The surgical management of musculoskeletal tumours is a challenging problem, particularly in pelvic and diaphyseal tumour resection where accurate determination of bony transection points is extremely important to optimise oncologic, functional and reconstructive options. The use of computer assisted navigation in these cases could improve surgical precision. We resected musculoskeletal tumours in fifteen patients using commercially available computer navigation software (Orthomap 3D). Of the eight pelvic tumours, three underwent biological reconstruction with extra corporeal irradiation; three endoprosthetic replacement (EPR) and two required no bony reconstruction. Four diaphyseal tumours had biological reconstruction. Two patients with proximal femoral sarcoma underwent extra-articular resection and EPR. One soft tissue sarcoma of the adductor compartment involving the femur was resected with EPR. Histological examination of the resected specimens revealed tumour free margins in all cases. Post-operative radiographs and CT show resection and reconstruction as planned in all cases. Several learning points were identified related to juvenile bony anatomy and intra-operative registration. The use of computer navigation in musculoskeletal oncology allows integration of local anatomy and tumour extent to identify resection margins accurately. Furthermore, it can aid in reconstruction following tumour resection. Our experience thus far has been encouraging.
The surgical management of musculoskeletal tumours is a challenging problem, particularly in pelvic and diaphyseal tumour resection where accurate determination of bony transection points is extremely important to optimise oncologic, functional and reconstructive options. The use of computer assisted navigation in these cases could improve surgical precision. We resected musculoskeletal tumours in fifteen patients using commercially available computer navigation software (Orthomap 3D).Background
Materials and methods
Bony tumours of the foot account for approximately 3% of all osseous tumours. However, literature regarding os calcis and talar tumours comprises individual case reports, short case series or literature reviews with no recent large series. We retrospectively reviewed the medical notes and imaging for all patients with calcaneal or talar tumours recorded in the Scottish Bone Tumour Registry since the 1940's. Demographics, presentation, investigation, histology, management and outcome were reviewed.Introduction
Methods
The purpose of this study was to determine if the use of a new 4 Dimensional CT scan aids the clinician in defining the size and area of the scapular bone to be removed arthroscopically in patients with Snapping Scapular Syndrome. From January 2009 – January 2011 nine consecutive patients with Snapping Scapular Syndrome were included. In six patients, (mean age 21±5 years, range 15–27) conservative treatment failed. These patients were positioned prone and demonstrated their snapping motion during the 7 seconds duration of the scan. The 4D CT machine scans 16 cm volumes in 0.3 seconds. It also scans motion, allowing a 3D reconstruction of the scapulothoracic joint, its’ movements and the dynamic area of impingement of the scapula on the surrounding structures. This scan has already improved arthroscopic removal of the supero-medial angle of the scapula. The scan showed in one case not only snapping of the superior medial angle of the scapula on the 2nd rib, but also extra bone impinging on the 3rd rib. Another case showed no real impingement but movement of the 2nd and 3rd rib by a tethering structure and a third case demonstrated impingement of the lateral third of the clavicle on the 2nd rib. The images provided by this new 4D CT scan offer greater pre-operative insight on the pathology in each individual patient with Snapping Scapular Syndrome. Therefore, we feel that it is a valuable addition to the assessment and treatment of these patients.
The purpose of this study was to determine the motion pattern of the Acromio-Clavicular (AC) joint in a normal shoulder with the use of the new 4 Dimensional CT scan. From April 2010 till January 2011 fourteen healthy volunteers (4 female, 10 male)(mean age 42±11 years) with no previous history of shoulder complaints participated in this study. The 4D CT machine scans motion, allowing a 3D reconstruction of the shoulder joint and its movements. Patients were positioned supine with their arm elevated 90° in the sagittal plane. During the 7 seconds duration of the scan they adducted their arm at that level and then elevated their arm upwards resisted by the gantry for 4 seconds, in this way simulating the clinical Bell-van Riet test for AC pathology. In the transverse plane the mean AC joint space measured in the neutral position is 1.8±0.5 mm. While adducting the arm the AC joint narrows 0.0±0.4 mm (with a positive value being narrowing and a negative value widening). On resisted elevation the joint space is narrowed 0.2±0.6 mm. The mean antero-posterior (AP) translation in this same plane is 0.2±2.2 mm on adduction (with a positive value being posterior translation of the clavicle and a negative value anterior translation) and 0.4±2.9 mm on resisted elevation. The new 4D CT scan demonstrates that the AC joint in a normal shoulder mainly translates in an AP direction, rather than being narrowed or widened, when the arm is adducted (with or without resisted active elevation).
