Between 1944 to 2003, ninety cases of Paget’s sarcoma from the Scottish Bone and Soft Tissue Tumour Registry were reviewed. The mean age of patients was 72.3 years (range, 30 to 85 years). There were 59 males and 30 females. The most frequent sites were the femur (26), pelvis (19), humerus (13), tibia (11), and thoraco-lumbosacral spine (9). Biopsy was done in 69 cases. In the remainder 20 cases, the histological diagnosis was confirmed either from examining amputated limb or at autopsy. The most common type was osteosarcoma. Local excision was performed in seven cases. Resection in two cases and prosthetic replacement in two cases was carried out. Twenty nine patients underwent amputation surgery. Chemotherapy was administered to 15 patients (including 2 preop chemotherapy). Fifty one patients received radiotherapy (preoperatively in eight patients). All the patients died within one year from the date of biopsy with an average survival time of 7.5 months. Patients with Paget’s sarcoma tend to have a very poor prognosis inspite of improvements in therapy strategies including surgery, radiation therapy, and chemotherapy. We emphasise the need for more research by a combined oncosurgical, oncological, radiological and histological approach in the management of Paget sarcoma to improve the prognosis.
Between 1944 to 2003, eighty nine cases of Paget’s sarcoma from the Scottish Bone and Soft Tissue Tumour Registry were reviewed. The mean age of patients was 72.3 years (range, 30 to 85 years). There were 59 males and 30 females. The most frequent sites were the femur (26), pelvis (19), humerus (13), tibia (11), and thoracolumbosacral spine (9). Biopsy was done in 69 cases. In the remainder 20 cases, the histological diagnosis was confirmed either from examining amputated limb or at autopsy. The most common type was osteosarcoma. Local excision was performed in seven cases. Resection in two cases and prosthetic replacement in two cases was carried out. Twenty nine patients underwent amputation surgery. Chemotherapy was administered to 15 patients (including 2 preop chemotherapy). Fifty one patients received radiotherapy (preoperatively in eight patients). All the patients died within one year from the date of biopsy with an average survival time of 7.5 months. Patients with Paget’s sarcoma tend to have a very poor prognosis inspite of improvements in therapy strategies including surgery, radiation therapy, and chemotherapy. We emphasise the need for more research by a combined oncosurgical, oncological, radiological and histological approach in the management of Paget sarcoma to improve the prognosis.
We examined differences in the rate of open reduction, operating time, length of hospital stay and outcome between two groups of children with displaced supracondylar fractures of the humerus who underwent surgery either within 12 hours of the injury or later. There were 77 children with type-3 supracondylar fractures. Of these, in 43 the fracture was reduced and pinned within 12 hours and in 34 more than 12 hours after injury. Both groups were similar in regard to gender, age and length of follow-up. Bivariate and logistical regression analysis showed no statistical difference between the groups. The number of peri-operative complications was low and did not affect the outcome regardless of the timing of treatment. Our study confirmed that the treatment of uncomplicated displaced supracondylar fractures of the humerus can be early or delayed. In these circumstances operations at night can be avoided.
In shallow or deficient sockets, we describe a simple technique by 180° rotation of the Cormet 2000 metal-on-metal resurfacing pegged acetabular prosthesis. This works by utilising ischio-pubic splines for superolateral socket engagement. We have used this technique in three patients with successful outcome avoiding the need of structural graft augmentation. In one patient, this technique was supplemented with cadaveric allograft.
The aim of this study was to evaluate whether duration of surgery correlates with the survival and final outcome of the patient with metastatic bone disease. Between 1999 and 2002, 23 consecutive patients with impending or complete pathological fractures of the femur due to metastatic bone disease caused by variety of malignancies or an unknown primary were reviewed. These fractures were treated with intramedullary fixation in the form of long intramedullary hip screw, long Gamma nail or AO nail. These patients were followed up clinically and radiologically until death from the primary disease. The results obtained demonstrate a mean survival time between 9 days to 12 months. Pain relief was achieved in 90% patients. Ambulatory status was improved in 47% patients. The postoperative course was complicated by four technical and five systemic complications. Intramedullary nailing is a safe and effective method in the treatment of metastatic bone disease. It provides good functional result with pain relief and improved mobility. The operating time does not predictably correlate with the survival and final outcome of the patient.
Breast carcinoma is the most common cause for bony metastases. Skeletal complications in women with meta-static breast carcinoma often occur multiple times in a single patient and significantly contribute to the patient morbidity. We describe a 62 year old lady with a known metastatic breast carcinoma who presented with simultaneous quadruple extremity diaphyseal long bone fractures after a trivial fall. To the author’s best knowledge, similar report has never been previously described in the literature. The wish and general condition of the patient, and concurrent occurrence of four long bone fractures dictated the non-operative mode of treatment in this case.Where the life expectancy is assumed to be less than six weeks, the multidisciplinary team should give careful consideration on selection of best treatment choice between simultaneous or sequential surgical fixation of multiple long bone fractures and conservative palliative treatment. With treatment suited for an end-of-life circumstance, the educational lesson for dissemination to the readers is that in a patient where there is an extremely high likelihood of imminent perioperative mortality after sustaining quadruple extremity diaphyseal proximal long bone fractures simultaneously, conservative palliative treatment should be primarily considered over an aggressive operative fixation.
We report the results of application of a strategy for deformity correction in hypophosphataemic rickets using careful preoperative planning, multiple osteotomies where appropriate and acute or gradual correction using internal or circular external fixation or a combination. 7 patients with 25 limb segments (14 femur and 11 Tibia) had deformity correction with either intramedullary nailing (10 Femur and 3 Tibia) or llizarov ring fixator (4 femur and 8 Tibia). The average age was 18 years (7–39 years), 5 were female and 2 male, had an average follow up of 36 months (10–77 months). All patients had adequate control of rickets pre operatively. Clinical examination and analysis of pre and post-operative X-rays were carried out by an observer not involved in the surgical procedures. Standardised X-rays were analysed using the method of Paley and Tetsworth ( Satisfactory correction of deformity was achieved in both frontal and sagittal plane. There were total 8 episodes of soft tissue infection with no long-term consequence. Average ankle ROM was 7–44 and knee ROM was 0–128. There is no recurrence of the deformity. All patients were happy with outcome and are prepared to undergo same treatment if required, even though some were restricted in terms of sport and leisure activities. We conclude that satisfactory correction of deformity in VDRR can be achieved and maintained with nailing or llizarov fixator in short term with minimal complications, no recurrence and excellent outcome.