Condromixoid sarcoma is a rare tumor (about 2,3% of soft tissue sarcomas in one of the series published) occurring mainly in muscular part of extremities. The reconstruction after block resection of tumor lesions of dorsal column invading the thorax almost always represents a great challenge to the surgical team. The case presented reports an infrequent location of this rare tumor what highlights it in an oncologic point of view. From the surgical point of view the surgical steps of wide tumor resection are described and of the reconstruction of the dorsal column and the involved thoracicregion (adjacent to vital structures) what resulted in an asymptomatic correction.

The authors present a case of a 47 years old patient operated to a volumous dorsal condromixoid sarcoma, practically asymptomatic, with invasion and compression of the neurological space and thoracic cavity. After biopsy, a wide resection of the tumor was made, using a double surgical approach (anterior and posterior), with resection of posterior part of vertebras D6–D9 and part of the 7th, 8th and 9th costal arches. The reconstruction consisted in correction of thoracic wall with prosthesis and stabilization of column with pedicular instrumentation from D5 to D11. The post-operatory recover had no complications and in clinically the patient is asymptomatic.

Only the elevated level of suspicion conducted the realization of biopsy in an apparent innocent lesion. The Condromixoid sarcoma occurs rarely in the nervous axis, what created some difficulties in the histological diagnosis. The dimensions of the tumor mass and its localization were object of great discussion and of detailed surgical planning. After a massive surgical resection, the clinical result after 2 years of follow-up is excellent (patient asymptomatic). The almost inevitable oncological decision of surgery in a malignant tumor with medullar cord compression was the only effective way of treatment.

Purpose of the study: Latissimus dorsi transfer is proposed for irreparable superior and posterior rotator cuff tears, particularly in the effect of deficient active external rotation. The purpose of this study was to analyzed outcome at minimum two years follow-up.

Material and methods: Between 2001 and 2002, eleven patients underwent latissimus dorsi transfer for an irreparable tear of the supraspinatus and infraspinatus. Surgery was proposed because of the patient’s young age and occupational activity level, or because of a disabling deficit of active external rotation. There were six men and five women, mean age 52.5 years (range 36–66 years). There were seven right shoulders and nine dominant shoulders. Symptom onset was progressive in seven with a mean duration of 33 months (range 2–144 months). Active external rotation was measured at −14° to 29° in five patients with a positive dropping test. Three patients presented pseudoparalysis. The preoperative Constant score was 52±12 points. Preoperative the subacromial space measured less than 6 mm in all patients. Muscle degeneration of the infraspinatus was noted grade 2 or greater (Goutallier).

Results: Mean follow-up was 26 months (range 24–36). Subjective outcome was very satisfactory for eight patients, satisfactory for one and disappointing for two. Seven of nine patients resumed their occupational activity. The postoperative Constant score was 73±10 points. None of the patients presented pseudoparalysis at review. Pain was improved in all. Active external rotation was significantly improved in six. Postoperative, the dropping test persisted in two patients. The subacromial space was still 6 mm. Better results were obtained when active deficit was predominant than when anterior elevation (pseudoparalytic shoulder) or external rotation (positive dropping test) were predominant.

Discussion and conclusion: Latissimus dorsi transfer provides a solution for irreparable superior and posterior rotator cuff tears. The pain relief is significant. Active external rotation is improved. This is an interesting alternative in young patients or when the motor deficit is a severe handicap.

Purpose of the study: When repairing rotator cuff tears, injury to the infraspinatus is generally a posterior extension of a supraspinatus tear. The description of isolated tears of the infraspinatus has not been to our knowledge reported in the literature. We report a series of 13 cases with more than one year follow-up.

Material and methods: Thirteen patients underwent surgery for an isolated tear of the infraspinatus between 1995 and 2004. There were ten men and three women. Mean age at surgery was 47 years (range 34–62). The right shoulder was involved in seven of the thirteen cases, and the dominant shoulder in eight. A progressive onset was observed in eleven patients and nine had a history of treated calcified tendinopathy. Clinically, pain was the predominant symptom. The Jobe test was deficient in all patients as was external rotation (except one patient). The preoperative Constant score was 70 (range 62–87). X-rays revealed type C posterior calcification in nine patients. A full-thickness tear was observed in seven cases, a partial deep tear in three, and a partial superficial tear in three. Isolated fatty degeneration of the infraspinatus noted Goutallier grade 2 or greater was observed in seven patients. Open surgical repair was preformed in all patients.

Results: Mean time to revision was 29 months (range 12–82). Subjectively, six patients were very satisfied, six were satisfied, and one was disappointed (failure by secondary tear). Two shoulder-hand syndromes were noted in the postoperative period. At last follow-up, the Constant score was 83.5 (range 64–97). All patients except one were satisfied with pain relief but the lack of force was significant.

Discussion and conclusion: Isolated tears of the infra-spinatus are rare, but there is a notable relationship with calcifying tendinopathy of the same tendon. Repair should be undertaken before the development of fatty degeneration in order to improve the chances of force recovery.

Resection of the distal femur or proximal tibia en bloc has been performed on twenty-six patients with primary bone tumours. The gap was filled with autogenous bone grafts stabilised with a long intramedullary nail, thus arthrodesing the knee. In two cases temporary stabilisation with a Kuntscher rod and acrylic cement was adopted because of adjuvant chemotherapy. Union was achieved in twenty-four cases (92 per cent). Infection was the main and practically the only major complication, occurring in five (19 per cent) of the cases: it healed with union in three, healed with non-union in one, and led to an above-knee amputation in the fifth case. Follow-up has been from one to eight years with an average of four years.