Materials and Methods: Consecutive 39 patients who underwent first metatarsophalangeal joint (MTPJ) arthrodesis for hallux rigidus were assessed clinically, radiographically and functionally at a mean follow up of 21.45 months. Clinical assessment was performed by two blinded assessors in a specially arranged research clinic. Radiological examinations were performed separately by two independent researchers on digitalised weight bearing radiographs. Functional outcome was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and a short form-12 (SF-12) questionnaire.

Results: There were 19 patients who had dorsal contoured titanium plates and 20 patients who had single inter fragmentary screw fixation. Both the groups were comparable preoperatively. All except 5 patients achieved radiological fusion at a mean of 7.64 weeks. Over all rate of fusion in the present series is 87.1%. There were 4 non-unions in the plate group and one in screw group. Mean AOFAS score was 74.94 in the screw group and 70.63 in the plate group. There were no hardware problems in the single screw group. However in the plate group one patient with non-union broke the plate and another patient had back out of screws. There were no statistically significant differences in terms of pain-relief, activity-limitation, cosmetic appearance, foot wear requirements, dorsiflexion angle, hallux-valgus angle and inclination angles and SF 12 scores. Four patients in the plate group and one in screw group were unsatisfied with the surgery.

Conclusions: Solid fusion has resulted in good pain relief and patient satisfaction in both groups. In the dorsal plate group 4 patients (21.6%) had non-unions, two patients had metal problems. We have stopped using the plate alone technique for the fixation of first MTPJ fusion.

Background: Skin grafting is one of the simplest techniques of providing skin cover following enbloc resection of soft tissue sarcomas on extremities. But many authors have questioned the tolerance of skin graft to post operative radiotherapy.

Aim: To assess the integrity of skin grafts following post operative radiotherapy for soft tissue sarcomas on extremities.

Material and methods: During the period between 1997 and 2003, 10 patients received postoperative external beam radiotherapy following excision of soft tissue sarcomas on extremities and skin grafting at this regional soft tissue sarcoma unit. Age of these patients ranged from 26 years to 92 years. Malignant fibrous histiocytoma was the commonly encountered tumour. Commonest site of resection and skin grafting was lower leg. These patients were analysed for interval between skin grafting and radiotherapy, dose, type and fractions of radiation, break in radiotherapy, adjuvant chemotherapy and effect of radiation on skin graft.

Results: One patient developed moist desquamation and two developed dry desquamation during the course of treatment. All acute skin reactions were healed within 3 weeks of completion of radiotherapy. No patients required further soft tissue reconstruction.

Conclusion: Adjuvant external beam radiotherapy can be delivered to skin-grafted areas on extremities following enbloc excision of soft tissue sarcomas without any major complications. Our experience indicates that the radiation reaction can be minimised if the graft is allowed to heal adequately prior to the initiation of radiotherapy.

Background: Skin grafting is one of the simplest techniques of providing skin cover following enbloc resection of soft tissue sarcomas on extremities. But many authors have questioned the tolerance of skin graft to post operative radiotherapy.

Aim: To assess the integrity of skin grafts following post operative radiotherapy for soft tissue sarcomas on extremities.

Material and methods: During the period between 1997 and 2003, 10 patients received postoperative external beam radiotherapy following excision of soft tissue sarcomas on extremities and skin grafting at this regional soft tissue sarcoma unit. Age of these patients ranged from 26 years to 92 years. Malignant fibrous histiocytoma was the commonly encountered tumour. Commonest site of resection and skin grafting was lower leg. These patients were retrospectively analysed for interval between skin grafting and radiotherapy, dose, type and fractions of radiation, break in radiotherapy, adjuvant chemotherapy and effect of radiation on skin graft. Results: One patient developed moist desquamation and two developed dry desquamation during the course of treatment. All acute skin reactions were healed within 3 weeks of completion of radiotherapy. No patients required further soft tissue reconstruction.

Conclusion: Adjuvant external beam radiotherapy can be delivered to skin-grafted areas on extremities following enbloc excision of soft tissue sarcomas without any major complications. Our experience indicates that the radiation reaction can be minimised if the graft is allowed to heal adequately prior to the initiation of radiotherapy.

Background: Extra skeletal osteosarcomas are rare malignancies that account for less than 1% of all soft tissue sarcomas. We describe this tumour arising in the belly of vastus medialis muscle in a 56-year-old woman.

Case report: A 56 year old, otherwise healthy teacher was referred to this regional soft tissue sarcoma unit regarding a progressively enlarging mass in her right thigh. She had noticed this swelling 12 months ago, which remained pain free. On examination there was a firm swelling on the medial side of the thigh measuring 6 cm in diameter. There was no regional lymphadinopathy. MRI scan was reported as a probable soft tissue sarcoma arising from vastus medialis. An open biopsy was reported as a sarcoma of chondroid differentiation but a specific diagnosis of extraskeletal osteosarcoma was reached only after definitive tumour resection. She was treated by wide resection, post operative radiotherapy and combined chemotherapy. At 24 months of follow up she remained tumour free.

Relevant literature is reviewed.

Background: Adult rhabdomyosarcoma is a relatively rare tumour. Good prognosis has been reported in children with multimodality of management. Because of its rarity, very little has been written about this tumour in adults especially on extremities.

Aim- To analyse the results of multimodality treatment of rhabdomyosarcoma of extremities in adults treated over a period of ten years in a UK regional centre.

Material and Methods – Between 1991 and 2002, eight patients underwent enbloc resection for rhabdomyosarcoma of extremities. There were four men and four women. Age of these patients ranged from 21 to 78years. Locations of these tumours were thigh in 5 patients, legs in 2 patients and shoulder in one. Treatment consisted of surgical resection in all patients combined with radiotherapy or chemotherapy or both. These patients were studied retrospectively for surgical and treatment details, tumour recurrence, secondary and mortality. Results are analysed in relation to histological subtype, size of the tumour (less or more than 5cm) and stage of the disease.

Conclusion: Our experience shows a significant incidence of metastatic recurrence and mortality in these patients. Major determinant of disease control (local and distant) seems to be the size of the tumour at presentation. Treatment must be individualized, but complete local excision with a tumour-free margin should be the goal. Major ablative amputation surgery was not performed.