Osteochondromas occur are most commonly in the distal femur, proximal tibia and fibula and the proximal humerus. There are no large studies focusing on the clinical presentation, management and outcome of treatment for patients with an osteochondroma involving the proximal fibula. The purpose of this study is to specifically understand the manifestation of the proximal fibular osteochondroma on the preoperative peroneal nerve function, and how surgical management of the osteochondroma affects function immediately postoperatively and at long-term followup. This is an IRB-approved retrospective review of a consecutive series of patients with a proximal fibular osteochondroma (PFO) treated operatively at a single institution from 1990 to 2013. The medical record was carefully reviewed to identify demographic data, clinical data and especially the status of the peroneal function at various time points. There were 25 patients with 31 affected extremities who underwent surgical excision of the PFO at an average age of 12.4 years (range 3.0–17.9 years). There were 16 males and 9 females. The underlying diagnosis was isolated PFO in 2(8%) patients and multiple hereditary exostosis (MHE) in 23(92%) patients. Preoperatively, 9 (29%) had a foot drop and 22 (71%) did not. Those with preoperative foot drop underwent surgery at a younger age (9.1 vs 13.8 years) (p<0.004). Five of the nine (55.5%) had complete resolution, three (33.3%) had improvement, and one (11.1%) persisted postoperatively and required AFO. Of the 22 who were normal preoperatively, 5 (22.7%) developed a postoperative foot drop-three (60%) completely resolved, 1 (20%) improved, and 1 (20%) persisted and was found to have a transected nerve at exploration. In total, 23 of the 25 (92%) patients who had a PFO excision, had a normal or near-normal peroneal nerve function including those who had poor function preoperatively. A proximal fibular osteochondroma can result in a high incidence of peroneal nerve dysfunction prior to any treatment, but responds the majority of the time to surgical intervention with removal of the osteochondroma. For those who have normal preoperative function, 1 in 4 will develop a postoperative foot drop but nearly all improve spontaneously unless iatrogenic injured

This case series highlights the use of the Ganz approach (trochanteric slide approach) and surgical dislocation for excision of fibrous dysplasia of the femoral neck, pigmented villonodular synovitis and synovial chondromatosis of the hip.

The first patient was a 16-year-old girl, who presented with pain in her hip, having fallen whilst playing football. Investigations revealed a fibrous dysplasia, which was successfully excised returning her to an active lifestyle.

The second patient was a 27-year-old lady, who presented having suffered left hip pain for four years. She was diagnosed with a pigmented villonodular synovitis, which was excised and the patient was able to return to the gym.

The third patient was a 41-year-old lady, who presented after experiencing right hip pain both at night and at rest for a year, without any trauma. She was diagnosed with synovial chondromatosis and returned to all activities of daily living.

The Ganz approach allows safe dislocation of the hip joint without the risk of osteonecrosis of the femoral head. We demonstrate that it is possible to obtain excellent exposure of the femoral neck, head and acetabulum to surgically treat these three tumours of the hip. The surgeon can thus be reassured that complete excision of the tumour has occurred.

This series can recommend the Ganz approach with trochanteric slide and full surgical dislocation of the hip to excise pigmented villonodular synovitis, synovial chondromatosis and fibrous dysplasia of the hip.

PVNS or TGCT (Pigmented Villonodular Synovitis, or Tenosynovial Giant Cell tumour) is a benign tumour affecting the synovial lining of joints and tendon sheaths, historically treated with surgical excision or debridement. We have shown previously this management is fraught with high recurrence rates, especially in its diffuse form. We present the encouraging early results of medical management for this condition with use of a CSF1 inhibitor, in comparison to a cohort of 137 cases previously treated at our institution

Aim. Squamous cell carcinoma (SCC) is a rare but often devastating complication of chronic osteomyelitis. Optimum diagnosis and management are not well established. This paper aimed to develop a definitive, evidence-based approach to its diagnosis and management. Method. A systematic review of relevant published studies available in English from 1999-present was conducted. Strict inclusion criteria ensured that the diagnoses of osteomyelitis and SCC were explicit and valid. Additional cases from our institution were included using the same eligibility criteria. Data regarding patient demographics, osteomyelitis diagnosis, SCC diagnosis and its management and patient outcomes were collected. Statistical significance was assessed by Fisher's exact test. Results. Nineteen publications involving 98 patients plus eight patients managed locally were included. Eighty percent of patients were male, diagnosed with SCC at an average age of 59 years old (24–82 years), 31 years after their osteomyelitis diagnosis (3–67 years). Multiple bones were affected: tibia or fibula (59%), femur (17%), pelvis and sacrum (8%), bones of the foot and ankle (8%) and upper limbs (6%). Malignant transformation was associated predominantly with sinus (82%), ulceration (61%) and discharge (41%). SCC was diagnosed by biopsy (77%) or incidentally (23%) following definitive management for osteomyelitis. Twenty-two percent of patients had a staging CT scan. Seventy-six percent of patients underwent amputation, 16% underwent limb-sparing wide local excision and the remaining patients were palliated. Incidental diagnosis of SCC was associated with poorer outcomes in terms of death or disease recurrence (one year, p=0.052, five years p=0.021, Fisher's exact test) as was metastatic disease at SCC diagnosis (one year, p=0.006, five years, p=0.032, Fisher's exact test) and pelvic or sacral disease (one year p<0.001, five years p=0.002, Fisher's exact test). All patients who were not actively treated died within one year of SCC diagnosis. Data was suggestive that more patients who underwent amputation (versus wide local excision) were disease free at one and five years, but this was not statistically significant (one year, p=0.058, five years, p= 0.152, Fisher's exact test). Conclusions. SCC should be suspected in all cases of chronic osteomyelitis with skin changes, particularly where changes exceed 3 years duration and involve the pelvis. Multiple biopsies for histology should be taken in all suspected cases, as well as routinely during surgical excision of osteomyelitis when chronic skin changes are present. Once SCC is identified, staging CT scan should be performed to guide management. Amputation, where possible, should be considered

Purpose of the study. Fibromatosis is a benign, but locally aggressive tumour. We had a series of patients who had a high rate of recurrence though they had a wide surgical excision. The question raised was whether there are newer treatment modalities with a higher success rate. We did a retrospective study and review of the literature in order to see if there was anything new that can help us reduce recurrences. Materials and Methods. A retrospective study of all patients who presented with histologically confirmed fibromatosis at an orthopaedic practice in the past 19 years was conducted. Age of the patient at first presentation; sex; tumour site; surgery performed; histological results; first line of treatment and recurrence rate were reviewed. Patients were also contacted telephonically in order to know if they had any recurrence that was managed by another orthopaedic surgeon. Results. We evaluated 17 patients of which 8 were males and 9 females. The mean age was 25.87 years (range 2–52 years). All of the primary sites were extra abdominal. Median follow up was 3.9 years (0–9) with a mean recurrence rate of 2.3 times. All the patients were treated with a wide marginal surgical excision without adjuvant therapy. Conclusion. Fibromatosis has a high recurrence rate with our current treatment modalities. Complete surgical excision does not guarantee a good outcome. A wide variety of treatment modalities are available. Non-surgical treatment includes: hormonal therapies; NSAIDs; chemotherapy; and radiotherapy. Wide surgical excision is the mainstay of treatment but a multidisciplinary approach is necessary in order to optimize the efficacy of our treatment. Level of evidence: Level III. NO DISCLOSURES

Study Design. Prospective cohort study. Objective. To assess the safety and efficacy of an intra-operative gamma probe in the surgical treatment of osteoid osteomas and osteoblastomas arising from the spine. Summary of background data. Spinal osteoid osteomas and osteoblastomas are difficult to localise and may present adjacent to neural structures. Complete surgical excision of the nidus is a pre-requisite for curative resection. Methods. All patients with a presumptive diagnosis of osteoid osteoma or osteoblastoma were investigated with plain radiography, computed tomography, magnetic resonance imaging and a technitium bone scan. Nine patients underwent surgical excision. 600 MBq of 99m technitium HMDP was administered intravenously three hours prior to surgery. A sterile cadmium telluride detector connected to a digital counter/ratemeter was used to detect gamma radiation emitted by the tumour intra-operatively to assist with localisation and confirmation of complete excision. Results. Between October 1995 and September 2006, nine patients required surgical excision for seven osteoid osteomas and two osteoblastomas arising from the spine. All patients were between the ages of 9-31 years and presented with back or neck pain. All tumours involved the posterior elements of the spine. Three patients had previous failed treatment including CT-guided radiofrequency ablation and surgical excision. In all cases the counts per second (cps) dropped significantly following excision. Histological examination confirmed complete excision in all cases. The mean follow-up was 4.5 years (range 0.5-11 years). All patients reported disappearance of the characteristic pre-operative pain. Conclusions. The use of an intra-operative gamma probe helps to localise and confirm complete excision of osteoid osteoma and osteoblastoma arising from the spine. Accurate localisation results in safe excision with maximal conservation of surrounding normal bone, whilst minimising operative time, blood loss, hospital stay and risk of recurrence

Bertolotti first described articulation of the L5 transverse process with the sacrum as a cause of back pain in 1917. Since then little attention has been payed to these atypical articulations despite their high reported incidence. Here we describe our early experience of surgical treatment and propose a validated CT based classification of lumbosacral segment abnormalities (LSSA). 400 lumbosacral CT scans were reviewed (NBT), a classification devised and incidence of abnormalities recorded. 40 patients were selected and 4 independent observers classified each scan. Case notes for all patients (C&V) who received steroid injections into or surgical excision of LSSAs were reviewed. Results as follows:. 5 types of abnormality were identified. Type 0 - normal. Type 1 - asymmetrical shortening of the iliolumbar ligament. Type 2 - transverse process of L5 within 2mm of the sacrum. Type 3 - diarthrodial joint (3A: no evidence of degeneration 3B: degenerative change). Type 4 - transverse process and sacrum have fused. Type 5 - extends to L4. 54.5% of patients had abnormalities. The kappa values for the intra-observer results were 0.69 to 0.88 and the inter-observer ratings gave a combined score of over 0.7 indicating substantial agreement. Our CT classification of LSSAs is both straight forward to use and repeatable. The incidence of these abnormalities is higher in our population of CT scans compared to previous published series using plain radiographs. All patients treated with surgical excision of established articulations (Type 3A or above) reported good or excellent outcomes following excision

Heterotopic Ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). In most cases it is asymptomatic, however, in some patients it can limit range of motion and lead to poor outcomes. The objective of this review was to assess and report incidence, risk factors, prophylaxis, and management of HO after TEA. A systematic search was conducted using MEDLINE, EMBASE, and PubMed to retrieve all relevant studies evaluating occurrence of HO after TEA. The search was performed in duplicate and a quality assessment was performed of all included studies. A total of 1907 studies were retrieved of which 45 studies were included involving 2256 TEA patients. HO was radiographically present in 10% of patients and was symptomatic in 3%. Less than 1% of patients went on to surgical excision of HO, with outcomes following surgery reported as good or excellent as assessed by range of motion and Mayo Elbow Performance Scores (MEPS). TEA due to ankylosis, primary osteoarthritis, and posttraumatic arthritis are more likely to develop symptomatic HO. HO is an uncommon complication following TEA with the majority of patients developing HO being asymptomatic and requiring no surgical management. Routine HO prophylaxis for TEA is not supported by the literature. The effectiveness of prophylaxis in high risk patients is uncertain and future studies are required to clarify its usefulness. The strength of these conclusions are limited by inconsistent reporting in the available literature

Myxofibrosarcoma (MFS) is the second most common subtype of soft tissue sarcoma (STS) and is associated with a high rate of local recurrence after resection. These tumours frequently present with peri-lesional edema, termed “tumour tails” on staging MRI scans [1]. Tumour tails(TT) may contain satellite neoplastic cells or can represent benign reactive edema. There are no clear radiological features to distinguish malignant from reactive peri-lesional edema which limits accurate surgical planning, resulting in either high rates of inadvertently positive resection margins and local recurrences or overly-aggressive resections which negatively impact function and increase morbidity [2]. The objective of this pilot study was to prospectively study a cohort of MFS patients with TTs in an attempt to identify radiological features that predict which type of edema is malignant and requires resection together with the main tumour mass. Patients diagnosed with MFS on biopsy at an orthopaedic oncology referral centre between January 1-December 31 2018 who also had TTs on staging MRI scans were prospectively recruited for the study. Tumours were treated with wide surgical excision, including the TTs, and (neo)adjuvant radiotherapy as per institutional protocol. Staging MRI scans were reviewed in a blinded fashion by two musculoskeletal radiologists to distinguish malignant from reactive TTs. The main tumour mass underwent standard histological evaluation while the regions encompassing the TTs were photographed and sectioned into grids. Each tissue section was examined histologically for the presence of satellite neoplastic cells based on morphological criteria. Radiological and histological findings were compared. Six patients met the inclusion criteria and underwent analysis. All tumours were located in the extremities and were deep to fascia. Mean age at presentation was 67 years (range 51 – 85), with a male:female ratio of 4:2. All patients received radiotherapy (50 Gy), either pre- (n=4) or post-operatively (n=2) based on multidisciplinary tumor board discussion or enrolment in a prospective clinical trial. Radiologically, TTs were labelled as malignant in four patients (66.7%) and as benign TTs in two others. The tails were recognised to be malignant due to the differing signal characteristics to reactive edema on mixed MRI sequences. The radiological evaluation correlated exactly with histological analysis, as satellite neoplastic cells were identified microscopically in the same four cases in which the TTs were designated to be malignant by MRI (specificity&sensitivity=100%). Surgical resection margins were microscopically positive in 50% of cases in the TTs themselves, and 75% of cases in which TTs were designated as malignant on staging MRI. “The malignant nature of peri-lesional edema in MFS, also known as the TT, was accurately predicted in this small pilot study based on specific radiological features which correlated exactly with histologic identification of isolated tumor cells. These findings validate development of a larger prospective study to recruit additional patients with tumor tails beyond just MFS, in order to more robustly study the correlation between the MRI appearance and histological distribution of satellite sarcoma cells in peri-lesional edema in STS. We are already recruiting to this expanded radiological-histological investigation including evaluation of additional novel MRI sequences

Background. Morton's neuroma (MN) is a common cause of metatarsalgia. Whilst there are a many treatment modalities available, studies looking at the long term effectiveness of most forms of treatment are scarce. The injection of MN with alcohol has gained popularity over the past ten years with widespread media coverage. Many surgeons have anecdotally questioned the long-term effectiveness. Sixty patients underwent alcohol injection for the treatment of MN by Radiologists at our institution. These results were originally published showing 92% (92/100) success rates and only 3% (3/100) requiring surgical excision at a mean follow up of 10.5 mths. The authors concluded that alcohol injection was comparable to results for surgical excision. Methods. We were able to review forty five of this original cohort with an average follow up of 61 (range, 33 to 73) months. The modified Johnson score and visual analogue scales were used to assess the patients and compare these results to five year results available in the literature for surgical management. Results. Our results indicated that by five years 36% (16/45) had undergone surgical treatment and a further 45% (13/29) had return of symptoms. Only 29% (13/45) remained symptom free. Results at five years showed statistically significant differences (P< 0.05) compared to surgical management, with 67.8% complete resolution of symptoms with surgery and 33% in the alcohol injection group. Conclusion. Injection with alcohol sclerosant for MN has been marketed as a definitive management option comparable to surgical excision. Our investigation illustrated that although short term results are encouraging; alcohol injection does not offer permanent resolution of symptoms for most patients, can be associated with considerable morbidity and that results are not comparable to surgery. Our investigation provides the only long term data for alcohol injection treatment of MN

Dermatofibrosarcoma protuberans (DFSP) is a rare, monoclonal dermal neoplasm. DFSP is known to be locally aggressive and infiltrative, but with a very low systemic recurrence risk. It is reported to be associated with high local recurrence rates following surgical excision. Positive or marginal resection margins can lead to a high risk of local recurrence. The objective was to determine the oncologic outcome for DFSP treated at our institution. We reviewed our prospectively collected database for all DFSP treated at our unit between 1990 and 2016. Patients were included whether or not they had excision prior to referral (“whoops” procedure). Those with fibrosarcomatous degeneration at presentation to our unit or less than 1 year of follow-up were excluded. The goal of surgery was a negative margin with a minimum margin of 2 cm where possible. Patients were followed up after surgery to monitor complications, recurrence, transformation and/or metastasis. 139 patients with a mean age of 42.7 (SD=14.1) were included. Mean follow-up was 56 months.101 patients had prior “whoops” surgery before referral. 14 patients were also treated with radiotherapy (13 preoperatively, 1 postoperatively). Following surgery, 6 patients had positive margins, 4 underwent radiation treatment while the other 2 had no further treatment. One patient who presented to our unit with a local recurrence developed a further local recurrence, which demonstrated fibrosarcomatous degeneration at the time of resection (1/139, 0.7%). 1 other patient developed a lesion at another site. The recurrence rate in our DFSP cohort is significantly lower than previous reports. Wide margin resection following oncologic principles can result in a very low recurrence rate. After the initial recovery phase, these patients do not require ongoing, frequent follow-up. Future studies should look at if closer margins can also produce similar treatment outcome

Haemangiomas are benign tumours with increased number of normal or abnormal appearing blood vessels. They are the commonest soft tissue tumours of infancy and childhood and comprise 7% of all soft tissue tumours. Our study is a retrospective analysis of 120 referred cases of various vascular anomalies in the last 10 years. Eighty cases had confirmed haemangiomas. MRI scan and needle biopsy formed the basis of diagnosis. M:F = 42:38. Mean age at presentation was 34.8 years, with the youngest and eldest patient being 3.5 and 78 years respectively. 5 patients were lost to study. Sites of occurrence were upper limb(32), lower limb(32), axilla(3), foot(5), thumb(1), knee(4), spine(1), posterior chest wall(2). 55/80 patients were managed non-operatively by way of Sclerotherapy/Embolisation, watchful observation or symptomatic treatment. 4/55 cases were assessed to be unsuitable for sclerotherapy and 1 patient was subjected to surgery. 6/55 cases did not respond to sclerotherapy. 25/55 cases were managed with surgical excision. Complete excision was the primary goal of surgery. Intralesional margins were accepted if lesions were close to neurovascular structures. Indications for surgery were 1) Pain with functional and/or developmental disturbance, 2) Sudden increase in size, 3) Recurrent haemarthrosis, 4) Failure of sclerotherapy. There were 3 cases of incomplete excision among those operated. 6/25 cases had recurrence 1-8 years after surgery. Mean follow-up was 38.4 weeks (range6-12 months). We have had a success rate of 81.48% with non-operative management of symptomatic haemangiomas. Surgical excision of haemangiomas has borne 76% satisfactory results for pain relief/functional recovery. We believe that extensive haemangiomata covering large surface areas are not suitable for surgical excision. Majority of cases can be successfully managed non-operatively by way of sclerotherapy/embolisation and watchful observation. MRI scan coupled with trucut needle biopsy has been most successful for diagnosis. Highly vascular sarcomata can mimic haemangiomas, hence histological diagnosis is crucial

Lymph node metastasis are a rare occurrence in soft tissue sarcomas of the extremity, arising in less than 5% of patients. Few studies have evaluated the prognosis and survival of patients with a lymph node metastasis. Early reports compared lymph node involvement to lung metastasis, while others suggested a slightly better outcome. The purpose of this study was to evaluate the impact of lymph node metastasis on patient survival and to investigate the histologic and clinical features associated with lymph node involvement. A retrospective review was done of the prospectively collected soft tissue sarcoma database at our institution. Two thousand forty-five patients had surgery for soft tissue sarcoma of an extremity between January 1986 and August 2017. Included patients either presented with a synchronous lymph node metastasis or were diagnosed with a lymph node metastasis after their initial treatment. Demographic, treatment, and outcome data for patients with lymph node involvement were obtained from the clinical and radiographic records. Lymph node metastases were identified as palpable adenopathy by physical examination and were further characterized on cross-sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) scans. All cases were confirmed by pathologic examination of biopsy specimens. A pathologist with expertise in sarcoma determined the histologic type and graded tumors as 1, 2, or 3. One hundred eighteen patients with a mean age of 55.7 (SD=18.9) were included in our study. Seventy-two (61.3%) out of 119 patients were male. Thirty six patients (57.1%) had lymph node involvement at diagnosis. The mean follow-up from the date of the first surgery was 56.3 months. The most common histological diagnoses were Malignant fibrous histiocytoma (35) and liposarcoma (12). Ninety eight patients (89%) underwent surgical treatment of the lymph node metastasis while 21 (17.6%) were treated with chemotherapy and/or radiation therapy. The mean survival was 52.6 months (range 1–307). Our results suggest that patients with a lymph node metastasis have a better prognosis than previously described. Their overall survival is superior to patients diagnosed with lung metastasis. A signifant proportion of patients may expect long term survival after surgical excision of lymph node metastasis. Furthermore, our study also indicates that different histological subtypes such as liposarcoma or malignant peripheral nerve sheath tumor (MPNST) may also be responsible for lymph node metastasis. Additional studies to further improve the treatment of soft tissue sarcoma nodal metastasis are warranted

Wound complications are common in patients with soft tissue sarcomas (STS) treated with surgical excision. Limited data is available on predictive factors for wound complications beyond the relationship to neo-adjuvant or adjuvant radiotherapy. Likewise, the association between blood transfusion, patient comorbidities and post-operative outcomes is not well described. In the present study we identified the predictive factors for blood transfusion and wound complications in patients undergoing surgical resection of soft tissue sarcoma from a national cohort. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent surgical resection of a STS from 2005 to 2013. Primary malignant soft tissue neoplasms were identified using the following ICD-9 codes: 171.2, 171.3 and 171.6. Patients treated with both wide excision and amputation were identified using the current procedural terminology (CPT) codes. Prolonged operative time was defined as greater than 90th percentile of time required per procedure. A multivariable logistic regression model was used to identify associations between patient factors and post-operative wound complications (superficial and deep surgical site infections (SSI), and wound dehiscence). A similar regression model sought to identify prognostic factors for blood transfusion and associations with post-operative outcomes. A total of 788 patients met our inclusion criteria. Of theses, 64.2% had tumours in the lower limb, 23.1% patients had tumours in the upper limb, and 12.7% patients had pelvic tumours. Six hundred and forty patients (81.2%) underwent surgical excision; 148 (18.8%) patients had an amputation. Multivariable logistic regression modeling identified American Society of Anaesthesiologist (ASA) class 3 and 4 (OR=2.3, P=0.03; OR=8.3, P=0.001, respectively), amputation (OR=14.0, P<0.001) and prolonged operative time (OR=4.6, P<0.001) as significant predictors of blood transfusion. Radiotherapy (OR=2.6, P=0.01) and amputation (OR=2.6, P=0.01) were identified as predictors of superficial SSI, whereas ASA class 4 (OR=6.2, P=0.03), prolonged operative time (OR=3.9, P=0.012) and return to the operating room (OR=10.5, P<0.001) were associated with deep SSI. Male gender (OR=1.8, P=0.03), diabetes (OR=2.3, P=0.03), ASA class 3 (OR=2.4, P=0.003), amputation (OR=3.8, P<0.001) and steroids (OR=4.5, P=0.03) were identified as predictors for wound dehiscence and open SSI. A national cohort demonstrates that male gender, diabetes, chronic steroid use, higher ASA score and radiotherapy are associated with an increased incidence of wound complications. One in twenty-three patients undergoing resection of an STS will require a blood transfusion, and this risk is correlated with amputation, prolonged operative time and increased ASA score. Strategies to decrease the risk of blood transfusion and wound complication should be considered for these patient groups

Introduction. Charcot Arthropathy related foot and ankle deformities are a serious challenge. Surgical treatment of these deformities is now well established. The traditional surgical method of extensive surgical exposure, excision of bone, acute correction and internal fixation is not always appropriate in presence of active ulceration, deep infection and poor bone quality. Minimally invasive osteotomies and gradual correction of deformities with a circular frame are proving helpful in minimizing complications. We present our experience with the use of Taylor Spatial Frame (TSF) in 10 patients with recurrent ulceration and deformity. Materials and Methods. Our indication for the treatment with TSF is recurrent or intractable ulceration with or without active bone infection or a history of infection in a deformed foot and/or ankle. There are 2 female and 8 male patients in this cohort. We used a long bone module for ankle and hindfoot deformities (3 patients) and a forefoot 6×6 butt frame (7 patients) for midfoot deformities. An osteotomy through midfoot was performed in all chronic stable midfoot deformity cases and a calcaneal osteotomy and gradual correction through ankle in when hindfoot and ankle deformities co-existed. Results. Our outcome measures are a complete healing of ulcer and infection without recurrence, clinically plantigrade foot and ability to wear regular shoes or diabetic footwear. We achieved this outcome in 9 out of 10 patients. Successful patients remain ulcer free at minimum 7 and maximum 14 years follow up. Complications included eight episodes of pin infection that responded to oral antibiotics only and two pin breakages. Conclusions. Our results confirm that Taylor Spatial Frame treatment is a good alternative to traditional surgery in high-risk complex Charcot neuroarthropathy foot and ankle deformities

Aim. Chronic osteomyelitis (OM) is usually treated with surgical excision of infected bone and subsequent dead space management to prevent local recurrence. We report outcome after antibiotic loaded biocomposite (ALB). 1. for management of infected bone defects. Method. We report a consecutive series of 97 patients with chronic OM treated at one institution by a multidisciplinary team, using a single-stage revision protocol inspired by a recently published study. 2. . The treatment protocol includes surgical debridement, tissue sampling, dead-space management using the ALB, stabilization and empirical antibiotic therapy adjusted based on culturing. Closure was performed directly, with a local flap, a free flap or secondarily. This series includes all patients operated using the ALB at our institution, since its implementation 26 months ago. The senior author (HG) performed 65 (67%) of the operations. The remaining procedures were performed by 14 different surgeons. Results. Mean age was 66.2 years (26 to 92). In 41 patients, OM followed an overlying soft-tissue infection, 30 followed surgical management of a closed fracture in the affected bone, 18 followed elective surgical procedures in the area, 5 followed open fractures of the affected bone, 2 were spontaneous following bacteremia and 1 patient had previously been diagnosed with OM in the affected bone. Seventy one (73,2%) of the included patients had systemic comorbidities (Cierny-Mader Class B hosts), thirty eight were diabetics, twenty-three were active smokers and twenty-five had a past history of smoking, fourteen consumed alcohol in quantities constituting alcohol abuse and 9 had a previous history of alcohol abuse. Patients were followed-up by chart review for a mean of 5.8 months (0 to 25). Twelve patients required a soft-tissue revision after a mean time of 2.2 months (0 to 12). Eleven patients required bone revision after a mean time of 3.4 months (0 to 10) where the ALB was re-applied in nine cases. Six patients required amputation after a mean time of 3.2 months (0 to 12). Two patients died after a 1 and 5 months respectively. Seventy patients (73%) had no adverse advents following surgery. Conclusions. An acceptable outcome was obtained considering a heterogeneous population with a high comorbidity rate and considerable smoking and alcohol abuse

Hydatid disease of the bone and soft tissue of the musculoskeletal system is uncommon. The dissemination mode leads to local malignancy with severe prognosis. Tunisia is an endemic area of the disease. Therefore we treated many patients affected the disease. We retrosectivelly reviwed 6 cases of bone hydatid cyst from 1990 to 2010. There were 3 males and 3 females. The mean age was 13 years. The localisation were 03 spinal, 2 in the proximal tibia and & localisation in trochanter. The diagnosis were histoligical in all patient. the mean delay for the diagnosis was 3 years. One patient with spinal localisation had neurological complication paraplegia. All the patient had surgical excision of the hydatid cyst. Ther ewere 3 cases with local recurrence. Because of the poor results with medical treatment, osseous hydatidosis must be treated by a radical operation with wide excision, adapted to each localization. In the main, the prognosis of osseous hydatidosis remains poor, especially with spinal and pelvic localizations, which are the most frequent ones. The prognosis and treatment of osseous hydatidosis belong in the same category as a locally malignant lesion

Heterotopic ossification (HO) is the formation of bone in extraskeletal sites. It is a major problem for combat-related casualties with 64% of such patients showing radiological evidence of the disease. Of these, 19% require surgical excision. Current prophylaxis is problematic due to poor efficacy and unsuitability in a military setting. Our novel anti-HO strategy is to use an inorganic reagent to inhibit the deposition of HA and disperse any pre-formed mineral. Literature review identified several potentially effective agents. These were tested for their ability to disperse solid monoliths of HA. In addition, a standard HA synthetic reaction was performed in the presence of each agent to establish their inhibiting activity. One reagent (a condensed phosphate) dispersed a solid monolith of HA by 38% (mass loss) over 30 days. This reagent was also shown to inhibit HA crystal synthesis yield by 28%. Early work on a hydrogel delivery system has produced favourable results. These preliminary data demonstrate proof of concept that HA may be dispersed and its formation inhibited by a non-toxic polyphosphate. This work will form the justification for development into in vitro osteogenic cell culture models and animal HO models

The incidence of clinically significant (Brooker stage 3–4) heterotopic ossification (HO) after THA is 3–7%. Risk factors include male gender, old age, a history of HO, Paget's disease, post-traumatic arthritis, osteonecrosis and rheumatoid arthritis. Prophylaxis for high-risk patients consists of 1) radiotherapy given as one dose of 7–8 Gy either pre-operatively (<4 hours) or post-operatively (within 72 hours) or 2) NSAIDS. Treatment of clinically significant HO includes intensive physiotherapy during the maturation phase of the disease and surgical excision in conjunction with a combination of radiotherapy and indomethacin once the HO has matured. Less invasive surgical approaches may be associated with a reduced incidence of HO

The incidence of clinically significant (Brooker stage 3–4) heterotopic ossification (HO) after THA is 3–7%. Risk factors include male gender, old age, a history of HO, Paget's disease, post-traumatic arthritis, osteonecrosis and rheumatoid arthritis. Prophylaxis for high-risk patients consists of 1) radiotherapy given as one dose of 7–8 Gy either pre-operatively (< 4 hours) or post-operatively (within 72 hours) or 2) NSAIDS. Treatment of clinically significant HO includes intensive physiotherapy during the maturation phase of the disease and surgical excision in conjunction with a combination of radiotherapy and indomethacin once the HO has matured. Less invasive surgical approaches may be associated with a reduced incidence of HO