the pelvis (n=1) and the distal radius (n=1). Preoperatively, the Springfield classification was: latent (n=14), active (n=36), aggressive (n=8); five tumors could not be classified. Treatment consisted in curettage-graft (n=40), curettage alone (n=17), curettage and cement filling (n=3), en bloc resection with reconstruction (n=3). Adjuvant alcoholization was used in one case. The histological study searched for an aneurysmal component within the tumor. Four patients were lost to follow-up and 59 patients were analyzed with a mean follow-up of 53 months (range 1–162 months). Statistical tests were applied to the data set to search for factors of risk of recurrence. Results and discussion: The inaugural syndrome was pain (n=52) or a palpable mass (n=3); the tumor was a fortuitous discovery in one case. Comparison with series including both children and adults revealed certain specific features of this pediatric series. The sex ratio was lower in our series; the distal femur localization, frequent in adults, was rare in children. AT one year, the rate of recurrence was 34% in our series (18/53). Fifteen of the 18 recurrences concerned radiologically active (n=12) or aggressive (n=3) tumors. Recurrence predominated in the tarsal bones (3/3), the proximal humerus (6/14), the proximal femur (5/13) and the proximal tibia (3/14). An aneurysmal component was found in 22% of the recurrent tumors and in 16% of those without recurrence. Statistical tests failed to distinguish any significant correlation with recurrence for age, gender, type of treatment, Springfield grade or localization. Conclusion: The epidemiological data in this series of pediatric chondroblastoma showed features different from adults. The rate of recurrence was particularly high in this multicentric series (but not statistically significant) for localizations in the tarsal bones or a deep joint (with difficult access such as the shoulder and the hip) or with an aneurysmal component

Chondroblastomas arise in the epiphyseal area of bones. In the femoral head this can cause considerable difficulty in obtaining access as the epiphysis is entirely intra-articular. We have reviewed management and outcome of 10 patients with chondroblastoma of the femoral head to identify outcome and complications. The mean age was 14 years and all presented with pain (frequently in the knee) and a limp. All were diagnosed on plain Xray and MRI. Five younger children were treated by curettage by a lateral approach up the femoral neck (to try and minimise damage to the epiphysis) and five by a direct approach through the joint. Two of the five patients with a lateral approach developed local recurrence whilst none of the direct approaches did. Both local recurrences were cured with a direct curettage. One patient developed overlengthening of the leg by 1cm but there was no case of growth arrest or osteoarthritis. We recommend a direct approach to the lesion whenever possible to give the best chance of cure with a low risk of complications

Tartrate-resistant acid phosphatase is contained in multinucleated giant cells of giant cell tumour of bone (GCT) and chondroblastoma (CBL) as well as in osteo-clasts. Yet few studies have so far been done regarding serum acid phosphatase (AcP) level in patients of GCT or CBL. The purpose of this study is to elucidate the clinical significance of serum AcP as a tumour marker for GCT and CBL. Serum AcP value was examined in nine GCT patients and three CBL patients before and after surgery. In the GCT cases, serum AcP values before surgery were high in five cases. They were 14.0 IU/L, 68.7 IU/L, 45.9 IU/L, 21.9 and 31.3 IU/L (normal value; 7.1–12.6 IU/L). They decreased after surgery to 7.7 IU/L (55% of the preoperative value), 8.2 IU/L (12%), 7.8 IU/L (17%), 6.1 IU/L (28%) and 10.0 IU/L (32%), respectively. Serum AcP values before surgery were within normal limits in the remaining four GCT cases. Even in these four cases, postoperative serum AcP level was lower than the preoperative level. Postoperative/preoperative AcP ratios in these four cases were 67%, 80%, 69% and 76%. In the CBL cases, serum AcP values were high in all cases. They were 15.1 IU/L, 13.1 IU/L and 13.7 IU/L. They decreased after surgery to 10.3 IU/L (68% of the pre-operative value), 10.2 IU/L (78%) and 9.7 IU/L (71%), respectively, all within normal limits. Therefore, it is concluded that serum AcP is a useful tumour marker for GCT and CBL in diagnosing the tumour as well as in evaluating the efficacy of treatment

Introduction. Chondroblastomas are rare bone tumours accounting for approximately 1% of all benign bone lesions. They occur in children and adolescents and are more frequent in males. The conventional treatment for chondroblastomas is surgery, however, this can be difficult and disabling due to the apo- or epiphyseal location. Surgery is curative in most cases, but recurrence rates of 10%–35% have been reported in the literature. Radiofrequency ablation is well established in the treatment of osteoid osteomas and painful bone metastases. We report our experience with the use of radiofrequency ablation in the treatment of chondroblastomas. Methods. Seven patients were identified from our Tumour database with biopsy proven chondroblastomas who were treated with Percutaneous CT Guided Radiofrequency Thermo coagulation. Results. The tumour was successfully treated in all patients with no recurrences. In two cases, complications occurred; infraction of a sub-articular chondroblastoma in one case and cartilage and bone damage in the unaffected compartment of a knee joint in the other. Discussion. Radiofrequency thermocoagulation of chondroblastomas offers a minimally invasive alternative to open surgery. The risk of complications would appear lower than with open surgery. Multi-tined expandable electrode systems allow the treatment of large chondroblastomas

Introduction. Bony tumours of the foot account for approximately 3% of all osseous tumours. However, literature regarding os calcis and talar tumours comprises individual case reports, short case series or literature reviews with no recent large series. Methods. We retrospectively reviewed the medical notes and imaging for all patients with calcaneal or talar tumours recorded in the Scottish Bone Tumour Registry since the 1940's. Demographics, presentation, investigation, histology, management and outcome were reviewed. Results. 34 calcaneal tumours and 23 talar tumours were identified. Calcaneal tumours. 2:1 male prevalence, mean age at presentation 30, average length of symptoms 9 months. 4 cases presented with pathological fracture. 21 benign tumours including 6 unicameral bone cysts, 3 chondroblastoma, and a wide variety of individual lesions. 13 malignant tumours comprising 6 osteosarcoma, 5 chondrosarcoma and 2 Ewings sarcoma. Talar Tumours. male to female ratio 3:1, mean age at presentation 28, average length of symptoms 5 months. 20 benign cases including 7 osteoid osteoma, 4 chondroblastoma, and several individual lesions. 3 malignant lesions comprising 2 chondrosarcoma, 1 osteosarcoma. Discussion. Tumours of the hindfoot frequently are delayed in diagnosis due to their rarity and lack of clinician familiarity. They are more common in men, especially talar tumours, which are most commonly benign osteoid osteoma or chondroblastoma. Calcaneal tumours have 1 in 3 risk of malignancy and cover a wider variety of lesions. Osteosarcoma of the foot tends to present later than other anatomical regions. Outcome is dependant on early diagnosis, timely surgery and most importantly neo-adjuvant chemotherapy. Diagnosis is often made on plain radiograph but MRI is the gold standard. Despite their rarity clinicians should maintain a high index of suspicion as accurate and timely diagnosis is important to management and outcome

Introduction. Bony tumours of foot account for approximately 3% of osseous tumours. However, literature regarding calcaneal tumours comprises individual case reports, short case series or literature reviews, with last large case series in 1973. Literature on bony tumours of the talus is limited to case reports only. Methods. We retrospectively reviewed medical notes and imaging for all patients with calcaneal or talar tumours recorded in the Scottish Bone Tumour Registry since the 1940's. Demographics, presentation, investigation, histology, management and outcome were reviewed. Results. 38 calcaneal tumours and 24 talar tumours were identified. Calcaneal tumours. Mean age at presentation 30 with heel pain and swelling, average length of symptoms 9 months. 4 cases present with pathological fracture. 24 tumours benign including 6 unicameral bone cysts, 3 chondroblastoma, 3 PVNS with calcaneal erosion, and wide variety of individual lesions. 13 malignant tumours comprising 6 osteosarcoma, 5 chondrosarcoma and 2 Ewing's sarcoma. 1 metastatic carcinoma. Talar Tumours. Mean age at presentation 28 with ankle pain and occasionally swelling, average length of symptoms 5 months. 20 benign cases including 7 osteoid osteoma, 4 chondroblastoma, and variety of individual lesions. 3 malignant lesions comprising 2 chondrosarcoma, one osteosarcoma. Discussion. Tumours of hindfoot frequently are delayed in diagnosis due to rarity and lack of clinician familiarity. They are more common in men especially talar tumours which are most commonly benign osteoid osteoma or chondroblastoma. Calcaneal tumours have 1 in 3 risk of malignancy. Diagnosis is often made on plain radiograph but MRI is the gold standard. Conclusion. We present largest case series of calcaneal tumours and first case series of talar tumours from the Scottish Bone Tumour Registry. Despite their rarity clinicians should maintain a high index of suspicion as accurate and timely diagnosis is important to management and outcome

Radio Frequency Ablation (RFA) is a precise CT-guided technique to generate a small pre-defined field of dissecated tissue. Its’ present use in orthopaedic oncology is to treat osteoid osteoma. We have also treated other lesions with RFA and want to report our present indications and complications. From 2005 to 2008 we performed 30 procedures: 23 osteoid osteomas, five low-grade chondrosarcomas, one chondroblastoma and one thyroid metastasis. Localisations were femur in 14 cases, tibia in 10, calcaneus in two, fibula in two, sacrum in one and scapula in one. All patients were treated with CT- guided RFA (Boston Scientific). Follow-up for osteoid osteoma was done without additional imaging, all patients but one were pain free within 2 weeks; this one patient proved to have a chronic osteomyelitis although we thought we saw a nidus on CT. In one patient a burn wound complicated treatment because of unnoticed damage of the isolation layer of the probe. A free skin graft was necessary. We performed MRI controls and curettages for the chondrosarcomas in three patients, in one patient a fracture developed in the calcar femoris region after three months and a hip replacement was done. The patient with chondroblastoma is followed by MRI and there is no activity on contrast MRI two years after the procedure. In one lady a RFA was done for thyroid metastasis in the calcar femoris region. She fractured her collum femoris and got a hip replacement. In all tissue retrieved after RFA (curettage and hip replacement), there was complete necrosis of the tumour (chondrosarcoma grade one and thyroid metastasis). RFA is an effective procedure for osteoid osteoma. Fracture and skin burns can occur. It is promising in low-grade chondrosarcoma and chondroblastoma. A study has been initiated recently to evaluate effectiveness of RFA in low-grade chondrosarcoma < 4 cm

Isolated femoral neck lesions in children are rare and the differential diagnosis is wide. This study examines the spectrum of chronic non-traumatic bone lesions seen in the femoral neck region in children and emphasises the importance of tissue diagnosis. From 1990 to 2003, 23 children aged 1 to 3 years with chronic bone lesions of the femoral neck region were seen. Their case records and radiographs were reviewed retrospectively. Pain and a limp for 4 to 12 weeks were the main symptoms. Most children (18) had right-sided lesions. All had routine blood investigations, radiographs and bone scans. Histological and microbiological studies were done when pus and granulation tissue were found. We found infections, benign tumours and haematopoetic lesions. There were seven cases of tuberculosis and three of subacute pyogenic osteomyelitis. Six children had simple bone cysts, one a chondroblastoma, one a fibrous dysplasia and three osteoid osteoma. Two had eosinophilic granulomata. All 23 lesions were treated by curettage and biopsied. Bone graft was used in all the simple bone cysts, fibrous dysplasia and chondroblastoma. Internal fixation was used in one displaced fracture and the rest were immobilised in a spica. Follow-up ranged from 9 months to 8 years. All lesions showed healing. Coxa vara occurred in four patients and growth disturbances in five. Tuberculous lesions caused the greatest diagnostic dilemma as they resembled several benign bony conditions. Thorough examination is essential and biopsy is mandatory

Between 1974 and 1998, 34 patients with primary bone tumors and 28 with soft tissue tumors, all located in the foot, were surgically treated at our institutions. Of the 34 patients with a bone tumor, 27 (79%) had chondrogenic tumors: exostoses, 17; enchondromas, 7; benign chondroblastomas, 2 and chondrosarcoma, 1. This chondrosarcoma was misdiagnosed as a benign chondroblastoma at the initial biopsy. Five months after the initial curettage and bone grrafting, the tumor was recurred as a chondrosarcoma. This patient died with pulmonary metastasis another five months after the below the knee (BK) amputation. The differential diagnosis between benign chondrogenic tumors and low grade chondrosarcoma is very difficult as proposed by Mirra. Whereas the malignant tumor is very rare in the foot, the diagnosis of chondrogenic tumor should be made carefully. Of the 28 soft tissue tumors, diagnoses were giant cell tumor of tendon sheath or pigmented villonodular synovitis, 8; angioleiomyoma, 4; ganglion, 4; hemangioma, 2; miscellaneous benign tumors, 7 and soft tissue sarcomas (STS), 3. All patients with a STS were treated by a BK amputation, a partial foot amputation or a marginal resection, and died with pulmonary metastasis. However the function of the operated limb and the emotional acceptance were better in a patient with the less abrasion surgery. Conclusion: The majority of bone tumor in the foot was benign chondrogenic tumor. Even if the chondrosarcoma is very rare in the foot, it should be considered as a differential diagnosis to the benign chondrogenic tumors. Less abrasion surgeries for STS are recommended on the basis of functional evaluation and patient’s emotional acceptance, when the surgical margin is adequate wide

Introduction: Authors aim to present an interesting series of calcaneal tumors accrued from Scottish Bone Tumor Registry. The available literature is largely limited to the case reports. Bony tumors of the foot account for approximately 3% of all osseous tumors (1), of which Calcaneal location is the second most common site after the metatarsals in the foot. This study describes tumors of varying aetiology with regard to epidemiology, clinical features, diagnostic findings, treatment modalities and outcome. Material and Methods: This study is a retrospective review of the medical records and imaging modalities of forty patients with calcaneal tumors which were accrued from Scottish Bone Tumor Registry between January 1954 and December 2006. Patient demographics including presentation characteristics, and delay in the presentation from the onset of symptoms were noted. Plain radiographs followed by further imaging with CT, MR and Bone scanning were reviewed. Size, location and spread of the tumors were noted based on imaging modalities. The type of biopsy, histological diagnosis, type of resection and adjuvant therapy was noted. All patients were followed-up clinically and radiologically for a minimum of 2 yrs or until death. Results: There were 28 primary benign, 11 primary malignant and 1 secondary malignant tumors. In the cohot of 40 patients 26 were male and 14 females with mean age of 27 years. Pain (37/40), swelling (27/40) and restriction of movements (25/40) were the main presenting features. Pathological fractures were found in 4 patients. Mean duration of symptoms was 12 months. Histological diagnoses included Osteoid Osteoma (4/40), PVNS (4/40), Chondroblastoma (3/40), Simple bone cyst (3/40), ABC (3/40), GCT (3/40), Osteochondroma (2/40), Chondroblastoma, Enchondroma, Fibrous Histiocytoma and Glomus tumour (1 case each). Chondrosarcoma, Ewing’s and Paget’s sarcoma (2 cases each), Osteosarcoma, Spindle cell and Pleomorphic Sarcoma (1 case each). Thirty eight patients underwent operative management. Summary: Current study is one of the largest reported series of calcaneal tumors. A wide variety of lesions seem to involve patients from different age groups and either sex. Presentation features include mainly pain and swelling aggravated by walking. Radiological features may differ than those reported for common locations for the given tumor type. The recurrence rate for benign bone forming as well as cartilage tumors seem to be low provided adequate curettage or excision has been carried out. Whereas most benign lesions can be managed with limb salvage, below knee amputation sees to be a standard operation for primary malignant tumors. Metastatic lesions have poor survival prognosis

Introduction. The femoral neck in children is a common site for bone lesions. The majority are benign. However these lesions can cause diagnostic problems. Aim. To present a spectrum of chronic lesions of the femoral neck in children and emphasize the importance of tissue diagnosis. Materials and methods. Thirty two children with isolated chronic bone lesions in the femoral neck treated between 1994 and 2013were retrospectively reviewed. The ages ranged between 1–13 years. Clinical features were pain and limp. Routine blood tests, x-rays and CT scans were done in all and MRI scans in 5 cases. All diagnoses were confirmed histologically. Results. Three radiological patterns were seen: lucent or cystic in 22, infiltrative (permeative)in 2, and localized densities with nidus in 8 cases. Histologically the lesions were subacute osteomyelitis in 4, tuberculosis in 9, simple bone cyst in 7, osteoid osteoma in 7, chondroblastoma in 1, monostotic fibrous dysplasia in 2 and eosinophilic granuloma in 2 cases. Two tuberculous lesions were associated with subluxation of the hip and involvement of the head occurred in 2 others. Treatment and outcome. All lesions were curetted. Bone grafting was done in 10. Immobilisation was by internal fixation in 1, traction in 2 and spica cast in 29 cases. Follow up was 9 months to 11 years. Healing occurred in the majority. Recurrence occurred in 2 cases. Coxa vara developed in 6, and growth disturbance with shortening in 9 patients. Discussion. Femoral neck lesions are mainly benign, present diagnostic difficulty and treatment is challenging. There are problems with immobilization and of purchase with fixation devices due to poor bone stock on the neck of femur. The spica cast is a reliable method of immobilization in children under 10years. Growth disturbance and coxa vara can result after healing. CT scan is useful in assessing the architecture of the bone. NO DISCLOSURES

We report a case of an aneurysmal cyst localized in the patella of a 37-year-old man. The lesion was secondary to a chondroblastoma at six years follow-up after initial curettage and bone graft. It were no recurrence. Treatment of aneurysmal cysts depends on the degree of articular involvement. We made a detailed study of 11 cases of this rare localization of aneurysmal cysts reported in the literature

Bony tumours of the foot account for approximately 3% of all osseous tumours. However, literature regarding os calcis tumours comprises individual case reports, short case series or literature reviews, with the last large case series in 1973. We retrospectively reviewed the medical notes and imaging for all patients with calcaneal tumours recorded in the Scottish Bone Tumour Registry since the 1940's. Demographics, presentation, investigation, histology, management and outcome were reviewed. 38 calcaneal tumours were identified. Male to female ratio 2:1, mean age at presentation 30 with heel pain and swelling, average length of symptoms 9 months. 4 cases present with pathological fracture. 24 tumours benign including 6 unicameral bone cysts, 3 chondroblastoma, 3 PVNS with calcaneal erosion, and a wide variety of individual lesions. 13 malignant tumours comprising 6 osteosarcoma, 5 chondrosarcoma and 2 Ewings sarcoma. 1 metastatic carcinoma. Tumours of the calcaneus frequently are delayed in diagnosis due to their rarity and lack of clinician familiarity. They are more common in men and have a 1 in 3 risk of malignancy, covering a wide variety of lesions. Outcome is dependent on early diagnosis, timely surgery and most importantly neo-adjuvant chemotherapy. Diagnosis is often made on plain radiograph but MRI is the gold standard. We present the largest case series of calcaneal tumours, from our experience with the Scottish Bone Tumour Registry. Despite their rarity clinicians should maintain a high index of suspicion as accurate and timely diagnosis is important to management and outcome

There is limited literature available on the use of metal prosthetic replacements for the treatment of non-traumatic lesions of the proximal radius. This study discusses the implant survivorship and the functional outcome of the elbow following insertion of metal proximal radius endoprostheses performed at the Royal National Orthopaedic Hospital. We present a series of six patients treated with endoprosthetic reconstruction of the proximal radius following resection of non-traumatic pathologies. The patients included four females and two males, with a mean age of 39 years at the time of surgery. Their diagnoses included Ewing’s sarcoma, chondroblastoma, benign fibrous histiocytoma, radio-ulna synostosis and renal carcinoma metastases in two patients. Follow-up extended to 192 months with a mean of 76 months. During this time there were no complications with the prostheses, the most recent radiographs demonstrated secure fixation of the implants and none required revision. One patient developed posterior interosseuous nerve neuropraxia following surgery, which partially recovered, and another patient passed away as a result of disseminated metastatic renal cell carcinoma which was present preoperatively. The patient with radio-ulna synostosis had a 25° fixed flexion deformity of the elbow post-operatively but good flexion, supination and pronation. All other patients had full ranges of movement at the elbow. Functional scores were assessed using the Mayo Elbow Performance Score with patients achieving a mean score of 86 out of 100. The results of the use of proximal radial endoprostheses for treatment of non-traumatic lesions are encouraging with regards to survivorship of the implant and functional outcome of the elbow

Introduction: There is limited literature available on the use of metal prosthetic replacements for the treatment of non-traumatic lesions of the proximal radius. This study is a medium-term follow-up of implant survivor-ship and the functional outcome following insertion of metal proximal radius endoprostheses performed at the Royal National Orthopaedic Hospital. Method: We present a series of six patients treated with endoprosthetic reconstruction of the proximal radius following resection of non-traumatic pathologies. The patients included four females and two males, with a mean age of 39 years at the time of surgery. Their diagnoses included Ewing’s sarcoma, chondroblastoma, benign fibrous histiocytoma, radio-ulna synostosis and renal carcinoma metastases in two patients. Follow-up extended to 192 months with a mean of 76 months. Results: During this time there were no complications with the prostheses, the most recent radiographs demonstrated secure fixation of the implants and none required revision. One patient developed posterior interosseuous nerve neuropraxia following surgery, which partially recovered, and another patient passed away as a result of disseminated metastatic renal cell carcinoma which was present pre-operatively. The patient with radio-ulna synostosis had a 25° fixed flexion deformity of the elbow post-operatively but good flexion, supination and pro-nation. All other patients had full ranges of movement at the elbow. Functional scores were assessed using the Mayo Elbow Performance Score with patients achieving a mean score of 86 (65 – 100) out of 100. Discussion: The results of the use of proximal radial endoprostheses for treatment of non-traumatic lesions are encouraging with regards to survivorship of the implant and functional outcome of the elbow