In this case study, we describe the clinical presentation and treatment of 36 patients with periosteal chondrosarcoma collected over a 59-year period by the archive of the Netherlands Committee on Bone Tumours. The demographics, clinical presentation, radiological features, treatment and follow-up are presented with the size, location, the histological grading of the tumour and the survival.

We found a slight predominance of men (61%), and a predilection for the distal femur (33%) and proximal humerus (33%). The metaphysis was the most common site (47%) and the most common presentation was with pain (44%). Half the tumours were classified histologically as grade 1. Pulmonary metastases were reported in one patient after an intra-lesional resection. A second patient died from local recurrence and possible pulmonary and skin metastases after an incomplete resection.

It is clearly important to make the diagnosis appropriately because an incomplete resection may result in local recurrence and metastatic spread. Staging for metastatic disease is recommended in grade II or III lesions.

These patients should be managed with a contrast-enhanced MRI of the tumour and histological confirmation by biopsy, followed by en-bloc excision.

Cite this article: Bone Joint J 2014;96-B:823–8.

This review of 27 cases serves to emphasis that periosteal chondrosarcoma and periosteal osteosarcoma are two distinct entities. Clinically, periosteal chondrosarcoma is less painful than periosteal osteosarcoma and runs a slower course. Radiographically, periosteal chondrosarcoma tends to affect the metaphysis and contains granular or "popcorn" opacities; while periosteal osteosarcoma more often affects the mid-diaphysis and shows lytic lesions with some spicules of reactive bone perpendicular to the underlying cortex. Histologically, periosteal chondrosarcoma shows lobular well-differentiated cartilage with Grade I or II (rarely Grade III) malignancy; periosteal osteosarcoma has a chondroid matrix with some osteoid component and Grade II or III malignancy. The prognosis in periosteal chondrosarcoma is good; conservative surgery is usually effective and metastases are very uncommon. In periosteal osteosarcoma the prognosis is less satisfactory but is better than that of other osteosarcomata; wide surgical excision is, however, needed and the incidence of metastases is about 15 per cent

Introduction: Bone transport, or distraction osteogenesis, is a recognised technique to reconstruct extensive bony defects resulting from excision of bony tumours. Ilizarov demonstrated bone formation under tension allowing the movement of a free segment of living bone to fill intercalary defects. This study assesses the use of bone transport in the management of patients with resectable long bone tumours. Methods: We retrospectively reviewed patients who underwent bone transport in two institutions, performed by a single surgeon. A total of 14 patients were included in the study. There were 11 males and 3 females. Histological results demonstrated osteosarcoma (n=7), Ewing’s sarcoma (n=6), and parosteal chondrosarcoma (n=1). The site of the tumour was the femur and tibia in 8 and 6 cases respectively. Results: Bone transport was fully completed in 9 patients. Of the 5 patients remaining, 3 are currently in cast, 1 is currently undergoing tibial lengthening, and 1 patient died from local recurrence and distant spread of disease. The average length of bone resected in the tibia was 11 cm (range 8–15 cm), while in the femur the average was higher at 16.5 cm (range 12–27 cm). All patients underwent autologous bone grafting of their docking site from either the anterior or posterior iliac crest on the ipsilateral side. The average time in frame was 24.8 months. One patient undergoing tibial bone transport fell and sustained an ipsilateral supracondylar femoral fracture which was successfully treated with an external ring fixator. Discussion: Bone transport is a recognised method of reconstructing extensive bony defects and is beneficial for patients with a good prognosis. It is a specialised technique and requires a multidisciplinary approach. Other techniques can be less time consuming however distraction osteogenesis avoids the complications associated with prosthetic or allograft replacements

Objectives

We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells.

Aims

The primary aim of this study was to determine the morbidity of a tibial strut autograft and characterize the rate of bony union following its use.

The purpose of this study was to assess the outcome of 15 patients (mean age 13.6 years (7 to 25)) with a primary sarcoma of the tibial diaphysis who had undergone excision of the affected segment that was then irradiated (90 Gy) and reimplanted with an ipsilateral vascularised fibular graft within it.

The mean follow-up was 57 months (22 to 99). The mean time to full weight-bearing was 23 weeks (9 to 57) and to complete radiological union 42.1 weeks (33 to 55). Of the 15 patients, seven required a further operation, four to obtain skin cover. The mean Musculoskeletal Society Tumor Society functional score at final follow-up was 27 out of 30 once union was complete. The functional results were comparable with those of allograft reconstruction and had a similar rate of complication.

We believe this to be a satisfactory method of biological reconstruction of the tibial diaphysis in selected patients.