Aims. The study aimed to assess the clinical outcomes of arthroscopic debridement and partial excision in patients with traumatic central tears of the triangular fibrocartilage complex (TFCC), and to identify prognostic factors associated with unfavourable clinical outcomes. Methods. A retrospective analysis was conducted on patients arthroscopically diagnosed with Palmer 1 A lesions who underwent arthroscopic debridement and partial excision from March 2009 to February 2021, with a minimum follow-up of 24 months. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Mayo Wrist Score (MWS), and visual analogue scale (VAS) for pain. The poor outcome group was defined as patients whose preoperative and last follow-up clinical score difference was less than the minimal clinically important difference of the DASH score (10.83). Baseline characteristics, arthroscopic findings, and radiological factors (ulnar variance, MRI, or arthrography) were evaluated to predict poor clinical outcomes. Results. A total of 114 patients were enrolled in this study, with a mean follow-up period of 29.8 months (SD 14.4). The mean DASH score improved from 36.5 (SD 21.5) to 16.7 (SD 14.3), the mean MWS from 59.7 (SD 17.9) to 79.3 (SD 14.3), and the mean VAS pain score improved from 5.9 (SD 1.8) to 2.2 (SD 2.0) at the last follow-up (all p < 0.001). Among the 114 patients, 16 (14%) experienced poor clinical outcomes and ten (8.8%) required secondary ulnar shortening osteotomy. Positive ulnar variance was the only factor significantly associated with poor clinical outcomes (p < 0.001). Positive ulnar variance was present in 38 patients (33%); among them, eight patients (21%) required additional operations. Conclusion. Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. The presence of positive ulnar variance was associated with poor clinical outcomes, but close observation after arthroscopic debridement is more likely to be recommended than ulnar shortening osteotomy as a primary treatment. Cite this article: Bone Joint J 2024;106-B(4):380–386

National Hunt jockeys suffer a disproportionate number of clavicular fractures and their return to riding may be considerably delayed by refracture and symptomatic nonunion, with obvious implications. We report six such cases in which excision of the clavicular fragment distal to the fracture was associated with an early return to work and no recurrent injury to the shoulder.

The December 2023 Foot & Ankle Roundup. 360. looks at: Subchondral bone cysts remodel after correction of varus deformity in ankle arthritis; 3D-printed modular endoprosthesis reconstruction following total calcanectomy; Percutaneous partial bone excision in the management of diabetic toe osteomyelitis; Hemiepiphysiodesis is a viable surgical option for Juvenile hallux valgus; Ankle arthroplasty vs arthrodesis: which comes out on top?; Patient-related risk factors for poorer outcome following total ankle arthroplasty; The Outcomes in Ankle Replacement Study

Orthopaedic pathology at the craniocervical junction (CCJ) is uncommon. This is a retrospective analysis of 37 patients who underwent transoral surgery. The indications were fixed rotatory subluxation in 12 patients, myelopathy following nonunion of the dens in 15, tuberculous abscesses in seven, congenital anomalies in two and chordoma in one. There were 29 males and the mean age was 24 years (3 to 57). Neurological deficit was present in 19 patients. Other symptoms included hoarseness, difficulty swallowing, neck pain and limitation of movement. All patients had a CT scan, MR angiography, MRI and dental consultation to exclude oral sepsis. After the transoral release, 29 patients underwent atlanto-axial fusion and two occipito-axial fusion. Following nasal intubation the skull was immobilised in tongs with 2-kg traction. A Jacques catheter was used to retract the uvula. The CCJ was located with an image intensifier and the posterior pharyngeal wall was infiltrated with 5 cc of local anaesthetic and Por-8. The atlanto-axial joints (AAJ) were released and in children with fixed rotatory subluxation the atlantodentate interval was cleared of fibrous tissue. The 15 patients with non-union of the dens underwent anterior release of the AAJs and the fracture site. The seven patients with abscesses had incision and drainage. Two patients with basilar invagination required excision of the dens. The chordoma was partially excised. One patient required a partial excision of the dens to reduce a posterior dislocation of the AAJ. A patient with chronic atlanto-axial subluxation owing to a type-I fracture required a partial excision of the superior part of atlas. Two patients with CSF leaks were treated successfully. There were cases of sepsis. Two patients developed occipital pressure sores. One patient died 5 days after surgery because of pulmonary embolus. The transoral approach is safe and effective in treating pathology at the CCJ

The June 2024 Wrist & Hand Roundup³⁶⁰ looks at: One-year outcomes of the anatomical front and back reconstruction for scapholunate dissociation; Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist: results after 3.5 years; Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex; The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study; Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery?; Provision of a home-based video-assisted therapy programme in thumb carpometacarpal arthroplasty; Is replantation associated with better hand function after traumatic hand amputation than after revision amputation?; Diagnostic performance of artificial intelligence for detection of scaphoid and distal radius fractures: a systematic review.

1. The clinical, radiographic and pathological features of aneurysmal bone cyst are described and illustrated by case reports. 2. Reasons are given for accepting the lesion as a clinical and pathological entity. 3. The cyst has a tendency to spontaneous regression and healing may occur after partial excision

1. Seventy-seven operations on the patella have been reviewed. 2. There is no evidence that arthritic changes in the femoral condyles are an inevitable sequel of complete excision of the patella. 3. There is a direct relationship between the severity of symptoms after complete excision of the patella and the extent of ossification in the quadriceps tendon. 4. Patello-femoral arthritis after partial excision of the patella may be due to faulty realignment of the patellar ligament and consequent tilting of the patellar remnant towards the femoral condyles

We describe an operation to relieve compression of the lateral antebrachial cutaneous nerve at the elbow. Between 1987 and 1997 we operated on seven patients, one with bilateral compression. In two the compression was associated with injury to biceps. A longitudinal or a transverse incision was carried out and the nerve was released from the deep fascia. Partial excision of the biceps aponeurosis was undertaken in the patients who did not have injury to biceps; some additional procedures were required for those patients with injuries. All patients had symptomatic relief

Clear-cell sarcoma is a very rare tumor, and is almost always associated with tendons or aponeuroses or is metastatic from other organs. Sporadic cases only have been reported involving primarily the bone or extending from soft tissues to surrounding bones. To our knowledge, the ilium has not been previously reported as the primary site for clear cell sarcoma. We report a rare case of Primary clear cell sarcoma involving right ilium region in a 18-year-old boy presented with a painful swelling over right ilium and limp on right lower limb of ten month duration. He was initially suspected having tuberculosis based on clinicoradiological evaluation and diagnosis of primry clear cell sarcoma could be established on histopathology. Patient was treated with partial excision of the ilium, the remaining ilium was fused with sacrum. Stabilization was achieved with a cortical autograft harvested from the right fibula and fixation with a titanium plate. The patient had no local recurrences but the plate holding ilium to sacrum broke and was removed in the subsequent surgery after which he developed Trendelenberg’s gait

Purpose. Curative treatment of malignancies in the sacrum and lumbar spine frequently requires en-bloc spinopelvic resection. There is no standard classification of these procedures. We present a classification of these resections based on analysis of 45 consecutive cases of oncologic spinopelvic resections. This classification implies a surgical approach, staging algorithm, bony and soft tissue reconstruction, and functional outcomes following surgery. Method. We reviewed oncologic staging, surgical resections, and reconstructions of 45 consecutive patients undergoing spinopelvic resection with curative intent. Mean follow-up of surviving patients was 38 months. Common themes in these cases were identified to formulate the surgical classification. Results. Tumors included chondrosarcoma (n=11), other sarcomas (n=11), osteosarcoma (n=9), chordoma (n=6), locally invasive carcinoma (n=5), and others (n=3). Resections could be divided into 5 types based on the exent of the lumbosacral resection and the need for an associated external hemipelvectomy. Type 1 resections included a total sacrectomy +/− lumbar spine resection. Type 2 resections included hemisacrectomy +/− partial lumbar excision, and iliac wing resection. Type 3 resections encompassed external hemipelvectomy with hemisacrectomy +/− partial lumbar excision. Type 4 resections encompassed external hemipelvectomy with total sacrectomy +/− lumbar excision. Type 5 excisions involved hemicorporectomy type procedures. For each type of resection we have developed guidelines for trans- vs retroperitoneal surgical approaches, staging of the resections, bony and soft tissue reconstructive procedures to re-establish spinopelvic continuity, and predicted functional outcomes for patients. At mean 38 month follow-up on surviving patients, 28 are living and 17 are deceased. Twenty-two of 28 surviving patients are disease free. Nineteen of 26 surviving patients are independent in their activities of daily living. Conclusion. En bloc spinopelvic resections may be classified into five types based on the extent of lumbosacral excision and the need for concurrent hemipelvectomy. Using this classification system, we have formulated treatment strategies to guide surgical approach, procedural staging, bony and soft tissue reconstructive procedures, and expected functional outcomes. Long term survival and independent function can be achieved in this challenging patient population

Background: Tumors and tumor-like lesions of the clavicle are uncommon and often present with a diagnostic problem. Although almost every type of tumor has been reported from this location the true incidence of primary tumors is 0.5–1%. Materials and Methods: A retrospective review of the Scottish Bone Tumor Registry (1940–2000). All histologically confirmed lesions with minimum 5 year follow-up are included. Results: 32 lesions were identified from the registry. The age at presentation varied from 4 years to 84 years. There were 7 myelomas, 10 lymphomas, 2 Ewing sarcomas,1 osteosarcoma, 1 chondrosarcoma, 1 Giant Cell tumor, 1 Aneurismal bone cyst, 1 chondroma, 1 unicameral bone cysts, 1 non-ossifying fibroma, and 6 eosinophilic granulomas. 3 cases presented with pathological fractures. Majority lesions involved the medial third. Malignant lesion underwent excision and adjuvant chemo-radiotherapy. The cumulative 5 year survival was 80% when adequate surgical margins were achieved. Death was usually due to soft tissue and skeletal metastasis. Benign lesions were treated with curettage and bone grafting or by partial excision of the clavicle. 3 cases of eosinophilic granulomas and the solitary chondroma required no further treatment after biopsy. Discussion: Metastatic tumors are more common than primary tumors in this region. Among primary lesions, malignant tumors are more common than benign. All ages can be affected. The subcutaneous location of the clavicle usually aids in early diagnosis. Anatomically, the medial third was the commonest site involved. Prognosis is good if adequate surgical margins can be achieved and if there is no distal spread. Partial or total claviclectomy usually results in good functional outcomes

The purpose of this study was to analyse and to recommend solutions for early complications with a new total knee mobile bearing device, that promises a logical synthesis of combined A/P translation and rotation ability, but has shown early surgical technique related complications. Materials and Methods: There were 244 Low Contact Stress (LCS) A/P glide total knee replacements (TKA) performed in the time between 1995 and 1999. Mean age was 67.2 years (range: 53-83). Mean follow-up was 16.5 months (range: 1-51). There was an unusual high incidence of anterior knee pain in this group compared with excellent results utilising rotating platform LCS TKA in this centre. Diagnostic evaluation included radiographs, arthroscopical evaluation, and positron emission tomography in five selected cases. Results: There were 11 (4.5%) cases with Hoffa fatpad impingement, progressive ligament instability in 5 (2.0%) cases, arthrofibrosis in 4 (1.6%) cases, one malposition of tibial component, and one proximal tibial AVN. Five PET 18F-FDG scans prior to revision surgery revealed increased up-take correlated with intraoperative findings of fatpad fibrosis and/or necrosis. Conclusion: The LCS A/P glide mobile bearing TKA has theoretical advantages over both meniscal and rotating mobile bearing knee designs. Early occurrence of Hoffa fatpad impingement was caused by surgical mal-technique in this centre that usually retains the vast majority of the fat pad. Revision surgery revealed evidence of impingement and all cases revealed clinical improved after partial excision of the fatpad. We, therefore, recommend partial to total excision of the Hoffa fat pad for utilisation of the A/P glide prosthesis

Beckground: Head and neck region is a rare site location for sarcomas and there are difficulties of surgery management.With the exception of those arising in relatively superficial locations, are rarely amenable to wide local excision. Incisional biopsy for diagnostic purposes is usually all that is feasible. Multimodal treatment is mandatory to achieve local control. The present study examines multimodal treatment outcome in children and adolescents with head and neck soft tissue sarcomas (H& NS). Patients and Methods. Patients with H& NS who underwent chemotherapy +/− radiotherapy, after surgery, in Institute of Oncology Bucharest between 1990– 2007 were identified. Clinical charts and pathology reports were examinated. The study included 42 pts.(29 male and 13 female); median age was 14 years years (range 3 – 21). Sites of primary tumor: parameningeal: 18 pts; non-parameningeal 16 pts and orbit: 8pts. Histologic types: rhabdomyosarcomas and undifferentiated sarcomas represent 52%. Staging (TNM pretreatment staging classification for IRS-IV): St. I+II-36% ; St. III- 34%; St.IV-30%. All the pts were treated multidisciplinary: Surgery + Chemotherapy(PCT) +/− Radiotherapy(RT). Type of surgery performed: partial excision:54%; complete excision: 4 pts (9%); incisional biopsy: 37%. Type of RT: Exclusive RT in inoperable tumors(4 pts) ; external RT- postoperative(59%) curietherapy: 1 pt; gammaknife: 1pt. Neoadjuvant PCT were applied for 16% of pts and adjuvant PCT for 85,7% of pts.. Chemotherapy protocols used after 1992 was: IVA, IVE, VAIA, CEVAIE, and before 1992: CYVADIC, CYVADACT. All cases were followed minimum 2 years after the end of the treatment. Results: Overall survival estimated by Kaplan Meier curve: 66%/ 1 year, 43%/ 5 years. OS according to the stages of disease ; stage I-II: 93% at 1 year,73% ar 5 years; stage III and IV: 47% at 1 year, 23% at 5 years. EFS in sarcomas treated with S+PCT+RT is 41%, versus 16.5% for sarcomas treated with S+CT. Observations: The diagnosis in advanced stages was due to the confusion with nononcological diseases. Conclusions: 1. EFS was highest in sarcomas treated S+CT+RT face to sarcomas trated S+CT. 2 EFS at 2–3 yrs. in children’s soft tissues sarcoma could be considered as cure

The December 2022 Foot & Ankle Roundup³⁶⁰ looks at: Evans calcaneal osteotomy and multiplanar correction in flat foot deformity; Inflammatory biomarkers in tibialis posterior tendon dysfunction; Takedown of ankle fusions and conversion to total ankle arthroplasty; Surgical incision closure with three different materials; Absorbable sutures are not inferior to nonabsorbable sutures for tendo Achilles repair; Zadek’s osteotomy is a reliable technique for treating Haglund’s syndrome; How to best assess patient limitations after acute Achilles tendon injury; Advances in the management of infected nonunion of the foot and ankle.

Aims

To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection.

Aims

To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs).

Aims

The aim of this study was to compare the outcome of revision total knee arthroplasty (TKA) with and without proximalisation of the tibial tubercle in patients with a failed primary TKA who have pseudo patella baja.

Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or forearm or ligament injury, where stiffness following non-operative management is the primary concern. Displaced unstable fractures of the radial head are usually associated with other fractures or ligament injuries, and restoration of radiocapitellar contact by reconstruction or prosthetic replacement of the fractured head is necessary to prevent subluxation or dislocation of the elbow and forearm. In fractures with three or fewer fragments (two articular fragments and the neck) and little or no metaphyseal comminution, open reduction and internal fixation may give good results. However, fragmented unstable fractures of the radial head are prone to early failure of fixation and nonunion when fixed. Excision of the radial head is associated with good long-term results, but in patients with instability of the elbow or forearm, prosthetic replacement is preferred.

This review considers the characteristics of stable and unstable fractures of the radial head, as well as discussing the debatable aspects of management, in light of the current best evidence.

Cite this article: Bone Joint J 2013;95-B:151–9.