This case series highlights the use of the Ganz approach and surgical dislocation for excision of fibrous dysplasia of the femoral neck, pigmented villonodular synovitis and synovial chrondromatosis of the hip, which has never been described for use with all three tumours together. These are rare benign tumours, which were found incidentally and required excision. We demonstrate that it is possible to obtain excellent exposure of the femoral neck, head and acetabulum allowing easy inspection, exploration and debridement of these three tumours of the hip.
Decreasing the chance of local relapse or infection after
Although most peripheral nerve sheath tumours are benign, some are malignant. The management of malignant tumours usually involves wide excision and is facilitated by knowledge of the diagnosis prior to operation. Imaging modalities, including MRI, give anatomical information but do not distinguish between benign and malignant nerve tumours. We therefore introduced the use of ultrasound guided needle biopsy for suspected nerve tumours to our unit in 2004. Prior to this, excision biopsy was carried out in all cases. We aimed to review our experience with needle biopsy and determine whether it has an effective role in the management of peripheral nerve tumours. All patients who had a needle biopsy for suspected peripheral nerve tumours from January 2004 to December 2011 were identified from our tumour database and clinical notes reviewed. In all cases, biopsy was carried out under ultrasound guidance with local anaesthesia to obtain a 1mm core of tissue. From 25 patients reviewed, 21 (84%) had a successful biopsy. In 3 cases the biopsy was unable to be completed due to pain and in 1 patient insufficient tumour tissue was obtained. 1 patient had a temporary radial nerve palsy following needle biopsy which recovered fully. In biopsies that were successful, 19 (90%) showed a benign peripheral nerve tumour. Following diagnosis of a benign lesion, only 2 patients required to have
Background. Surgical resection of middle facet tarsal coalition is a well documented treatment option in symptomatic individuals that do not respond to conservative treatment. The ability to return to full recreational activity post resection may have implications on foot biomechanics and possibly degenerative changes in the subtalar and adjacent joints. Hypothesis. Open resection of middle facet tarsal coalitions should improve subtalar joint motion and biomechanical function and facilitate return to sports. Aim. The aim of this study was to assess the outcomes of open resection of middle facet tarsal coalitions (MFTCs) with particular emphasis on return to sports. Methods. Retrospective review of clinical and radiographic records of paediatric and adolescent patients who had open resection of middle facet tarsal coalitions. The ankle and hind foot were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hind foot Scale (AOFAS). We also quantified the return-to-activity time after tarsal coalition surgery. Results. We identified thirteen patients (Mean age; 13.7years Range; 7–21 years) with eighteen middle facet tarsal coalitions operated over a seven year period. Ten patients (12 feet) who underwent resection had an average return to recreational activity time of approximately twelve weeks and reported better exercise tolerance post resection. Conclusion.
Bone tumours may recur locally even after wide
We evaluated the possible induction of a systemic immune response to increase anti-tumour activity by the re-implantation of destructive tumour tissue treated by liquid nitrogen in a murine osteosarcoma (LM8) model. The tumours were randomised to treatment by excision alone or by cryotreatment after excision. Tissue from the tumour was frozen in liquid nitrogen, thawed in distilled water and then re-implanted in the same animal. In addition, some mice received an immunological response modifier of OK-432 after treatment. We measured the levels of interferon-gamma and interleukin-12 cytokines and the cytotoxicity activity of splenocytes against murine LM8 osteosarcoma cells. The number of lung and the size of abdominal metastases were also measured. Re-implantation of tumour tissue after cryotreatment activated immune responses and inhibited metastatic tumour growth. OK-432 synergistically enhanced the anti-tumour effect. Our results suggest that the treatment of malignant bone tumours by reconstruction using autografts containing tumours which have been treated by liquid nitrogen may be of clinical value.
The aim of this study was to establish a classification system for the acromioclavicular joint using cadaveric dissection and radiological analyses of both reformatted computed tomographic scans and conventional radiographs centred on the joint. This classification should be useful for planning arthroscopic procedures or introducing a needle and in prospective studies of biomechanical stresses across the joint which may be associated with the development of joint pathology. We have demonstrated three main three-dimensional morphological groups namely flat, oblique and curved, on both cadaveric examination and radiological assessment. These groups were recognised in both the coronal and axial planes and were independent of age.