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Factors influencing treatment outcome of patients with Gram-negative bacterial (GNB) multidrug-resistant (MDR) and extensively drug-resistant (XDR) prosthetic joint infection (PJIs) were analysed. Data were collected (20 0 0-2015) by 18 centres. Treatment success was analysed by surgery type for PJI, resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) using logistic regression and survival analyses. A total of 131 patients (mean age 73.0 years, 35.9% male, 58.8% with co-morbidities) with MDR (n = 108) or XDR (n = 23) GNB PJI were assessed. The most common pathogens were Escherichia coli (33.6%), Pseudomonas aeruginosa (25.2%), Klebsiella pneumoniae (21.4%) and Enterobacter cloacae (17.6%). Pseudomonas aeruginosa predominated in XDR cases. Isolates were carbapenem-resistant (n = 12), fluoroquinoloneresistant (n = 63) and ESBL-producers (n = 94). Treatment outcome was worse in XDR versus MDR cases (P = 0.018). Success rates did not differ for colistin versus non-colistin in XDR cases (P = 0.657), but colistin was less successful in MDR cases (P = 0.018). Debridement, antibiotics and implant retention (DAIR) (n = 67) was associated with higher failure rates versus non-DAIR (n = 64) (OR = 3.57, 95% CI 1.68-7.58; P < 0.001). Superiority of non-DAIR was confirmed by Kaplan-Meir analysis (HR = 0.36, 95% CI 0.20-0.67) and remained unchangeable by time of infection (early/late), antimicrobial resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) (Breslow-Day, P = 0.737). DAIR is associated with higher failure rates even in early MDR/XDR GNB PJIs versus implant removal. Colistin should be preserved for XDR cases as it is detrimental in MDR infections. (c) 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Metastatic disease is the most common malignancy of bone. Prostate, breast, lung, kidney and thyroid cancer account for 80% of skeletal metastases. Bone metastases are associated with significant skeletal morbidity including severe bone pain, pathological fractures, spinal cord or nerve roots compression, and malignant hypercalcemia. These events compromise greatly the quality of life of the patients. The treatment of cancer patients with bone metastases is mostly aimed at palliation. Currently, modern treatments are available for the palliative management of patients with metastatic bone disease. These include modern radiation therapy, chemotherapy, embolization, electrochemotherapy, radiofrequency ablation, and high intensity focused ultrasound. This article aims to present these palliative treatments for the patients with bone metastases, summarize the clinical applications, and review the techniques and results. It gives an extensive overview of the possibilities of palliation in patients with metastatic cancer to bone. As such it is of interest for all physicians with no experience with these developments to make palliative procedures safer and more reliable.

OBJECTIVE: Purpose of this retrospective study was (1) to evaluate overall survival and survival to local recurrence of patients with unifocal and multifocal tumor and (2) to evaluate survival to local recurrence after intralesional or wide surgery. MATERIAL AND METHODS: We reviewed 62 patients with epithelioid hemangioendothelioma of bone, treated from 1985 to 2010. Histological sections and immunohistochemistry were evaluated. Tumor presented as unifocal in 49 patients and as multifocal in 13. RESULTS: Mean follow-up was 9 years. Five patients (10%) with unifocal tumor progressed to multifocal. Overall survival was 92% at 10 years. Survival with unifocal tumor was significantly higher than survival with multifocal tumor. Survival to local recurrence was 76% at 10 years, significantly higher after wide resection than after intralesional surgery, while there was no statistical difference comparing unifocal and multifocal tumor. At multivariate analysis both variables showed no statistically significance. CONCLUSION: Wide surgical excision reduces the risk of local recurrence, but functional results and morbidity need to be considered individually when defining surgical indications. Due to the risk of radiation-induced sarcomas, radiation therapy should be reserved to those cases not amenable to wide surgery or when lesions are seated locations difficult to treat. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Aim Bone metastases of the upper limb are a frequent complication of primary tumors. The aim of this study is to evaluate treatment and functional results of patients with prosthetic reconstruction of the proximal humerus. Method Between 1975 and 2007, 67 patients were treated by resection of humeral metastasis and reconstruction with prosthesis. Cemented modular prostheses of the proximal humerus were implanted in 59 cases (all MRS Bioimpianti® prostheses), uncemented prostheses in 2 (HMRS® Stryker), 4 elbow Coonrad-Morrey prostheses (in 2 cases with bone allograft), 1 elbow custom-made cemented and 1 intercalary prosthesis (Osteobridge Merete®). Sites of primary tumors: kidney (23), lung (13), bone and unknow (7 each), liver and breast (3 each), bladder, endometrium, thyroid, soft tissues and nervous tissues (2 each), ovarium (1). Complications were evaluated and univariate analysis with actuarial Kaplan-Meier curves of implant survival was performed. Functional results were assessed with the MSTS system. Results At mean follow-up 27 months oncologic outcome showed 7 patients NED (mean time 7 yrs.), 57 DOD, 3 lost to follow-up. Complications were deep infection (2 cases, 3%) and loosening (1 case, 1.5%) causing failure requiring revision. Functional results were good or excellent in 93% of patients, with average score of 71%. Conclusion Resection of metastatic lesion is indicated: 1) for patients with solitary metastases and long free interval from treatment of primary cancer, 2) for patients with meta-epiphyseal metastases not amenable to durable internal fixation even in presence multiple metastases. Indications of resections are increasing, due to prolonged survival with newer medical treatments. Different reconstructive techniques are available, depending on type of resection and soft tissues removal. Cemented prostheses are mostly used, since cemented fixation is not affected by radiotherapy. Although prognosis was poor, prosthetic reconstructions of the humerus provided satisfactory results. Trauma Copyright © 2011, British Editorial Society of Bone & Joint Surgery

When we were asked to edit an eBook on ‘Advances in Bone Metastasis Management’, we accepted enthusiastically for several reasons. First of all, the idea of an eBook that could be easily available to the readers and disseminate the newer concepts on the subject was appealing; second, the possibility of gathering several excellent authors dealing with the different aspects and concepts on metastatic disease to the skeleton and its treatment sounded exciting to us. But perhaps the most intriguing factor was that of having a really multidisciplinary team approach to the issues of metastatic diseases and its multidisciplinary treatment. This book certainly does not have the presumption of completeness, rather the aim of offering an update on the newer concepts and treatments of the very frequent problem of bone metastases. It was felt that concise chapters providing both summarized information and updated references on the different aspects of metastasization, medical treatment, radiotherapy, surgical treatments and the newer palliative options could be useful to the readers in our modern era, where sometimes it is not easy to find time to read complete major textbooks. We certainly hope that this book can meet the needs of our readers.

EN BLOC RESECTION VERSUS CURETTAGE FOR PELVIC BONE METASTASES

RESULTS AND PROGNOSTIC FACTORS IN 109 PATIENTS WITH DEDIFFERENTIATED CHONDROSARCOMA

Expandable femur prostheses for Bone Sarcomas in Children: Analysis of three different prostheses

Radiation-induced sarcomas are rare, high-grade sarcomas that may arise within the radiation field at a mean latency period of 3-55 years after radiation therapy, doses of which range from 45 to 60 Gy. Radiation-induced osteosarcomas, fibrosarcomas, and malignant fibrous histiocytomas are the most common. Wide resection with limb salvage or amputation is recommended for improved local control. Adjuvant radiation therapy and chemotherapy have not been shown to improve survival rates significantly. The prognosis is poor.

Ibernoma: revisione di 17 casi trattati presso l’Istituto Ortopedico Rizzoli

Orthopaedic diseases affect a broad spectrum of patients, and many of these have concomitant medical problems that may differ from those of the general surgical population. Acute postoperative renal failure is thought to arise secondary to acute tubular necrosis from volume depletion, reduction in glomerular filtration rate, hypotension, and nephrotoxic drugs. If acute renal failure occurs and necessitates hemodialysis, morbidity and mortality are significantly increased. To enhance the literature, we performed this study to review the rates and risk factors for acute renal failure in orthopaedic surgery. This information may be useful for orthopaedic surgeons and treating physicians during the rehabilitation stage, to provide a rationale to stratify a patient's risk of acute renal failure or death on the basis of perioperative medical factors and type of surgery, or for improved perioperative monitoring, better surveillance, and preventive measures to reduce this risk.

Distal femur reconstruction with modular prostheses: the Rizzoli experience

Survival and function of limb salvage and amputation for osteosarcomas of the distal tibia

Post radiation sarcoma: a single institutional experience on 52 cases

Le protesi allungabili nella ricostruzione per resezione dei tumori ossei del femore in pazienti in accrescimento: analisi comparativa di tre sistemi protesici nell’esperienza dell’Istituto Ortopedico Rizzoli

Il trattamento del granuloma eosinofilo solitario del rachide nei pazienti sintomatici mediante infiltrazione intralesionale di Depo-Medrol TC guidata: risultati clinici e radiografici

Tumori lipomatosi atipici degli arti

Treatment and ourcomes of patients with osteosarcoma of the distal tibia

Selective embolization for bone metastases with N-Butyl cyanoacrylate: 309 procedures in 7 years

Surgical treatment for Giant Cell Tumour of the sacrum. An update on the experience of Institute Rizzoli

Le protesi allungabili: esperienza dell’Istituto Rizzoli

Embolizzazione selettiva con N-2 Butil Cianoacrilato nelle metastasi scheletriche: 309 procedure in 7 anni

Le ricostruzioni di femore distale con protesi modulari: analisi della sopravvivenza degli impianti confrontando protesi con ginocchio a snodo fisso e rotante

Treatment and outcome of patient with osteosarcoma of the distal femur

Trattamento e risultati in 42 pazienti con osteosarcoma della tibia distale

The role of surgical treatment for hematologic neoplase of bone

Pelvic resection for bone tumours with and withourt reconstruction: the Rizzoli experience

Humeral metastases treated with resection and prosthetic reconstruction: a prognostic and fonctional analysis of 67 patients

Il trattamento del granuloma eosinofilo solitario nei pazienti pediatrici con infiltrazione di Depo-Medrol: risultati clinici e radiografici in 66 casi

Unblocked resection vs curettage for pelvic bone metastases

Emangioendotelioma dell’osso: trattamento e risultati oncologici in 52 casi

Il trattamento chirurgico delle metastasi del femore. Inchiodamento e ricostruzione protesica a confronto: analisi degli impianti e sopravvivenza oncologica

The role of impact factor in evaluating the value of scientific publications is critically reviewed. Other possible criteria for evaluation are assessed and proposed.

Il sistema protesico GMRS nelle ricostruzioni dell’arto inferiore in Oncologia Muscoloscheletrica

Surgery of Giant Cell Tumours of the sacrum: an analysis of 31 cases

BACKGROUND: Studies for patients with pelvic chondrosarcomas are limited. This study determines the outcome of patients with pelvic chondrosarcomas, and whether there is any association with tumors' grade, type, stage, margins and pelvic location. MATERIALS AND METHODS: We retrospectively studied 215 patients with pelvic chondrosarcomas. All patients had biopsy and histological diagnosis of their tumors followed by limb salvage or amputation. We staged patients using the Musculoskeletal Tumor Society system. We performed a univariate and multivariate analysis of the survival to death, local recurrence and metastasis with respect to grade, type (central vs. peripheral), stage, margins, and pelvic location, and the survival to death of patients with and without local recurrence. RESULTS: Grade was the most important univariate and multivariate predictor of the survival of the patients. Dedifferentiation was associated with significantly lower overall survival. Peripheral chondrosarcomas predicted survival only in the univariate analysis. Surgical margins predicted local recurrence only in the multivariate analysis. Periacetabular location was associated with lower survival to death and local recurrence. The occurrence of local recurrence compromises the overall survival. CONCLUSION: Grade was the most important predictor of the overall survival of patients with chondrosarcomas of the pelvis.

Background/Aim: Synovial chondromatosis associated, intra-articular loose bodies are usually small in size. Giant intra-articular loose bodies are rare.

Four children and six adults required en bloc resection of the lateral malleolus for malignant tumors. There were four osteosarcomas. three chondrosarcomas, two Ewing’s sarcomas, and one adamantinoma. Surgical margins were wide in seven patients, marginal in two, and intralesional in one. A primary ankle arthrodesis was done in four adults and bracing without any reconstruction was done in four children and two adults. During a mean followup of 14.5 years (range, 3-30 years), there were two local recurrences (two of 10 patients) after a marginal excision and an intralesional excision. One patient had reoperation for a skip osteosarcoma lesion in the proximal fibula. Other complications included chronic osteomyelitis, a lateral talus subluxation and cavovarus deformity, and recurrent ankle instability and degenerative changes of the ankle. At the latest followup, all 10 patients showed no evidence of disease. Five patients who had primary or late ankle arthrodesis had a Musculoskeletal Tumor Society, and International Society of Limb Salvage functional score of 28 points (92%), and two adolescents who had postoperative bracing alone had a functional score of 24 points (80%). The three remaining patients had a salvage amputation. Level of Evidence: Therapeutic study, Level IV (case seriesno, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Von Recklinghausen disease, or neurofibromatosis, is a congenital and familial disorder with an autosomal dominant pattern of inheritance. The disease primarily affects ectodermal tissues arising from the neural crest. It is divided into two basic forms: peripheral (type 1) and central (type 2), characterized by distinct skeletal and soft-tissue manifestations(1-6). Type-l neurofibromatosis usually manifests in early childhood and is more frequent than the type-2 form of the disease(7,8). Skeletal abnormalities and dysplasias, including erosive or pressure bone defects, pseudarthroses, and cranial defects, are diagnosed in approximately 80% of patients with type-1 neurofibromatosis. In addition, multiple nonossifying fibromas that predominantly affect the metaphyseal parts of the long tubular bones tend to develop in patients with this type of the disease(1). The most serious, and often fatal, complication of the disease is a malignant peripheral nerve sheath tumor. Most cases are located within the soft tissue of the proximal part of an extremity, the buttocks, or the shoulder girdle. Skeletal involvement usually occurs as a result of secondary invasion by a soft-tissue lesion; a primary malignant peripheral nerve sheath tumor in bone is extremely rare(9-12). These malignant tumors are highly aggressive, with a high propensity for distant metastases, especially to the lung, liver, and bones(11-13). We are aware of only one reported case of irradiation-induced malignant transformation of a neurofibromatous bone lesion of von Recklinghausen disease to malignant fibrous histiocytoma(14). We describe the case of a young patient with type-1 neurofibromatosis in whom a malignant fibrous histiocytoma of bone was diagnosed at the site of fibrous bone lesions without previous irradiation. The patient was informed that data concerning the case would be submitted for publication.

This retrospective study assessed the diagnostic accuracy and clinical usefulness of the Harlow Wood needle biopsy for spinal lesions. The medical records of 238 patients (138 men and 100 women) who underwent closed spine biopsy from 1987 through 1997 were reviewed. Patient age ranged from 21 to 83 years. Lesions involved the thoracic vertebrae in 127 patients, the lumbar vertebrae in 99 patients, and the sacrurn in 12 patients. Cultures of the biopsy specimens were examined histopathologically and cytologically. One hundred twenty-four patients were diagnosed with a spinal infection, and 68 patients were diagnosed with a tumor. In the remaining 46 patients, the biopsy specimens were negative for infection or neoplasia in 20 patients and not diagnostic in 26 (10.9%) patients. There were no major complications. The Harlow Wood needle biopsy is a simple, repeatable procedure with satisfactory diagnostic accuracy (89.1%) and can be performed on an outpatient basis.

Background. Infections of the musculoskeletal system are tuberculous in nature in 1-5% of cases. The sacroiliac joint is involved in 3-9.7%. We describe the case of a 32-year-old man with tuberculous sacroiliitis presented as a growing mass on the lateral aspect of his right proximal and mid-thigh. Open biopsy, histology, cultures and PCR established the diagnosis of tuberculosis. Results: After surgical drainage of the abscess, the patient was administrated a triple antibiotic regimen for 12 months. Seven years postoperatively, the patient is disease-free with no functional limitation. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.

The small carpal bones are infrequent sites for osteoid osteomas, and their clinical and imaging pictures may be quite confusing leading to suspect other etiologies. The authors present herein an unusual case of osteoid osteoma of the scaphoid superimposed on a wrist injury caused by a fall on the outstretched hand.

Study Design. A retrospective study was performed to identify horizontal fractures of the body of the axis, with special attention to their pattern, prevalence, and clinical outcome. Objective. The prevalence of this type of injury and the long - term clinical behavior are examined. Summary of Background Data. Although isolated cases have been reported, horizontal Chance-type fractures of the body of the axis are not common cervical spine injuries. Methods. The medical records of 674 consecutive patients with fractures of the cervical spine admitted to the authors’ institute from 1970 to 2002 were reviewed. Of them, 2 (0.3%) had a horizontal Chance-type fracture of the body of the axis. Neurologic deficits were not diagnosed at admission. Mechanism of injury, treatment, and long-term follow-up were evaluated. Results. Both patients were treated nonoperatively. At the latest follow-up, 3 and 12 years, respectively, both patients had a satisfactory clinical outcome. Conclusion. Horizontal fractures of the Chance-type of the body of the axis are rare. Conservative treatment proved to be effective.

The aim of this study was to evaluate the changes of the internal (IID) and external meniscal interhorn distance (EID) of the medial and the lateral meniscus under loading. Sagittal magnetic resonance images of 15 knees were studied. The medial and lateral meniscus were examined with the knee at 0 degrees and 30 degrees of flexion, under no load, with load equal to 50% of body weight and with load equal to 100% of body weight. Under no load, the mean IID was 19.9 mm for the medial meniscus and 12.3 mm for the lateral meniscus and the mean EID was 44.6 mm for the medial meniscus and 34.4 mm for the lateral meniscus. Under load equal to 50% and 100% of patient’s body weight, there was a significant increase in both distances (p < 0.05). Under constant loading, flexion of the knee from 0 degrees to 30 degrees, decreased the EID of both menisci. In conclusion, loading increases both IID and EID. Knee position affects only the EID. The quality of magnetic resonance images may affect the reliability of such measurements. (c) 2005 Elsevier B.V. All rights reserved.