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Outcomes for adults with soft tissue sarcoma are better when managed at referral centers. Care guidelines advise for 5 main criteria: 1-Imaging before biopsy; 2-Tumor biopsy before surgery; 3-Multidiscipinary team discussion (MTD) before biopsy; 4-Biopsy in "expert centers"; 5-Somatic molecular biology feasible. The aim is to describe and assess the prognostic impact of initial management of STS according to the type of referring centers and the number of optimal criteria.Monocentric retrospective analysis of the management of 127 youths (0-25 years) with localized STS treated from 2006 to 2015.Median age at diagnosis was 9.6 years (range: 025). Overall, only 41% patients had 5/5, 28% 3-4, 31% ≤2. No adequate imaging was performed before surgery/biopsy for 18% patients, no biopsy before treatment for 29%. Patients referred by "expert centers" had higher compliance to guidelines (P = 0.025). Upfront surgery was performed in 59/127 patients. Immediate re-operation was inversely related to the number of criteria (0% when 5 criteria vs. 14% for 3-4, 46% if ≤ 2; P 0.001). For malignant tumors, outcome was better when 5 criteria were reached: 5 year EFS 90.8% (81.4-100.0%) vs. 71.6 for (60.4-84.9%; ≤4 criteria; p = 0.033), OS 93.6% (85.5-100%) vs. 79.5% (68.9-91.8%; p = 0.11), and LRFFS 90.6% (81.0-100.0) vs. 73.1% (62.0-86.3%; p = 0.047).Less than half of the youths with STS are initially managed according to international guidelines, highlighting the need for better information about optimal management. These results plead for immediate management in reference centers to reduce initial burden of therapy.

Forearm deformities are often observed in patients with hereditary multiple osteochondroma, resulting in functional disability and cosmetic impairment. The aim of this study was to assess clinical and radiological outcomes after corrective osteotomy of the radius (COR). We performed a retrospective analysis of clinical and radiologic data from patients with forearm deformities who underwent COR combined with osteochondroma resection between 1978 and 2015. Seventeen patients (17 forearms) were included. The mean (range) age at surgery was 11.8 years (3.2-14.4), and the mean interval between surgery and last follow-up was 8.2 years (2-34.2). Range of motion was moderately increased and postoperative radiological assessments found significant improvements in ulnar variance, radial articular angle, bowing of the radius, and carpal slip. At last follow-up, a loss of ulnar variance correction was noted in 11 cases (mean loss: 4mm). The mean score on the Quick Disabilities of the Arm, Shoulder and Hand self-administered questionnaire was 13.9. Our results show that a forearm deformity in a patient with hereditary multiple osteochondroma is an appropriate indication for COR combined with osteochondroma resection and should be performed at the end of growth. This simple, safe technique corrects bowing of the radius and radius-ulna length discrepancy and could limit the risk of radial head dislocation. LEVEL OF EVIDENCE: IV.

Most of tumours of the foot are tumour-like (synovial cyst, foreign body reactions and epidermal inclusion cyst) or benign conditions (tenosynovial giant cells tumours, planta fibromatosis). Malignant tumours of the soft-tissue and skeleton are very rare in the foot and their diagnosis is often delayed with referral to specialised teams after initial inappropriate procedures or unplanned excisions. The adverse effect of these misdiagnosed tumours is the increasing rate of amputation or local recurrences in the involved patients. In every lump, imaging should be discussed before any local treatment. Every lesion which is not an obvious synovial cyst or plantar fibromatosis should have a biopsy performed. After the age of 40 years, chondrosarcoma is the most usual malignant tumour of the foot. In young patients bone tumours such as osteosarcoma or Ewing’s sarcoma, are very unusually located in the foot. Synovial sarcoma is the most frequent histological diagnosis in soft tissues. Epithelioid sarcoma or clear cell sarcoma, involve more frequently the foot and ankle than other sites. The classic local treatment of malignant conditions of the foot and ankle was below-knee amputation at different levels. Nowadays, with the development of adjuvant therapies, some patients may benefit from conservative surgery or partial amputation after multidisciplinary team discussions. The prognosis of foot malignancy is not different from that at other locations, except perhaps in chondrosarcoma, which seems to be less aggressive in the foot. The anatomy of the foot is very complex with many bony and soft tissue structures in a relatively small space making large resections and conservative treatments difficult to achieve. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160078. Originally published online at www.efortopenreviews.org

Timely vaccination after childhood cancer treatment is vital for protecting against vaccine-preventable diseases during survivorship. However, caregiver intention for restarting vaccinations, such as getting catch-up or booster vaccines, after cancer treatment is unknown. Methods: We surveyed primary caregivers ages 18 or older with a child who had completed cancer treatment in the prior 3–24 months (N = 129; participation rate = 60.3%). Participants were asked about demographics, their child's vaccination status, and healthcare factors (e.g., provider recommendations, barriers). We examined the influence of whether the oncology care team recommended catch-up or booster vaccines on caregiver intention to restart vaccines using multivariable generalized linear models. Vaccine barriers were examined by intention in chi- square tests. Results: Caregivers were primarily aged 30–49 years (82.0%), mothers (81.2%), college graduates (44.8%), married (89.1%), and Non-Hispanic (90.3%). In total, 67% of caregivers intended to restart vaccines for their child and 49.6% reported that they had a discussion with the cancer care team about catch-up or booster vaccines. Caregivers who discussed vaccines with their child's cancer care team were much more likely to report intention to restart vaccination (Relative Risk (RR) = 1.82, 95% CI 1.37–2.45). The most common barrier to restarting vaccines after cancer was not knowing which vaccines to get, which was common across both groups (intend to restart = 31% vs. did not intend = 40.5%, P = 0.29). Of caregivers, 93.1% who intended to restart vaccines felt vaccines were safe compared to 79.5% of those who did not (P = 0.02). Conclusions: Caregivers of childhood cancer survivors need guidance for restarting vaccinations after cancer treatment, including information on safety and which vaccines their child needs. Provider recommendations positively influence caregiver's intention to restart vaccines. Clinical guidelines are needed to support providers in making tailored vaccination recommendations after cancer treatment.

This study was concluded on paraplegic and tetraplegic patients of all aetiologies except neoplasic, where paralysis developed within 48 hours. All patients were admitted to the rehabilitation department within 90 days after the onset of paralysis. In a preliminary review of 328 files, there were 27 cases of clinical deep vein thrombosis (DVT) and 10 with pulmonary embolism (PE), 6 of which were fatal. A prospective study was conducted, based on systematic detection of asymptomatic DVT with phlebography. Among the 147 patients, 20 previously presented with DVT. The 127 others underwent phlebography which showed 39 DVT in 29 patients. Eighty seven patients with negative phlebography underwent a second study a month later which showed 14 DVT in 12 patients. Only one minor pulmonary embolism occurred in these 147 patients. The incidence of DVT after acute spinal cord injury and the frequent absence of clinical manifestations were confirmed. Prophylactic anticoagulant therapy is useful but insufficient. This study demonstrates that systematic and repeated detection of DVT by phlebography may reduce the incidence of PE.

A prototype 'telethesis', a telemanipulator for high level tetraplegic and similarly disabled persons, has been developed in the French Spartacus project. The system has a modular control structure, both in the choice of transducers and in the microprocessor programmes assuring the ergonomic link with the individual user. A special training procedure has been developed and tested both in the laboratory and in the hospital. Six tetraplegic patients have used the system in the laboratory and seven in hospital. The experience of 6 months of experimentation in the occupational therapy department with the seven patients is reported. The telethesis has been well accepted by four of them, two of whom have used it for prolonged periods of time. One case has not been adapted with great success prior to his departure, and in two others the use of the system has been rejected, largely for psychological reasons.

Pour thousand participants met at the World Rehabilitation Congress in Winnipeg (23rd – 27th, 6, 1980), 10% of them were severely handicapped persons with motor and sensory involvement and representing 101 countries.