Volumen 1 (2018): Edición 1 (June 2018)

Ankle fracture is one of the most common fractures in adults and among pregnant women. In pregnancy, the treatment must be prompt because of the risks and complications that could involve both mother and fetus. In this article, we reported the management of a patient with a bimalleolar fracture in pregnancy, its treatment, and evolution.

Introduction. Chondrosarcoma is a malignant tumor of cartilaginous origin representing approximately 20-30% of all bone malignant tumors and occupying the second place in terms of their incidence. It usually affects adults between 40 and 60 years old, but can be encountered at older ages as well.

Materials and methods. We report the case of a 55-year-old male patient who presented to our department with 2 weeks-long right hip pain and partial loss of functionality in right limb. We performed X-rays, magnetic resonance imaging, computed tomography, bone scintigraphy, and angiography, which established the diagnosis of pelvic tumor. Biopsy of the tumor was performed by iliofemoral approach and its result showed moderately differentiated chondrosarcoma. Orthopaedic surgery was performed, with tumoral removal within oncological limits, pelvic reconstruction using acrylic bone cement impregnated with Vancomycin and total hip arthroplasty.

Results were assessed using the Musculoskeletal Tumor Rating Scale and a score of 23 out of 35 was obtained (the higher the better). Postoperative complications consisted in flap-skin necrosis that resolved within 2 months after surgery.

Conclusion. Bone defects repair using antibiotic impregnated cement drastically reduced the rate of postoperative infections, thus decreasing both morbidity and mortality. In spite of technological advancement, long-term prognosis remains reserved in chondrosarcoma, due to its specific aggressivity, resistance to chemo- and radiotherapy and high rate of recurrence.

Diffuse large B cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphomas, which has shown an increasing incidence in the past decades. 7% of primary bone tumors consist of non-Hodgkin lymphomas. The etiology of this type of lymphoma is still unclear. Our aim was to study the latest research papers; to highlight the importance of cooperation between different medical specialty departments, in rare cases like NHL as PBT with associated HBV infection.

Case report: We present the case of a 39-year-old male patient, who presented to the orthopedic department of the University Emergency Hospital of Bucharest, with moderate pain, swelling, and a palpable mass of the right lower limb.

Management and Outcome: The patient underwent several investigations, whose result was DLBCL and an associated HBV infection. Due to the aggressive form of DLBCL, chemotherapeutical treatment has to be initiated as soon as possible to prevent further growth of the tumor. An antiviral therapy had to be initiated to prevent the hepatic failure, which could appear after chemotherapy and in the acute phase of viral infection.

Discussion: Our case raised the question regarding what kind of relationship could be identified between the HBV infection and NHL, and how this condition influenced the outcome of the treatment.

One of the most common neoplasms in the world, ranking third, is the colorectal cancer. 96% of all cases of colorectal cancer are adenocarcinoma. The prognostic of this diagnostic is a bad one, with low 5-years survival rate. Although the most common locations for the metastases are the liver and the lungs, the bones can also be targeted (5.5%).

We present the case of a 65-year-old male who came to the hospital with pain and tumefaction at the right fibular head. After extensive clinical and paraclinical examinations, a biopsy was performed, at which stage the entire tumor was removed. The result was that of moderate differentiated adenocarcinoma. The patient was then further examined and a tumor was discovered at the sigmoid colon. The primary tumor was removed and the patient underwent oncological treatment. 2 years later, the patient returned with a recurrence of the bone metastasis. After a PET-CT that infirmed other metastases coupled with a satisfactory evolution of the primary tumor, the decision was made to amputate the knee above. Biopsy is an essential step that establishes the correct diagnostic and dictates the right choice of treatment solution. Counseling is also essential, so that the patient can choose and accept the best treatment option.

Pleomorphic sarcomas or spindle cell sarcomas of the bone are rare malignant tumors that affect the adult. Fracture in the affected bone is the most frequent first symptom. Multimodal treatment is similar to the one for osteosarcoma, but the benefit is less evidence-based, due to the rarity of this sarcoma subtype. The present paper is a case report of a 73-year-old patient, who presented with a comminuted fracture of the distal third of the femur after a fall on ice. Differential diagnosis of bone metastasis was made. After the histopathological confirmation, the surgical team decided to amputate, with prior patient consent. The tumor was staged pT1NxMx, R0. Immunohistochemical studies confirmed the histopathological diagnosis. A lytic lesion in the stump bone appeared on post-operative MRI and was interpreted as skip metastasis. No other metastatic sites were detected. The multidisciplinary team decided for adjuvant chemotherapy (3 courses) and then radiotherapy. He was unable to receive the total planned dose of radiotherapy due to local toxicity. Even so, he is free of recurrence on long-term follow-up.

Myxofibrosarcoma or myxoid malignant fibrous histiocytoma is one of the most common sarcomas of the limb. It is usually treated multimodally. Most frequent sites of metastasis are the bone, lung and lymph nodes. The present paper is a case report of a 65-year-old male with myxofibrosarcoma of the fibularis longus muscle, for which he first underwent surgery - tumor resection with appropriate margins. The tumor was staged pT2b cN0 cM0. Postoperative PET-CT revealed metabolically inactive pulmonary nodules. Two months after surgery, he underwent adjuvant radiotherapy, a total dose of 60 Gy and 6 courses of chemotherapy (doxorubicin and ifosfamide). Pulmonary nodules have been stationary on all subsequent imagistic studies. He is free of recurrence on long-term follow-up.

Increasing interest in using minimally invasive approaches in TKA has led to the question: how much deformity is accepted for using MIS in TKA? A single surgeon performed 87 consecutive TKAs with mini-subvastus approach, using unconstrained prosthesis in 84 knees and constrained prosthesis in 3 knees. We conducted a prospective study in which patients were divided into two groups according to preoperative tibiofemoral axes (TFM), one group with 160°<TFM<195° and the second group with 160°≥TFM≥195°. Clinical and radiographic outcomes were compared. Postoperative ROM and knee score were improved in both groups, with similar results (p<0.01). Postoperative radiographic analyses showed that TFM was improved in both groups (p<0.01) with the coronal alignment inferior in 160°≥TFM≥195° group than the 160°<TFM<195° group. The results of this study suggest that mini-subvastus approach is a proper technique to use in primary TKA in patients with a TFM angle less than 160° and more than 195° with similar results with TFM angle between 160° and 195°, and for the use of constrained prosthesis designs with promising results. Preoperative TFM angle less than 160° and greater than 195° increases the risk of component malposition in coronal plane.

With the growth of the aging population worldwide, osteoporosis represents a serious health problem, which implies higher morbidity and costs, despite the continuous advances in treatment options. It involves both sexes, although menopausal women are mainly affected. This article is a brief review of literature on current osteoporosis treatment options.

Pathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.

This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.

Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.

The aim of this paper was to review the existing described methods for measuring postoperative TKA alignment in sagittal and axial plane and to review the existing literature regarding the axial plane evaluation with the use of the computer tomography. The most frequent mistakes when positioning the total knee arthroplasty (TKA) components are done in the axial plane, so it is necessary to know what the limits of the radiographic evaluation are and, for this evaluation, the CT scan is the most valuable in assessing the rotation of the components.