Plain radiologic findings and chronological changes of incipient phase osteosarcoma overlooked by primary physicians

Defining Growing Pains: A Scoping Review

BACKGROUND AND OBJECTIVES

Up to one third of children may be diagnosed with growing pains, but considerable uncertainty surrounds how to make this diagnosis. The objective of this study was to detail the definitions of growing pains in the medical literature.

METHODS

Scoping review with 8 electronic databases and 6 diagnostic classification systems searched from their inception to January 2021. The study selection included peer-reviewed articles or theses referring to "growing pain(s)" or "growth pain(s)" in relation to children or adolescents. Data extraction was performed independently by 2 reviewers.

RESULTS

We included 145 studies and 2 diagnostic systems (ICD-10 and SNOMED). Definition characteristics were grouped into 8 categories: pain location, age of onset, pain pattern, pain trajectory, pain types and risk factors, relationship to activity, severity and functional impact, and physical examination and investigations. There was extremely poor consensus between studies as to the basis for a diagnosis of growing pains. The most consistent component was lower limb pain, which was mentioned in 50% of sources. Pain in the evening or night (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components to be mentioned in more than 30% of articles. Notably, more than 80% of studies made no reference to age of onset in their definition, and 93% did not refer to growth. Limitations of this study are that the included studies were not specifically designed to define growing pains.

CONCLUSIONS

There is no clarity in the medical research literature regarding what defines growing pain. Clinicians should be wary of relying on the diagnosis to direct treatment decisions.

Genesis and Symptom Interval of Osteosarcoma Following High-Energy Trauma

We report three cases of femoral fracture, which subsequently developed osteosarcoma within the course of illness. The first patient presented with a spiral fracture treated with an interlocking femoral nail. He presented five months later with a painful knee swelling and was diagnosed with osteosarcoma. He was asymptomatic despite initial radiographs showed osteolysis at the distal metaphysis. The fracture united well and no evidence of marrow or soft tissue contamination. The second patient had a distal femoral fracture and underwent plate stabilization. Osteosarcoma developed at the united fracture site three years later. Both survived six to seven years without evidence of disease following the standard treatment protocol. The third patient had a closed distal third fracture treated with dynamic compression plating. He presented with an osteoblastic lesion in the proximal femur three years later. There was no initial radiological evidence of osteosarcoma one year before the clinical manifestation of the disease.

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.

Persistent Shoulder Pain in Young Male: Osteosarcoma

A 16-year-old Malay boy presented to Kota Bharu Health Care Centre, Kelantan, with left shoulder pain after sustaining a fall. On further history taking, it was noted that the pain preceded the fall by 1 month. The early changes of osteosarcoma were visible on an X-ray during the initial presentation; however, this was missed by the primary care doctors. Three months later, the patient presented with persistent pain in the left shoulder and was diagnosed with osteosarcoma.

Osteosarcoma: Accurately diagnosing this bone-chilling disease

Osteosarcoma is the most common primary bone malignancy in children and adolescents. Because the incidence of osteosarcoma is low and the disease occurs in physically active patients, it may be misdiagnosed as a more benign condition, thus leading to late diagnosis. This article describes the disease's most frequent presenting complaints and initial radiographic findings, as well as its risk factors and common misdiagnoses. Clinicians should consider osteosarcoma in young patients with persistent bone pain, especially pain with weight-bearing.