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Although osteosarcoma is the most common primary malignancy of bone, it has only been reported to arise from the patella in a handful of cases. Telangiectatic osteosarcoma accounts for <5% of all osteosarcomas, and it is distinguished histologically by spaces, often blood filled, separated by septa containing highly malignant cells and radiographically by a predominately lytic and/or expansile component. Telangiectatic osteosarcoma can be radiologically confused with aneurysmal bone cyst or giant cell tumor. A 22-year-old otherwise healthy man presented with increasing pain, swelling, and limited flexion of the right knee after failing physical therapy for anterior knee pain. Standard anteroposterior and lateral radiographs demonstrated a diffuse destructive process involving the majority of the patella (including loss of the inferior patellar cortex) and a lytic lesion of the proximal tibia. Apparent osteoid matrix was visible in the soft tissue extension along the inferior pole of the patella. A computed tomography scan of the chest showed 2 pulmonary nodules consistent with metastatic disease. Evaluation of core needle biopsy showed osteosarcoma with telangiectatic features. Given that the majority of the tumor involved the patella/extensor mechanism, it was clear that the tumor originated in the patella. This case presents the first published report of a telangiectatic osteosarcoma arising from the patella. Full article available online at OrthoSuperSite.com/view.asp?rID=29623 [ABSTRACT FROM AUTHOR]

Radiolucent implants offer theoretical advantages of increased ability to evaluate the fracture site for healing and recurrence and potentially less effect on radiation treatment, avoiding scatter. Their clinical utility and outcomes have yet to be proven in a well-designed randomized trial or large cohort study, although studies based on other indications have shown relative safety and they are approved by the US Food and Drug Administration for treatment of pathologic fractures. Further research is necessary to better understand when and how these implants should be implemented in practice. [ Orthopedics . 2022;45(3):e115-e121.].

Glomus tumors are small, benign tumors that arise from glomus bodies, structures found normally within the dermis that assist in temperature regulation via their vasoconstrictive response to sympathetic stimuli. Glomus tumors are found typically in the hand and are classically a cause of focal pain and temperature sensitivity. They often present as a small blue lesion seen under the nail bed of a finger or a toe and cause point tenderness. Glomus tumors of peripheral nerves are exceedingly rare and can lead to disability akin to compressive neuropathy when present. This case report explores the unusual presentation of a rare and large glomus tumor of the sciatic nerve. The patient presented with symptoms such as those mentioned above and was assumed to have sciatica emanating from spinal and neuroforaminal stenosis. Although she repeatedly and appropriately sought medical attention for her condition, she was improperly diagnosed and ultimately experienced a significant deterioration of her function, eventually undergoing an unnecessary surgical procedure. On referral to the authors' institution, the patient was evaluated and found to have a glomus tumor involving the sciatic nerve. This is the largest glomus tumor of a peripheral nerve that has been reported to date. Although the patient's presentation was insidious and her diagnosis was uncommon, this underscores the importance of developing a differential diagnosis based primarily on a thorough physical examination and, only then, correlating imaging to clinical findings. Additionally, given the atypical presentation and intractable course of this patient's condition, the examiner must consider neoplastic entities and space-occupying lesions as part of the differential diagnosis. [Orthopedics. 2018; 41(1):e151-e153.]., (Copyright 2017, SLACK Incorporated.)

Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of such implants is restricted by the amount of bone available for stem fixation adjacent to the defect. This study aimed to determine whether short osseous segment fixation with acceptable outcomes and complication rate can be reliably achieved with a customized intercalary endoprosthesis following extended diaphysectomy. A retrospective review of prospectively collected data was performed on 6 patients receiving customized anchor plugs for short segment fixation with a double compressive osseointegration intercalary implant to reconstruct segmental defects. Five of the implants were augmented with cement to support fixation in metaphyseal bone. Patient age at surgery ranged from 12 to 86 years. At mean follow-up of 39 months, mean Musculoskeletal Tumor Society functional score was 26.3, with 5 of 6 patients achieving scores of 27 or greater. Stable fixation was achieved in all patients, with the shortest segment of bone 3.7 cm in length. Three mechanical implant failures requiring revision surgery occurred. No patient required revision of the entire implant, secondary adjacent joint replacement, or secondary amputation. No patient exhibited aseptic loosening, and no case was complicated by infection. Excellent functional outcomes were seen with follow-up out to 9 years. This suggests that cement-augmented double compressive osseointegration intercalary endoprosthetic reconstruction can extend the benefits of intercalary replacement to many patients who otherwise might require adjacent joint or physeal sacrifice. However, patients should be counseled on the high risk of implant failure with subsequent need for revision surgery. [Orthopedics. 2017; 40(6):e964-e970.]., (Copyright 2017, SLACK Incorporated.)