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Abstract Objectives: To assess patient and tumor characteristics and treatment outcomes, focusing on local recurrence rates based on treatment type. Methods: This is a retrospective review of cases of GCTB of the distal radius, identified from the databases of 74 patients in Brazilian institutions specializing in musculoskeletal tumor treatment. Data were collected from electronic and paper medical records by 18 centers between 1989 and 2021. Variables included demographic data, clinical presentation, treatment-related factors, and primary outcome (local recurrence rate). Results: Among the 74 patients in the study, the mean age at diagnosis was 32.6 years, with a slight female predominance. Pathological fractures on presentation were observed in 15.7% of patients, and pulmonary metastasis in 1.4%. Treatment approaches were divided equally between intralesional curettage and en bloc resection. The overall local recurrence rate was 25.7% and was higher in patients treated with intralesional curettage (35.1%) compared to resection (16.2%). Conclusions: The study confirms high recurrence risk with intralesional curettage, emphasizing the need for standardized protocols and improved surgical techniques to reduce recurrence rates and enhance outcomes for distal radius GCTB patients. Level of Evidence III; Retrospective Cohort Study.

ABSTRACT Objectives: to identify oncological-orthopedic studies published in Acta Ortopédica Brasileira over three decades; to classify them according to the type and level of evidence (LE); to observe the inter-rater agreement in the classification of studies; to analyze the studies retrospectively, according to levels of evidence; and to outline the evolution of the evidence in the study period. Methods: Descriptive analyses were performed with absolute and relative frequencies of studies published between 1993 and 2022. Inter-rater agreement was analyzed by percentage of agreement and Kappa statistic (95%CI). The interpretation of the magnitude of the agreement was performed according to Landis & Koch. The association between classifications and publication period was analyzed using Fisher’s exact test. The analyses were performed using the R program (significance of 5%). Results: 69/1349 papers were selected; there was a significant association between type of study, statistical methodology, and LE with publication period (p < 0.05); inter-rater agreement regarding LE was 92.8%. Conclusions: Oncological-orthopedic studies accounted for 5.1% of all published papers. Regarding the LE, 80% were NE IV and V studies, despite the evolution observed between the first and last decade (decrease in LE V studies and increase in LE II, III and IV). Level of Evidence III, Retrospective Comparative Study.

ABSTRACT Introduction: Giant cell tumor of bone (GCTB) mainly affects young adults’ long bone epiphyses, threatening bone strength and joint function. Surgery is the primary treatment, although post-surgery recurrence is significant. This study analyzes patient profiles, treatments, and outcomes for GCTB in Brazil. Methods: We retrospectively assessed local recurrence, metastasis, and treatment approaches in 643 GCTB patients across 16 Brazilian centers (1989-2021), considering regional differences. Results: 5.1% (n=33) developed pulmonary metastases, 14.3% (n=92) had pathological fractures, and the local recurrence rate was 18.2% (n=114). Higher rates of pulmonary metastases (12.1%) and advanced tumors (Campanacci III, 88.9%) were noted in lower-income North and Northeast regions. The North also had more pathological fractures (33.3%), extensive resections (61.1%), and amputations (27.8%). These regions faced longer surgical delays (36-39 days) than the South and Southeast (27-33 days). Conclusions: Our findings corroborate international data, underscoring regional disparities in Brazil that may lead to worse outcomes in disadvantaged areas. This highlights the need for improved orthopedic oncology care in Brazil’s economically and structurally challenged regions. Level of Evidence III; Retrospective Cohort.

Abstract The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.

Abstract Multiple myeloma (MM) is a hematological malignancy characterized by unregulated and clonal proliferation of plasma cells in the bone marrow; these cells produce and secrete an anomalous monoclonal immunoglobulin, or a fragment of this, called M protein. The clinical manifestations of MM result from the proliferation of these plasmocytes, the excessive production of monoclonal immunoglobulin and the suppression of normal humoral immunity, leading to hypercalcemia, bone destruction, renal failure, suppression of hematopoiesis and humoral immunity, increasing the risk for the development of infections. The increase in life expectancy of the world population led to a concomitant increase in the prevalence of MM, a pathology that usually affects the elderly population. The aim of this review is to update the reader on epidemiology, diagnostic criteria, differential diagnosis with other monoclonal gam-mopathies, systemic treatment and prognosis of MM.

Abstract The increase in life expectancy of the world population has led to a concomitant increase in the prevalence of multiple myeloma (MM), a disease that usually affects the elderly population. Bone lesions are frequent in patients with this condition, demanding an early approach, from drug treatment, through radiotherapy to orthopedic surgery (prophylactic or therapeutic) with the objective of preventing or delaying the occurrence of fracture, or, when this event has already occurred, treat it through stabilization or replacement (lesions located in the appendicular skeleton) and/or promote stabilization and spinal cord decompression (lesions located in the axial skeleton), providing rapid pain relief, return to ambulation and resocialization, returning quality of life to patients. The aim of this review isto update the reader on the findings of pathophysiology, clinical, laboratory and imaging, differential diagnosis and therapeutic approach of multiple myeloma multiple myeloma bone disease (MMBD).

ABSTRACT Objectives: Describe the frequency and types of outcomes in randomized clinical trials (RCT) of intervention for distal radius fractures, analyze how confusing outcome presentations can lead to misinterpretations, and suggest strategies to improve the reader's understanding of the decision-making process. Methods: A retrospective study was conducted through a systematized search on the PubMed® database in the last 10 years, in which only intervention RCT was included for distal radius fractures, and outcomes were analyzed. Results: Of the primary outcomes analyzed in the 75 selected articles, 46.6% were classified as clinical outcomes, 20% as surrogate, 30.6% as composite, 1.3% as complex scales, and 1.3% as safety outcomes. 34.7% of the articles did not report adverse events. Conclusion: The presentation of outcomes with little clinical relevance represented more than half of the sample (53.4%) - such studies can harm the reader since they confuse the interpretation of scientific evidence; the Core Outcome Measures in Effectiveness Trials (COMET) initiative could help health professionals in understanding and selecting the most appropriate therapeutic interventions for patients. Level of Evidence III; Retrospective comparative study .

ABSTRACT Objectives: To describe the regional distribution of hospital admission authorizations (HAA), hospitalization costs (HC), the average length of stay (LOS), and mortality rates (MR) related to primary total hip arthroplasties (THA) funded by the Brazilian Health Unic System (SUS) from 2012 to 2021. Methods: Descriptive cross-sectional study using secondary data of public domain obtained from the Department of Informatics of SUS (DATASUS) database website. Results: A total of 125,463 HAA were released with HC of 552,218,181.04 BRL in the evaluated period. The average LOS was of 6.8 days. MR was 1.62%. Conclusion: The regional distribution of HAA was 65,756 (52%) in the Southeast; 33,837 (27%) in the South; 14,882 (12%) in the Northeast; 9,364 (8%) in Midwest; and 1,624 (1%) in North - in 2020 there was a sharp decrease of the released HAA, probably due to the COVID-19 pandemic. HC was 293,474,673.20 BRL in the Southeast; 144,794,843.11 BRL in the South; 61,751,644.36 BRL in the Northeast; 45,724,353.80 BRL in the Midwest; and 6,472,666.57 BRL in the North. The average LOS was 6.7 in the Southeast; 5.3 in the South; 9.2 in the Northeast; 7.6 in the Midwest; and, 13.6 in the North. MR was as follows: Southeast=1.88%; South=1.07%; Northeast=1.83%; Midwest=1.44%; and North=1.47%. Evidence Level III; Retrospective Comparative Study .

Abstract Bone and soft tissue sarcomas consist of a heterogeneous group of malignant tumors of mesenchymal origin that can affect patients from any age. The precise staging of these lesions determines the best therapeutic strategies and prognosis estimates. Two staging systems are the most frequently used: the system proposed by the University of Florida group, led by Dr. William F. Enneking (1980) and adopted by the Musculoskeletal Tumor Society (MSTS), and the system developed by the American Joint Committee on Cancer (AJCC) (1977), currently in its 8th edition (2017). This paper updates the reader on the staging of bone and soft tissue sarcomas affecting the musculoskeletal system.

OBJETIVO: Avaliação funcional e oncológica do tratamento do TCG do segmento distal do rádio (estadio B3) mediante ressecção ampla e reconstrução com enxerto autólogo avascular da extremidade proximal da fíbula. MÉTODOS: A função residual foi avaliada mediante escore ISOLS, medida do arco residual global do punho operado, do percentual residual da força de preensão da mão e da preensão entre o polegar e o indicador. O controle oncológico foi avaliado mediante exame clínico do membro operado e avaliação por imagens do punho e do tórax. RESULTADOS: 17 pacientes avaliados, dez do sexo feminino (58,8%) e sete do sexo masculino (41,2%) com idades entre 16 e 61 anos (média de 32,3 anos), todos destros. Na avaliação funcional (ISOLS) observamos 11 resultados excelentes, dois bons e um ruim; os três casos que demandaram artrodese evoluíram com escore excelente. O arco residual global foi de 196,2 ± 116,6º. O arco residual do punho operada correspondeu a 58,9% do controle. A força de preensão da mão correspondeu a 55,4 ± 17,4% do controle. O percentual de "pinça" foi de 80,6 ± 14,8% do controle. Não constatamos recidiva ou metástases nesta casuística. CONCLUSÃO: A técnica propiciou resultados funcionais alentadores, assegurando o retorno dos pacientes às suas atividades. A ausência de recidiva local e/ou metástases, observada inclusive nos pacientes com seguimento mais longo, permite sugerir que a técnica parece ser segura no controle oncológico do tumor.OBJECTIVE: To functionally and oncologically assess the treatment of GCT on radius distal end (stage B3) following wide resection and reconstruction with avascular autologous graft from proximal fibular end. METHODS: The residual function was assessed using ISOLS score, measurement of the global residual arch of the operated wrist, residual percentage of the hand apprehension strength between thumb and index fingers. The oncologic monitoring was assessed by clinical examination of the operated limb and by imaging tests of the wrist and thorax. RESULTS: 17 patients were assessed: 10 females (58.8%) and seven males (41.2%), with aged ranging from 16 to 61 years (mean: 32.3 years), all of them right-handed. On the functional assessment (ISOLS), the results were as follows: 11 excellent, two good, and one poor. The three cases requiring arthrodesis evolved with excellent scores. The global residual arch was 196.2 ± 116.6º. The residual arch of the operated wrist corresponded to 58.9% of the control. The "pinch" percentage was 80.6 ± 14.8 % of control. We did not find recurrences or metastasis in this case series. CONCLUSION: This technique provided encouraging functional results, assuring patients' return to their usual activities. The absence of local recurrence and/or metastasis found even in the patients with longer follow-up times allow us to suggest this technique, which seems to be safe for oncologic control of the tumor.

Os autores avaliam os resultados de 35 procedimentos de descompressão cirúrgica do nervo ulnar realizados em 28 pacientes hansênicos. Os parâmetros utilizados incluíram a escala analógica visual, a escala comportamental, a avaliação da força muscular, a estesiometria e a avaliação do efeito do procedimento no que tange à diminuição da corticoterapia no pós-operatório. Observou-se resolução imediata da dor após a realização da cirurgia, melhora da força muscular em metade dos pacientes, melhora da sensibilidade em metade dos pacientes. A diminuição da dosagem da prednisona após a cirurgia foi constante e significativa após a operação.In this study, the authors assess the results of 35 surgical ulnar nerve decompression procedures performed on 28 leprous patients. The parameters employed included the visual analogue scale, the behavioral scale, the muscle strength evaluation, the esthesiometry and the evaluation of the effect of the procedure on decreasing postoperative corticoid therapy doses. Early resolution of pain was seen after surgery, muscle strength increased in half of the patients, sensitivity increased in half of the patients, with ongoing and significant decrease of prednisone doses after surgery.