Purpose: The literature on management of advanced soft tissue tumours is limited because of the rarity of cases following increased awareness and improved diagnostic resources.

Method: Our experience of managing 18 patients with fungating soft tissue tumours of the extremities and one patient with a sarcoma involving the scapular region (limb girdle) is presented. There were 14 males and 5 females. Average age was 70.6 yrs ranging between 37 – 98 years. 13 tumours involved lower limb and 6 the upper limb.

Results: The follow-up ranged from a minimum of 6 months to 10 years from the initial referral. The histological diagnosis was Sarcoma in 15 patients (Spindle cell sarcoma in 4, Fibrous Histiocytoma in 2, Pleomorphic sarcoma in 3, liposarcoma in 2, leiomyosarcoma in 2, Fibrosarcoma in 1 and 1 Round cell sarcoma). In the remaining 3 patients immunohistochemistry studies confirmed a Metastatic Squamous cell Sarcoma, a Metastatic Malignant Melanoma and a Metastases from a poorly differentiated upper GI malignancy each. Primary wide local excision was performed in 15 patients and primary amputation was performed in two patients. In 2 patients when tumour was unresectable due to the location and local spread, an embolisation was performed in both for palliation. Lung Metastases were present at the time of referral in 6 patients and developed later during follow-up in 4 patients. A histologically proven recurrence occurred in 6 patients after an average of 15.83 (4 to 41) months. Revision surgery was needed in 9 patients for either a positive margin on histology or a recurrence, including 3 secondary amputations. Local adjuvant Radiotherapy was given for 7 patients and a combination of radio and chemotherapy was used in 2 patients for metastases. Mortality was 53 % (9 patients) by the end of 32 months of follow-up.

Conclusion: Fungation in soft tissue tumours is rare and often a sign of locally advanced disease and a high grade nature, patients either have systemic spread by the time or develop later inspite of good local disease control. Primary wide local excision in such patients is difficult and has a high chance of a positive margin hence primary amputation may be better for local clearance. Recurrence of tumour and revision surgery is common and the mortality was > 50% at the end of 3 years from presentation to treatment in our series.

Introduction: It is common practice to screen the hips of infant with a family history of DDH clinically and ultra-sonographically in selective screening programmes. The practice of regular radiographic follow-up of infants with a positive family history of Developmental Hip Dysplasia (DDH) is based on the widespread belief that Primary Acetabular Dysplasia is a genetic disorder that can occur in the absence of frank hip subluxation or dislocation¹. It has been our practice to obtain a 6 – 12 month screening radiograph in such patients but this practice is not conclusively supported in the literature.

Materials and Methods: We reviewed all such infants who had a normal clinical and ultrasound examination of the hips at the 6–8 week screening examination but who, because of the family history underwent further radiographic screening after a 6–12 month interval. The radiographs of all such infants (n=77) were analysed for any signs of late hip dysplasia.

Results and Discussion: Sixty six infant had normal X rays at the 6–8 month assessment and were discharged. The remaining eleven patients had acetabular angles at the upper end of the normal range for age and were reviewed again with further radiographs at 12 months. At this stage ten patients were normal and were discharged. The remaining patient was reviewed again at 18 months and 24 months and finally proved to be normal and was discharged. The result of a postal survey has suggested that majority of BSCOS members do not get follow up x-ray done if the clinical and ultrasound scan is normal at screening visit.

Conclusion: All of the seventy seven patients eventually developed normal radiographs and we question the need for radiographic follow up of infants with a family history of DDH but who have a normal clinical examination and ultrasound scan at 6–8 weeks.

The practice of regular radiological follow-up of infants with a positive family history of developmental dysplasia of the hip is based on the widespread belief that primary acetabular dysplasia is a genetic disorder which can occur in the absence of frank subluxation or dislocation. We reviewed all infants who were involved in our screening programme for developmental dysplasia of the hip, between November 2002 and January 2004, and who had a normal clinical and ultrasound examination of the hip at six to eight weeks of age, but who, because of a family history of developmental dysplasia of the hip, had undergone further radiography after an interval of 6 to 12 months. The radiographs of 89 infants were analysed for signs of late dysplasia of the hip and assessed independently by three observers to allow for variability of measurement. There were 11 infants (11%) lost to follow-up.

All the patients had normal radiographs at the final follow-up and none required any intervention. We therefore question the need for routine radiological follow-up of infants with a positive family history of developmental dysplasia of the hip, but who are normal on clinical examination and assessment by ultrasound screening when six to eight weeks old.