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Background: The use of liquid nitrogen for management of the primary lesion in osteosarcoma, was first described in 1984. Surgical use of liquid nitrogen was first reported by Cooper 91 in 1962. Since then, many tumors have been treated locally with liquid nitrogen. Aim of the Work: The aim of this study is to review systematically studies to show if there is a difference between pedicle and free freezing in liquid nitrogen in reconstruction after long bone tumors in union and complication. Patients and Methods: Between 1999 and 2020 about 235 patient had limb salvage procedure by recycling of bone bearing tumor in liquid nitrogen out of them 205 patient included in this study were inclusion criteria are: Humans: male and female, age from 4 to 80 years, patients with malignant bone tumors either primary or secondary, different methods of fixation are included and minimal follow up of 12 months. Results: There are two techniques to recycle bone bearing tumor in liquid nitrogen ether FFP through en block resection of bone bearing tumor and to be recycled separately in liquid nitrogen then fixed in proximal and distal endes OR PFP through performing one side osteotomy maintaining the continuity of the bone with the body and emerge the bone bearing segment in liquid nitrogen and then fix the segment in it's position after completing the recycling. Conclusion: We searched to clarify differences between these two methods systematically regarding union time, functional scores, outcomes and complications as infection, graft failure, recurrence & skin necrosis. [ABSTRACT FROM AUTHOR]

Background: Metastatic tumors are the most common malignant lesion of the proximal femur, with carcinomas being the most frequent. The proximal femur and midfemur are common sites for primary bone sarcomas; approximately16% of Ewing’s sarcomas, 13% chondrosarcomas and 10% of osteosarcomas develop at these locations. The major aim in the management of patients who have bone malignancies is prolonging their survival. Primary bone sarcomas that require surgical resection can be treated by either amputation or limb salvage. Most studies which compared both approaches reported that limb salvage had no adverse effect on patients’ survival on long-term. Objective: This is a systematic review of literature with metaanalysis study that compare the functional outcomes and complications of the methods; proximal femoral hemi versus total arthroplasty after proximal femur resection followed by endoprosthetic reconstruction and provide recommendations by the best available evidence. Methods: We included Randomized control trails (RCTs), including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies and controlled clinical trials. We excluded cross-sectional studies, case reports, review articles, letters to the editor, meeting abstracts, and technique papers. Search results conducted to systematic review management software and manually screened for eligibility were included. Critical appraisal checklist was used to assess the search results based on the inclusion/exclusion criteria. Results: Twenty-three studies are included. Quality appraisal demonstrated that all but one study is retrospective. The pooled results from the meta-analysis showed that the rate of aseptic loosening was only 2% when reconstruction occurs with endoprosthetic proximal femoral hemiarthroplasty. There was unimportant heterogeneity in the included studies. The rate of conversion to total hip arthroplasty (THA) is 4.6% to 8% of oncological patients. The rate of periprosthetic fracture was only 1% Conclusion: Proximal femoral endoprosthesis has definitive benefits in the treatment of primary or metastatic tumors affecting the proximal femur. The implants tend to improve the function and quality of life of patients with metastatic disease and high-grade localized disease. It also provides them with a relatively pain-free limb with good functional capacity. With continuing advances in the surgical and oncological fields, there is a great potential for curative limb salvage surgery in the long term. Reconstruction with endoprosthetic Proximal femoral hemiarthroplasty after proximal femoral resection in young adults can confer additional stability with a reduced dislocation rates and systemic complications as compared to total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Functional magnetic resonance imaging (MRI) improves tissue characterization and staging of bone tumors compared to the information usually supplied by structural imaging. Dynamic MRI and diffusion MRI can be performed in everyday practice. Tumour characterization can benefit from perfusion MRI with dynamic gadolinium injection and enhancement time-intensity curve analysis combined with quantitative and qualitative diffusion MRI. Aim of the Work: is to elucidate the role of advanced MRI techniques in diagnosis of pediatric bone tumors and to assess the diagnostic potential of Dynamic contrast enhancement (DCE) in conjunction with Diffusion weighted imaging (DWI) in differentiating benign from malignant bone tumors. Patients and Methods: a prospective study conducted on thirty pediatric patients with clinically suspected and radiologically proven bone tumor or tumor like lesion. The patients were referred from the Department of Orthopedics, Ain Shams University. The patients were investigated using 1.5 Tesla magnetic resonance device. They were subjected to conventional MRI and DCMI. Results: DWI with measurement of Apparent diffusion coefficient (ADC) values helped in the differentiation of benign and malignant bone tumors, and that the best cut-off criterion is ADC of = 0.9 and this means that = 0.9 indicates malignant result while >0.9 is defined as benign results with overall sensitivity 100% and specificity 100%. A type II curve was seen in 23 cases (one malignant and twenty two benign), type IV was seen in 5 cases (all are malignant) and type V curve was seen in two malignant cases (after chemotherapeutic treatment). ROC analysis for the Dynamic contrast enhancement (DCE) showed a sensitivity of 75 % and specificity of 100%. Conclusion: DWI and DCE-MRI had been proven to be highly useful in the differentiation of benign and malignant bone tumors. Measurement of ADC values improved the accuracy of the diagnosis of bone tumors. Moreover; they could be used in the follow up of tumors and their response to therapy. [ABSTRACT FROM AUTHOR]