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Copp J, Magister S, Napora J, Getty P, Sontich J. Dual Magnetically Expandable Intramedullary Nails for Treatment of a Large Bony Defect in a Patient with Sarcoma: A Case Report. Strategies Trauma Limb Reconstr 2022; 17:189-194. [PMID: 36756295 PMCID: PMC9886027 DOI: 10.5005/jp-journals-10080-1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/16/2022] [Indexed: 01/01/2023] Open
Abstract
Aim To describe the surgical technique of performing an all-internal lengthening to address a large diaphyseal femur defect in the sarcoma patient. Background Various strategies exist to address large intercalary bone defects with various biomechanical and biological implications. Case description A 23-year-old female with high-grade osteosarcoma of her left femur underwent wide resection and an internal reconstruction of a 12.5-cm femoral defect using dual magnetic lengthening intramedullary nails resulting in restoration of leg lengths, and pre-resection function with minimal residual disability. Conclusion Preoperative chemotherapy, wide resection and post-operative chemotherapy for osteosarcoma are the current standard of care. Resection often leads to large bone defects requiring complex reconstruction. Following intercalary bone resection, biological reconstruction is a consideration. An all-inside technique was developed in an effort to minimise complications of long-term external fixation for distraction osteogenesis, or extensile secondary grafting procedures for induced membrane strategy. Clinical significance This previously unreported surgical technique allows for an all-internal lengthening of large diaphyseal bone defects. While specifically used in an oncologic post-resection setting, this technique is applicable to the broader limb reconstruction and lengthening practice and overcomes some inherent limitations to previously described techniques. How to cite this article Copp J, Magister S, Napora J, et al. Dual Magnetically Expandable Intramedullary Nails for Treatment of a Large Bony Defect in a Patient with Sarcoma: A Case Report. Strategies Trauma Limb Reconstr 2022;17(3):189-194.
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Affiliation(s)
- Jonathan Copp
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - Steven Magister
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - Joshua Napora
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - Patrick Getty
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
| | - John Sontich
- Department of Orthopaedics, University Hospitals, Cleveland, Ohio, United States of America
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Abboud S, Bhatt A, Pateva I, Saab S, Hameed M, Healey J, Getty P. Multidisciplinary, articular surface-preserving treatment strategy for locally aggressive epithelioid hemangioma of the acetabulum employing serial bland transarterial embolization. Skeletal Radiol 2022; 51:1493-1498. [PMID: 35001142 DOI: 10.1007/s00256-021-03977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 02/02/2023]
Abstract
Epithelioid hemangioma is a rare, histologically benign but locally aggressive primary vascular neoplasm that can rarely arise in bone. Mainstay treatment is surgical resection or curettage with bone grafting. We report a novel multidisciplinary, joint-sparing treatment approach for an epithelioid hemangioma of bone arising in the acetabulum causing severe thinning of the subchondral bone plate. After 4 sessions of transarterial bland particle and ethanol embolization, the resultant increased ossification of the tumor allowed preservation of the articular surface during surgical resection. Imaging follow-up 14 months after surgical resection showed no evidence of recurrence and continued ossification of the portions of the lesion treated only with embolization.
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Affiliation(s)
- Salim Abboud
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Aashish Bhatt
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Irina Pateva
- Division of Pediatric Hematology and Oncology, University Hospitals Rainbow Babies and Children's, Cleveland, OH, USA
| | - Shahrazad Saab
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Healey
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patrick Getty
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Mengers SRP, Knapik DM, Strony J, Nelson G, Faxon E, Renko N, Getty P, Gillespie R. The Use of Tumor Prostheses for Primary or Revision Reverse Total Shoulder Arthroplasty With Proximal Humeral Bone Loss. J Shoulder Elb Arthroplast 2022; 6:24715492211063108. [PMID: 35669621 PMCID: PMC9163720 DOI: 10.1177/24715492211063108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/23/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background During shoulder arthroplasty with substantial bone and soft tissue loss, reverse shoulder arthroplasty (RSA) with a tumor prosthesis may restore function, reduce pain, and improve implant fixation. Methods Thirteen adult patients undergoing RSA using a tumor prosthesis system were retrospectively reviewed. Preoperative visual analog score (VAS), single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), and forward flexion were compared to latest follow up. Postoperative radiographs and complications were recorded. Results Mean age at surgery was 68.4 years. Eight patients had undergone at least 1 prior operation on the indicated shoulder. Six patients required wide excision of proximal humerus tumor. At mean of 34 months postoperatively, significant improvements were noted in VAS (P = .03) and ASES score (P = .04). Active forward elevation was 81.1 degrees. For all patients, postoperative radiographs demonstrated satisfactory alignment. Complications occurred in 38% of patients, with 31% requiring reoperation. Conclusion In cases of failed shoulder arthroplasty with excessive bone and soft tissue loss or substantial tumor burden, RSA with a tumor prosthesis can reduce pain levels and improve functional outcomes. However, forward elevation remains limited, and postoperative complications are a concern.
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Affiliation(s)
- Sunita RP Mengers
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Derrick M Knapik
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - John Strony
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Grant Nelson
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Evan Faxon
- The College of Wooster, Wooster, OH, USA
| | - Nellie Renko
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | - Patrick Getty
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gillespie
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Sports Medicine Institute, Cleveland, OH, USA
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Abboud S, Kosaraju V, Bhatt A, Egler R, Elliott R, Faraji N, Mangla A, Mansur D, Rothermel L, Saab S, Young P, Getty P, Kosmas C. Multidisciplinary approach for repeat musculoskeletal lesion biopsy after nondiagnostic initial sampling: A 10-year single-center experience. J Surg Oncol 2020; 123:342-351. [PMID: 33051865 DOI: 10.1002/jso.26255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Success rates for initial image-guided biopsy of musculoskeletal (MSK) lesions have been well documented; evidence regarding success rates for repeat biopsy following initially nondiagnostic (ND) image-guided biopsy of MSK lesions is more limited. This study evaluates the outcomes of repeat computerized tomography-guided MSK biopsies following ND biopsies using a multidisciplinary approach. MATERIALS AND METHODS Electronic medical record search covering a 10-year period identified patients that received two or more biopsies for an MSK tumor or tumor-like process. The decision for initial and repeat image-guided biopsy of each lesion was made following multidisciplinary MSK tumor board review. Lesion location, histopathology results, size of biopsy needle when available, and change in technique between biopsy attempts was documented. RESULTS Repeat biopsy rate was 1.6%. 23 patients with repeat MSK biopsy were identified. A total of 17 of 23 (74%) repeat biopsy attempts were diagnostic. A total of 22 of 23 (96%) repeat biopsy attempts were clinically useful. Diagnostic repeat biopsies were described as employing one or more of five technical differences compared to the first biopsy attempt, the most common being improved targeting of the lesion itself. CONCLUSIONS A multidisciplinary approach may yield improved repeat-biopsy rates and clinical utility of repeat MSK biopsies compared to prior reports.
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Affiliation(s)
- Salim Abboud
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Vijaya Kosaraju
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Aashish Bhatt
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rachel Egler
- Division of Pediatric Hematology and Oncology, University Hospitals Rainbow Babies and Children's, Cleveland, Ohio, USA
| | - Robin Elliott
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Navid Faraji
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ankit Mangla
- Department of Medical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - David Mansur
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke Rothermel
- Department of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shahrazad Saab
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Peter Young
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Patrick Getty
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christos Kosmas
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Affiliation(s)
- Mark R. Robbin
- />Division of Musculoskeletal Imaging, Department of Diagnostic Radiology, University Hospitals Case Medical Center, Cleveland, OH USA
| | - Peter G. Pavlidakey
- />Department of Pathology and Laboratory Medicine, University Hospitals Case Medical Center, Cleveland, OH USA
| | - Patrick Getty
- />Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH USA
| | - Hooman Yarmohammadi
- />Interventional Radiology Center, Johns Hopkins Medical Institute, Baltimore, MD USA , />Interventional Radiology Center, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans Street, Baltimore, MD 21287 USA
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Canacci AM, Nunez C, Getty P, Abdul-Karim F. Diagnosis of malignant granular cell tumor metastatic to bone by fine needle aspiration cytology: a case report. Acta Cytol 2010; 54:190-2. [PMID: 20391977 DOI: 10.1159/000325007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malignant granular cell tumor (GCT) is a rare sarcoma that is often difficult to differentiate histologically from its benign counterpart. CASE A 69-year-old Caucasian man with a long history of multiple GCTs presented with new-onset left shoulder pain and limitation of movement. Radiographic studies revealed a lytic lesion within the left humeral metaphysis and a pathologic fracture. Computed tomography-guided fine needle aspiration and needle core biopsies were performed. The patient subse quently underwent curettage of the tumor with prophylactic fixation of the left proximal humerus. He received postsurgical radiation and physical therapy. CONCLUSION The diagnosis of metastatic malignant GCT was rendered in this case. The fne needle aspiration ofmetastatic GCT may lack cytologic features of malignancy. The diagnosis necessitates clinical correlation and an understanding of the spectrum of histopathologic changes in GCT and malignant
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Affiliation(s)
- Anastasia M Canacci
- Department of Pathology, University Hospitals Case Medical Center Cleveland, Ohio 44106, USA
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Abstract
UNLABELLED Intraoperative electron radiotherapy is used to treat surgical sites that potentially harbor occult tumor immediately after limb-sparing surgical resection of extremity soft tissue sarcomas. It is unknown whether single-fraction, high-dose intraoperative electron radiotherapy at the time of surgery increases wound morbidity when combined with preoperative or postoperative external beam radiotherapy. In a retrospective study, we evaluated whether intraoperative electron radiotherapy increased 90-day and late (> 90 days) wound complication rates by comparing patients who had adult extremity soft tissue sarcomas treated by limb-sparing surgery and preoperative (n = 14) or postoperative (n = 13) external beam radiotherapy. The median followup was 36 months. Seven (26%) patients had wound complications occurring within 90 days postoperatively and completion of radiotherapy. Late wound complication rates were similar. Two patients in each of the external beam radiotherapy groups required late subtotal limb amputations for prolonged wound complications. Our findings suggest intraoperative electron radiotherapy during limb-sparing surgery allows radiation dose escalation without increased 90-day or late-wound complication rates when combined with preoperative or postoperative external beam radiotherapy for patients with extremity soft tissue sarcomas. LEVEL OF EVIDENCE Prognostic Study, Level II (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charles Kunos
- Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, OH 44106-5000, USA.
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Abstract
Two relatively simple procedures and can improve thumb function in leprosy (Hansen's disease): one provides opposition for the thumb by an indicis proprius transfer; the other provides grasp for the hand lacking digits by phalangizing the first metacarpal.
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