Goals: Sarcomatous degeneration of giant cell tumours (GCT) occurs rarely. It occurs in less than 1% of the cases, and most of them are GCT previously treated with radiotherapy. The goal of this presentation is to review the CGT cases treated at our unit that have evolved towards malignization.

Methods: Retrospective study of 96 GCT treated at our Hospital between 1983 and 2005. 5 presented sarcomatous degeneration in their evolution. These were the cases of 3 men and 2 women with a mean age of malignization of 42 years (32 years – 54 years). The median follow-up period was 155 months (5 months – 209 months). 3 cases affected the distal femur, one case affected distal radius and one case affected proximal humerus, with a slight tendency to the right hemibody. The primary treatment for GCT in these patients was curettage and bone graft. Only one case had received previous radiotherapy. In the same period of time we had two cases of lung dissemination of CGT with typical histology, without previous malignization of tumour.

Results: Malignization takes place, on average, at the 1.8th recurrence (1.3). Histologically, we find 3 osteosarcomas and 2 indifferentiated tumours. Three patients developed distant dissemination; 2 patients died due to lung metastases, with a mean time between the first surgery and the sarcomatous degeneration of 90 months (40 monts – 183 months) and a mean time between malignization and mestastases of 22.3 months (9 months – 34 months) The treatment, once the malignization was diagnosed, consisted in wide resection and substitution with mega-arthroplasty in cases of distal femur and osteoarticular graft at the shoulder. 2 cases required amputation of the affected limb due to irresecable recurrence in soft tissues.

Conclusions: There is no predictive criteria of which type of primary typical CGT will evolve into sarcoma. The malignization always has as a result high grade sarcomas, with a high tendency to hematogenous dissemination. When lung metastases appear the survival prognosis is a number of months. We must suspect malignization of a benign CGT when one of the relapses shows a very rapid growth with radiologic aggressive characteristics; in these cases we prefer wide resection of the tumour instead of curettage and thus we prevent the possible sarcomatous degeneration.

Introduction and purpose: Hallux valgus is a pathological condition with a high incidence in adults. Both open and percutaneous surgical techniques have been developed for its treatment. The aim of our study is to retrospectively assess the validity of the minimally invasive surgical method used by our department and determine its rate of complications.

Materials and methods: We retrospectively studied 100 patients that underwent surgery for hallux valgus using the MIS technique between 2000 and 2005 in our department. These cases were operated by 2 experienced surgeons and had a maximum 2-year follow-up during which they were assessed both clinically and statistically to determine the outcome and complication rate of this surgical method.

Results: MIS osteotomy performed in our department (double osteotomy of the first toe, bunionectomy, tenotomy of the adductor of the first toe and osteotomies of the 2nd, 3^rd and 4^th metatarsals) for the treatment of hallux valgus resulted in a good degree of correction with an acceptable rate of recurrences and complications such as 2^nd metatarsal nonunion and superficial infections in less than 10% of cases. The majority of patients were completely satisfied with the clinical results with AOFAS assessment tests that were good or very good.

Conclusions: In spite of the fact that radiographically 35% of the patients suffered partial recurrences, more than 90% of the patients were clinically asymptomatic. Therefore we consider this a valid technique for the treatment of hallux valgus in adults.

Introduction and purpose: Cortical strut autografts provide primary stability to resolve fractures or pseudoarthrosis associated with major bone loss, or fractures close to joint prostheses.

Materials and methods: We present 8 cases in which strut autografts were used: one pseudoarthrosis of the humerus, three periprosthetic fractures in TKR and four fractures associated with hip prosthesis surgery.

We resolved the humeral pseudoarthrosis with struts and a PCL plate plus cancellous tissue graft. For the periprosthetic fractures of the knee and hip we used revision prostheses with extension stems plus struts, held in place with cerclage wires or compression bands, with or without plates.

In all cases functional rehabilitation started early. The mean non-weight-bearing period for lower limbs was 10 weeks (8–12 months).

Results: Primary stability made it possible to begin rehabilitation early in all cases. Total consolidation of the grafts in a mean time of 5 months (4–7 months), with complete recovery of bone stock. Excellent functional outcome with full return to daily activity as before surgery.

Conclusions: The use of strut autografts associated with osteosynthesis and/or revision prosthesis implantation makes it possible to resolve cases that require a large amount of bone graft and provides sufficient primary stability for fast rehabilitation. The proper final consolidation of the grafts and complete recovery of bone stock provides stability with full guarantee of long-term success.

Introduction and Objectives: Extraskeletal osseous sarcomas are very rare high-grade tumours. They include osteosarcoma, chondrosarcoma, and Ewing’s soft tissue sarcoma and their respective variants. We present a retrospective study of 25 cases covering the period from December 2002 to January 2003.

Materials and Methods: This study of 25 cases shows that this heterogeneous group of soft tissue sarcomas primarily affects adults (mean age 50.68; range 17 to 70 years). The thigh (36.60%) and the elbow-forearm (18.18%) are the most common locations for these tumours. In these cases, 14 chondrosarcomas, 8 osteosarcomas, and 3 Ewing’s sarcomas were diagnosed. Mean follow-up time was 48.9 months with a range of 16 to 197 months. There were 16 surgeries performed with wide or compartmental margins, while in the 5 remaining cases, amputations were performed, and one case of Ewing’s sarcoma of the pelvis was treated by means of chemotherapy and radiation therapy, as it was considered non-resectable. All cases of osteosarcoma and Ewing’s sarcoma were treated by means of pre- and postoperative chemotherapy and postoperative radiation therapy.

Results: The postoperative duration of symptoms ranged from 2 weeks to 6 years with a mean of 6 months. Local recurrence following surgery with wide or compartmental margens occurred in 8 cases, representing 35.45% (3 chondrosarcomas, 4 osteosarcomas, and 1 Ewing’s sarcoma). The total number of cases surviving without recurrence is 14 (63.6%), surviving cases with one or more recurrences is 5 (22.72%), one case is alive with metastasis (4.59%), and 3 sarcomas (2 ulcerated upon admission) had disseminated and the patients died (10.05%).

Discussion and Conclusions: All these tumours were high-grade sarcomas. The most common metastatic localizations were lungs, regional ganglia, and skeleton. The recommended treatment is surgery with wide or compartmental margins, if possible in the early stages, in conjunction with chemotherapy and radiation therapy. The worst prognosis corresponds to the osteosarcoma.