Aims

The risk of postoperative complications after resection of soft-tissue sarcoma in the medial thigh is higher than in other locations. This study investigated whether a vessel sealing system (VSS) could help reduce the risk of postoperative complications after wide resection of soft-tissue sarcoma in the medial thigh.

Purpose: Core needle biopsy is increasingly accepted for the diagnosis of bone and soft-tissue tumours. Advantages over open biopsy include reduced morbidity, time and cost; however diagnostic accuracy remains a concern. Our objective was to assess and compare the diagnostic accuracy of core needle, open, and fine needle biopsies. Method: We reviewed 286 cases collected in a prospective database between 2004 and 2007. Of these, 229 had core needle, 32 open, and 25 fine needle biopsies. 230 had soft-tissue lesions, 56 had bone lesions. The results of these biopsies were compared to the final resection diagnosis for accuracy and, where inaccurate, any effects on management. Results: Ninety-two percent of the core needle, 100% of the open and 72% of the fine needle biopsies had adequate tissue to make a diagnosis. Of the adequate specimens, the accuracy of core/open/fine needle biopsy was 96%, 97% and 94% for determining malignant versus benign; of the correctly identified malignant lesions 97%, 100% and 80% were accurate for histological grade; and 79%, 84%, 59% for histological subtype. Conclusion: Core needle biopsy yields diagnostic results comparable to open biopsy for determining malignancy and grade in bone and soft-tissue tumours. Fine needle biopsy has a high inadequate sampling rate and should not be used for diagnosing bone and soft-tissue tumours. Given the reduced cost and morbidity associated with core needle biopsies we believe they should be used routinely for diagnosis where possible, and open biopsy reserved for situations where an inadequate specimen is obtained or core biopsy is not feasible

Introduction and purpose: We present a new decision-making method to assist orthopaedists and radiologists in diagnosing soft-tissue tumours. It can distinguish between benign and malignant characteristics in these lesions and classify them histologically with satisfactory efficiency. The pre-surgical diagnosis of the nature of the tumour and whether it is benign or malignant is crucial to planning surgical procedures. Materials and methods: We reviewed our cases of soft-tissue tumours (47) studied by MRI over the past year and a half. They are part of a multicentre study involving several European hospitals (430 patients). We analysed the clinical and MRI data: age, clinical presentation, size, shape, location, edges, image signal, calcification, intratumour fat, dependency, fibrosis, relation to fascias, bone and vessel disorders. Results: With this method we detected 62% benign tumours and 38% malignant. The system sensitivity and specificity are 86% and 95%, respectively. Conclusions: It is easy to distinguish between vascular, nerve and cystic lesions. The diagnosis of fibrous, synovial and fatty lesions is complex in all cases. The method can help orthopaedists make a diagnosis before surgery, which will facilitate planning of surgical procedures

Introduction: We studied the role of intraoperative radiotherapy (IORT) in preventing local recurrence, in cases of malignant soft-tissue tumors and desmoids. Methods: Ten patients (age 5814yrs) with recurrent soft-tissue tumors, grade IIA/IIB, 3 – 7cm long, involving thigh, calf, forearm and thenar were widely excised and irradiated into the operating room by a specially designed electron linear accelerator. The field was irradiated with electons (10 – 15Gy, 3 – 7MeV) with a circular-cut applicator (Φ40 – Φ80). Results: Common local post-irradiation complications such as neuropathy, vascular damage, fibrosis, wound problems or bone necrosis, were not noticed. At follow-up (24 – 38months) four patients (40%) remain disease free. Six (60%) had recurrence shortly after operation, two developed lung metastases. Discussion and Conclusion: IORT permits the application of high dose radiation during surgery. Manual displacement of healthy tissues situated between the radiation beam and the target reduces its toxicity. Direct vision assures maximum precision in the administration of radiation. It eliminates any remaining tumor, intensifies radiotherapy‘s antitumoral effect as it permits the administration of high doses of radiation otherwise not approachable. External irradiation is applied after wound closure. IORT reduces the lapse time between surgical exploration and irradiation during which residual satellite cellular clones can grow. We did wide resection and IORT in aggressive, recurrent tumors, as an alternative to amputation. Considering the advantages of IORT, we conclude that modification of the dose and irradiated area may further improve the results and reduce unpleasant therapies

Introduction: Chromosomal analysis is becoming increasingly useful in the diagnosis and management of bone and soft-tissue sarcomas. The identification of chromosomal aberrations such as translations, deletions, additions of a part or whole chromosome, and other markers are associated with specific tumor subtypes. Material and Methods: Between 1998 and 2000, 78 bone and soft-tissue tumors were analyzed. Cytogenetic analysis was carried on a short-term cultured tissues by G-banding FISH and SKY procedures, as needed. Histopathological diagnoses included osteosarcoma – 16, Ewing’s sarcoma – 13, synovial sarcoma – 4, rhabdomyosarcoma – 4 (alveolar – 3, embryonal – 1), liposarcoma – 3, extra-abdominal fibromatosis – 3, alveolar soft part sarcoma – 12, and other soft-tissue sarcoma – 12. Other diagnoses included 8 hematological malignancies and 13 benign tumors. Results: Eight of the 16 osteosarcomas studies demonstrated complex hyperploid karyotypes compatible with the diagnosis of high-grade osteosarcoma. In most Ewing’s sarcoma, including three cases with a typical t(11;22) translocation, other chromosomal abnormalities such as trisomies of chromosomes 5,6,8, and 14 were observed. Three of the four synovial sarcomas had the typical t(X;18)(p11.2;q11.2) translocation. One of the synovial sarcomas was initially diagnosed on a histopathological basis as Ewing’s sarcoma but the cytogenetic analysis showed a complex X;18 translocation and led to change in diagnosis and related treatment. Only one of the alveolar rhabdomyosarcomas demonstrated the typical t(2;13)(q35;q14) translocation, while hypertetraploid set with double minutes (dmin) was detected in the other two cases. By using SKY, chromosome 1 was determined as the origin of one of the dmins, suggesting that PAX7 amplification could be involved in the pathogenesis of this tumor. Conclusions: Cytogenetic analysis of bone and soft-tissue tumors are of important clinical value for accurate diagnosis of tumor type. It can also provide information suggesting the pathogenesis of these tumors

Introduction: Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm most commonly presenting in young to middle-aged adults. LGFMS is an indolent tumour with a deceptively benign histological appearance. Local recurrences are not uncommon and tumours can metastasise. The FUS-CREB3L2 gene translocation has been shown to occur commonly in cases of LGFMS. The literature suggests that the FUS-CREB3L2 fusion-gene is a specific marker for LGFMS. Methods: We report the cytogenetic analysis of 29 LGFMS cases, and clinical outcomes of 21 patients treated surgically between 1998 and 2008 at our regional bone and soft-tissue tumour centre. Results: The mean age was 45.4 years and mean follow-up 30.1 months. The most common tumour location was the lower limb. There were no cases of local recurrence or metastasis. Fifteen patients (52.2%) were FUS-CREB3L2 translocation-positive, suggesting either that translocation incidence in our series is lower than other studies, or that reverse-transcriptase polymerase chain reaction (PCR) is less sensitive than the literature suggests. Patients testing positive presented at a younger age (38.2 years, compared to 45.6 years), and had larger tumours than their negative counterparts (mean diameter 97.6mm, compared to 65.2mm), although there was no difference in clinical outcome. Discussion: We conclude that PCR testing for the FUS-CREB3L2 translocation is a useful tool for confirming the diagnosis of LGFMS, but has no role in predicting short-term clinical outcome. It is not necessary to perform wide excision, and marginal margins are adequate. Longer-term follow-up is required to elucidate differences in the long-term clinical outcome between translocation-positive and negative patients

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm most commonly presenting in young to middle-aged adults. LGFMS is an indolent tumour with a deceptively benign histological appearance. Local recurrences are not uncommon and the tumours can metastasise. A particular gene translocation, FUS-CREB3L2, has been shown to occur commonly in cases of LGFMS. The literature suggests that the FUS-CREB3L2 fusion-gene is a specific marker for LGFMS. We report the cytogenetic analysis of 29 cases of LGFMS, and clinical outcomes of 21 patients treated surgically between 1998 and 2008 at our regional bone and soft-tissue tumour centre. The mean age was 45.4 years. The most common location of tumours in our series was the lower limb. The mean follow-up was 30.1 months (range 0 to 125 months). To date, there have been no cases of local recurrence or metastasis. Fifteen of our patients (52.2%) were FUS-CREB3L2 translocation-positive. This suggests either that the translocation incidence in our LGFMS series is lower than other studies, or that reverse-transcriptase polymerase chain reaction (PCR) is substantially less sensitive than the literature suggests. The patients in this series testing positive presented at a younger age (38.2 years, compared to 45.6 years), and had larger tumours than their negative counterparts (mean diameter 97.6mm, compared to 65.2mm), although there was no difference in clinical outcome. We conclude that PCR testing for the FUS-CREB3L2 translocation is a useful tool for confirming the diagnosis of LGFMS, but has no role in predicting short-term clinical outcome. In our experience it is not necessary to perform wide excision, and marginal margins are adequate. Longer-term follow-up is required to elucidate whether the previously reported recurrence and metastasis rates are a true reflection of the nature of this tumour, and may identify differences in the long-term clinical outcome between translocation-positive and negative patients

Introduciton In our experience, amputation is rarely indicated in osteosarcoma. Amputation is more frequently required in soft tissue sarcoma for the following reasons: 1) recurrent tumour in previously radiated field; 2) composite tissue involvement of soft tissue, bone, vessels and nerves; 3) size of lesion. We have measured functional outcome in bone and soft tissue sarcoma using a combination of clinimetric measures describing impairment and patient determined measures assessing disability (. 1. ,. 2. ). Methods In a matched case-control study (. 3. ), 12 patients with amputation were matched with 24 patients treated by limb-sparing surgery on the following variables: age, gender, length of follow-up, bone versus soft-tissue tumor, anatomic site, and treatment with adjuvant chemotherapy. End points included the Toronto Extremity Salvage Score (TESS), a measure of physical disability; the Shortform-36 (SF-36), a generic health status measure; and the Reintegration to Normal Living (RNL), a measure of handicap. Results Mean TESS score for the patients with amputations was 74.5 versus 85.1 for the limb-sparing patients. (p = .15). Only the physical function subscale of the SF-36 showed statistically significant differences, with means of 45 and 71.1 for the amputation versus limb-sparing groups, respectively (p = .03). The RNL for the amputation group was 84.4 versus 97 for the limb-sparing group (p = .05). Seven of the 12 patients with amputations experienced ongoing difficulty with the soft tissues overlying their stumps. There was a trend toward increased disability for those in the amputation group versus those in the limb-sparing group, with the amputation group showing significantly higher levels of handicap. Conclusions These data suggest that the differences in disability between amputation and limb-sparing patients are smaller than anticipated. The differences may be more notable in measuring handicap

Introduction: Total scapular resection causes a significant functional loss because of the sacrifice of the glenoid, which serves as a stable base for shoulder motion. The authors analyze their experience with two types of reconstructions following total scapular resection; suspension of the humeral head from the clavicle without endoprosthetic reconstruction of the scapula and endoprosthetic scapular reconstruction. Materials and Methods: Between 1979 and 1997, the authors treated 23 patients with scapular tumors that required total scapular resection. Patients were diagnosed with 14 bone and 9 soft-tissue tumors. Resection included total scapulectomy in 12 patients and enbloc resection of the scapula and humeral head in 11 patients. Reconstruction: All eleven patients who had resection of their humeral head underwent reconstruction of the humerus with endoprosthesis. Scapular endoprosthesis was further installed in 7 patients and suspension of the humeral head from the clavicle with a Dacron tape was performed in 16 patients (Suspension of the prosthetic humeral head from the clavicle – 4 patients; suspension of the native humeral head from the clavicle – 12 patients). Endoprosthetic reconstruction of the scapula was feasible only when the periscapular musculature was sufficient for endoprosthetic attachment and coverage. The scapular prosthesis was attached to the prosthetic humeral head with a Goretex® sleeve, which served as an artificial joint capsule. All patients were followed for a minimum of 2 years; follow-up included physical examination, radiological evaluation and functional evaluation according to the American Musculoskeletal Tumor Society system. Results: Elbow range-of-motion and hand dexterity were similar in the two groups of patients. However, compared with patients who undergone humeral suspension, those who had scapular endoprosthesis had better abduction (60°–90° vs. 10°–20°) of the shoulder joint. Moreover, these patients had better cosmetic appearance of the shoulder girdle. There were no deep wound infections, prosthetic failures, or secondary amputations. Overall, 6 patients who had scapular prosthesis (86%) and 10 patients who had humeral suspension (62%) had a good-to-excellent functional outcome. Conclusions: The number of patients who underwent a scapular endoprosthetic reconstruction is small and does not allow a valid statistical analysis; however, the authors feel that scapular endoprosthesis reconstruction is associated with better functional and cosmetic outcomes, when compared to humeral suspension. The authors recommend reconstruction of the scapula with endoprosthesis when periscapular musculature, remaining after tumor resection allows attachment and coverage of the prosthesis

Prediction tools are instruments which are commonly used to estimate the prognosis in oncology and facilitate clinical decision-making in a more personalized manner. Their popularity is shown by the increasing numbers of prediction tools, which have been described in the medical literature. Many of these tools have been shown to be useful in the field of soft-tissue sarcoma of the extremities (eSTS). In this annotation, we aim to provide an overview of the available prediction tools for eSTS, provide an approach for clinicians to evaluate the performance and usefulness of the available tools for their own patients, and discuss their possible applications in the management of patients with an eSTS.

Cite this article: Bone Joint J 2022;104-B(9):1011–1016.

Aims

The aim of this study is to evaluate the change in incidence rate of shoulder arthroplasty, indications, and surgeon volume trends associated with these procedures between January 2003 and April 2021 in the province of Nova Scotia, Canada.

Desmoid tumours are a rare fibroblastic proliferation of monoclonal origin, arising in deep soft-tissues. Histologically, they are characterized by locally aggressive behaviour and an inability to metastasize, and clinically by a heterogeneous and unpredictable course. Desmoid tumours can occur in any anatomical site, but commonly arise in the limbs. Despite their benign nature, they can be extremely disabling and sometimes life-threatening, causing severe pain and functional limitations. Their surgical management is complex and challenging, due to uncertainties surrounding the biological and clinical behaviour, rarity, and limited available literature. Resection has been the first-line approach for patients with a desmoid tumour but, during the last few decades, a shift towards a more conservative approach has occurred, with an initial ‘wait and see’ policy. Many medical and regional forms of treatment are also available for the management of this condition, and others have recently emerged with promising results. However, many areas of controversy remain, and further studies and global collaboration are needed to obtain prospective and randomized data, in order to develop an appropriate shared stepwise approach.

Cite this article: Bone Joint J 2023;105-B(7):729–734.

Aims

Tenosynovial giant cell tumour (TGCT) is a rare benign tumour of the musculoskeletal system. Surgical management is fraught with challenges due to high recurrence rates. The aim of this study was to describe surgical treatment and evaluate surgical outcomes of TGCT at an Australian tertiary referral centre for musculoskeletal tumours and to identify factors affecting recurrence rates.

The use of artificial intelligence (AI) is rapidly growing across many domains, of which the medical field is no exception. AI is an umbrella term defining the practical application of algorithms to generate useful output, without the need of human cognition. Owing to the expanding volume of patient information collected, known as ‘big data’, AI is showing promise as a useful tool in healthcare research and across all aspects of patient care pathways. Practical applications in orthopaedic surgery include: diagnostics, such as fracture recognition and tumour detection; predictive models of clinical and patient-reported outcome measures, such as calculating mortality rates and length of hospital stay; and real-time rehabilitation monitoring and surgical training. However, clinicians should remain cognizant of AI’s limitations, as the development of robust reporting and validation frameworks is of paramount importance to prevent avoidable errors and biases. The aim of this review article is to provide a comprehensive understanding of AI and its subfields, as well as to delineate its existing clinical applications in trauma and orthopaedic surgery. Furthermore, this narrative review expands upon the limitations of AI and future direction.

Cite this article: Bone Joint Res 2023;12(7):447–454.

The December 2013 Oncology Roundup³⁶⁰ looks at: Peri-articular resection fraught with complications; Navigated margins; Skeletal tumours and thromboembolism; Conditional survival in Ewing’s sarcoma; Reverse shoulders and tumour; For how long should we follow up sarcoma patients?; and already metastasised?

Objectives

In this cross sectional study, the impact and the efficacy of a surveillance programme for sarcomas of the extremities was analysed.

Objectives

Our objective was to predict the knee extension strength and post-operative function in quadriceps resection for soft-tissue sarcoma of the thigh.

The August 2012 Oncology Roundup³⁶⁰ looks at: prolonged symptom duration; peri-operative mortality and above-knee amputation; giant cell tumour of the spine; surgical resection for Ewing’s sarcoma; intercalary allograft reconstruction of the femur for tumour defects; and an induced membrane technique for large bone defects.

The August 2013 Oncology Roundup³⁶⁰ looks at: spinal osteosarcoma: all hope is not lost; intralesional curettage for low-grade chondrosarcoma?; isolated limb perfusion is a salvage option; worryingly high infection rates in patients with endoprostheses; how bad is endoprosthetic infection?; operatively treated metastatic disease; and cementoplasty gives immediate pain relief