Search

The aim of this article is to provide a short review of the literature concerning the basic principles, usefulness and limitations of ultrasound-guided biopsy of musculoskeletal soft-tissue tumors, with particular focus on core needle biopsies. Musculoskeletal soft-tissue tumors represent a rare and complex group of heterogeneous lesions. Prompt diagnosis of these uncommon lesions can improve the outcome and increase the patient survival rate. A biopsy examination of soft-tissue tumors with imaging modalities is necessary in all cases of aggressive or undetermined lesions. Although fine needle aspiration can be helpful for the biopsy of certain tumor types, core needle biopsy is a standard procedure in most tertiary sarcoma centers. It has a high diagnostic accuracy, low complication rate and lower price in comparison to open biopsy, and can replace it in the majority of cases of soft-tissue tumor assessment. However, the examining physician has to be familiar with the technique, and the strengths and potential difficulties in performing ultrasound-guided biopsy, as well as possible solutions to obstacles. Several recently developed ultrasound techniques can be helpful and improve the outcome of imaging-guided biopsies of musculoskeletal lesions.

Giant cell tumor of bone (GCTB) represents an intermediate, locally aggressive tumor, with a peak of incidence in the third decade of life with female predominance (2:1). The distal radius is the third most common localization and especially challenging in the treatment is saving the wrist joint function. In this report, we present a case of a 32-year-old patient diagnosed with a giant cell tumor of the distal radius, primarily treated with curettage of the bone. Due to aggressive tumor recurrence, considering local control of the tumor, we decided to perform a resection of the distal radius and reconstruction with an autologous proximal vascular fibular graft. We performed a SPECT/CT scan to confirm the functionality of the graft. We find this procedure a safe technique for local control of tumor recurrence and an ideal substitute for a limb salvage procedure. [ABSTRACT FROM AUTHOR]

We present a case of a 38-year-old woman with a soft tissue mass on the right knee in medial infrapatellar area. The flexion of the knee appeared to be limited and a pain was present at maximal flexion. Ultrasonography, standard X-ray and CT scan were performed for diagnosis of this soft tissue tumour. MRI was not done due to technical problems. Any how the MRI could provide us with more presumptions of the type of the tumour, but it will not affect the surgeon’s decision for operation. Any way the final diagnosis will come out of the histopatological findings. Arthroscopic examination was performed in order to eliminate possible problems in to the joint followed by open wide excision. A soft tissue tumour with dimensions of 5 x 4 x 1.5 cm was excised. Histopathological diagnosis was synovial haemangioma located in the infrapatellar fat pad. The patient was asymptomatic postoperatively. Haemangiomas located in infrapatellar fat pad are rare. Orthopaedic surgeons can often be confused by more common entities like chondromallatia of patella, synovitis of the knee, Hoffa’s disease, other soft tissue tumours, even lesion of meniscus. So, accurate diagnosis is very important for differentiation. Operative excision, arthroscopic or open wide, is definitive treatment for this benign tumour.

Introduction: Avascular necrosis or osteonecrosis of the femoral head is defined as a pathological process that results in a critical reduction in the blood supply to the hip head with increased intraosseous pressure. Avascular necrosis is a multifactorial disease. The treatment used so far consists of transosseous decompression of the femoral head and is the most commonly used method in the early stages of osteonecrosis. Aim: The aim of this study was to evaluate the results after application of bone marrow stem cells obtained from the pelvic ridge, which was applied to the necrotic zone after previous decompression. Material and methods. The study is of prospective character and included 30 patients with first, second, and third degrees of AVN according to the Ficat classification, determined with X-ray. The range of motion in the hip was examined preoperatively by using a goniometer, a radiological evaluation of the degree of AVN was performed, according to the Ficat classification, and the VAS scale and the Harris Hip Score were examined preoperatively and postoperatively. Results: The average value for the Harris Hip Score (HHS) preoperatively was: for Ficat I -66.32±5.1, for Ficat II - 49.19±3.4 and for Ficat III - 33.71±2.1. At the 3-month postoperative follow-up, the average HHS values were: 87.92±4.3 for Ficat I, 78.64±6.6 for Ficat II and 76.48±2.6 for Ficat III. The same values for HHS were obtained in the control examinations at the 6th and 12th month postoperatively, indicating the fact that good bone regeneration was achieved and the progression of the condition was prevented. A decrease in the HHS value was observed at the control examination at 1 year after the surgical treatment, in 3 patients according to the Ficat classification of grade III, in whom a total hip replacement surgery was performed. Conclusion: The use of stem cells in the treatment of avascular necrosis of the femoral head has achieved good functional results and reduced pain in operated patients. Radiographically, good bone regeneration was achieved and the progression of necrosis to a higher degree was prevented. [ABSTRACT FROM AUTHOR]

The aim of this article is to provide a short review of the literature concerning the basic principles, usefulness and limitations of ultrasound-guided biopsy of musculoskeletal softtissue tumors, with particular focus on core needle biopsies. Musculoskeletal soft-tissue tumors represent a rare and complex group of heterogeneous lesions. Prompt diagnosis of these uncommon lesions can improve the outcome and increase the patient survival rate. A biopsy examination of soft-tissue tumors with imaging modalities is necessary in all cases of aggressive or undetermined lesions. Although fine needle aspiration can be helpful for the biopsy of certain tumor types, core needle biopsy is a standard procedure in most tertiary sarcoma centers. It has a high diagnostic accuracy, low complication rate and lower price in comparison to open biopsy, and can replace it in the majority of cases of soft-tissue tumor assessment. However, the examining physician has to be familiar with the technique, and the strengths and potential difficulties in performing ultrasound-guided biopsy, as well as possible solutions to obstacles. Several recently developed ultrasound techniques can be helpful and improve the outcome of imaging-guided biopsies of musculoskeletal lesions. [ABSTRACT FROM AUTHOR]

Bone tumors and tumor-like conditions are rare entities of bones, and most are located around the knee. It is continuous dilemma if the bone lesion origins from the trauma.Our team has been consulted for 17 knee trauma associated with bone lesions. Lesions of bone were diagnosed as: tumor-like lesions; benign bone tumors; benign soft tissue tumor; aggressive bone tumor; malignant bone tumors. Three patients had foot thrombophlebitis and for their treatment has been consulted cardiologist.From 13 patients with tumorlike lesions and benign bone tumors only 4 were operated. Corticosteroids were applied in the bone cysts in 2 patients. Patients with aggressive bone tumors had their lesions excised and bone cement was used for the defect. Malignant bone tumors were treated with preoperative neoadjuvant and following surgery postoperative chemotherapy regimen. Bone lesions can be easily overseen. The fact that more than 60% of bone tumors are in the vicinity of the knee makes the diagnostic decision of knee trauma more difficult. [ABSTRACT FROM AUTHOR]

Tennis elbow or lateral epicondylitis is a type of repetitive strain injury, resulting from tendon overuse and failed healing of the tendon. The extensor carpi radialis brevis muscle plays a key role. This disease is a very common cause of the elbow pain in people and athletes between the ages of 30 and 50 years old. Aim: The aim is to present origins and treatment of tennis elbow or lateral epicondylitis. Material and methods: The study included 90 patients having tennis elbow, and they were divided to two groups according to different conservative treatment. Clinical and radiographic examinations (X-ray, ultrasonography and MRI) were analyzed during the evaluation. In this retrospective study 2 patients were followed with colour Doppler ultrasound. Results: Exactly 80 patients became symptom-free and regained normal function after 1 year. 6 patients in group 1 and 4 patients in group 2 returned 1 year later complaining persistent pain of the area of elbow, and minimized the participation in sportive activities. Conclusion: Conservative therapy is the best choice for treatment of tennis elbow. [ABSTRACT FROM AUTHOR]

Background: Radiographic examination of extremities in surgical lengthening and/or correction of deformities is of crucial importance for the assessment of new bone formation. The purpose of this study is to confirm the diagnostic value of radiography in precise detection of bone parameters in various lengthening or correction stages in patients treated by limb-lengthening and deformity correction. Patients and Methods: 50 patients were treated by the Ilizarov method of limb lengthening or deformity correction at the University Orthopaedic Surgery Clinic in Skopje, and analysed over the period from 2006 to 2012. The patients were divided into two groups. The first group consisted of 27 patients with limb-lengthening because of congenital shortening. The second group consisted of 23 patients treated for acquired limb deformities. The results in both groups were received in three stages of new bone formation and were based on the appearance of 3 radiographic parameters at the distraction/compression site. Results: The differences between the presence of all radiographic bone parameters in different stages of new bone formation were statistically signficant in both groups, especially the presence of the cortical margin in the first group (Cochran Q = 34.43, df = 2, p = 0.00000). The comparative analysis between the two groups showed a statistically significant difference in the presence of initial bone elements and cystic formations only in the first stage. Discussion and Conclusions: Almost no statistical significance in the differences between both groups of patients with regard to 3 radiographic parameters in 3 stages of new bone formation, indicates a minor influence of the etiopathogenetic background on the new bone formation in patients treated by gradual lengthening or correction of limb deformities. [ABSTRACT FROM AUTHOR]

Introduction : Avascular necrosis or osteonecrosis of the femoral head is defined as a pathological process that results in a critical reduction in the blood supply to the hip head with increased intraosseous pressure. Avascular necrosis is a multifactorial disease. The treatment used so far consists of transosseous decompression of the femoral head and is the most commonly used method in the early stages of osteonecrosis. Aim : The aim of this study was to evaluate the results after application of bone marrow stem cells obtained from the pelvic ridge, which was applied to the necrotic zone after previous decompression. Material and methods. The study is of prospective character and included 30 patients with first, second, and third degrees of AVN according to the Ficat classification, determined with X-ray. The range of motion in the hip was examined preoperatively by using a goniometer, a radiological evaluation of the degree of AVN was performed, according to the Ficat classification, and the VAS scale and the Harris Hip Score were examined preoperatively and postoperatively. Results : The average value for the Harris Hip Score (HHS) preoperatively was: for Ficat I -66.32±5.1, for Ficat II - 49.19±3.4 and for Ficat III - 33.71±2.1. At the 3-month postoperative follow-up, the average HHS values were: 87.92±4.3 for Ficat I, 78.64±6.6 for Ficat II and 76.48±2.6 for Ficat III. The same values for HHS were obtained in the control examinations at the 6th and 12th month postoperatively, indicating the fact that good bone regeneration was achieved and the progression of the condition was prevented. A decrease in the HHS value was observed at the control examination at 1 year after the surgical treatment, in 3 patients according to the Ficat classification of grade III, in whom a total hip replacement surgery was performed. Conclusion : The use of stem cells in the treatment of avascular necrosis of the femoral head has achieved good functional results and reduced pain in operated patients. Radiographically, good bone regeneration was achieved and the progression of necrosis to a higher degree was prevented., (© 2023 Vilijam Velkovski et al., published by Sciendo.)

Unlabelled: The aim of this study is to determine the accuracy of clinical and MRI diagnosis in comparison with arthroscopy for detection of meniscal lesions. Also, to answer if MRI diagnosis impacts on the decision of the surgeon for the choice of treatment (operative or conservative)., Material and Methods: We examined 70 patients with knee injuries. Clinical diagnosis was established using the case-history of the patient and positive clinical tests for meniscal injuries (McMurray and Aplay). All patients underwent MRI on a 1.5 T magnet for MRI diagnosis. This was followed by arthroscopy for final diagnosis. Clinical and MRI diagnoses were correlated with the arthroscopic diagnosis which was used as a gold standard., Results: Of 70 patients with knee injuries, 55 had a clinical diagnosis of meniscal lesions out of whom 44 patients had a medial meniscal lesion and 11 had a lateral meniscal lesion. Arthroscopy confirmed the clinical diagnosis in 32 patients (72.72%) (44 vs 32) in medial meniscal lesion, and 8 patients (72.7%) (11 vs 8) with a lateral meniscal lesion. In MRI diagnosis of 56 patients with medial meniscal lesion arthroscopy confirmed the diagnosis in 34 patients (60.7%) (56 vs 34) and pf 10 patients with lateral meniscal lesion arthroscopy confirmed the diagnosis in 6 patients (60%) (10 vs 6). The sensitivity, specificity, PPV and NPV of clinical diagnosis versus MRI for medial meniscus were (79.9% vs 79.5%); (58.1% vs 38.1%); (69.8% vs 69.6%); (69.2% vs 69.2%). The sensitivity, specificity, PPV and NPV of clinical diagnosis versus MRI for lateral meniscus were (50% vs 40%); (92.7% vs 92.7%); (63.6% vs 60%); (87.9% vs 85.5%)., Conclusions: Carefully performed clinical examination can give an equal or better diagnosis of meniscal lesions in comparison with MRI diagnosis. Any experienced orthopaedic surgeon can trust his clinical diagnosis as an indication of arthroscopy. When the clinical diagnosis is established, with no doubts due to positivity of the clinical tests, the MRI is not essential. In suspected cases where there is a dilemma, MRI is very helpful in making a decision for arthroscopy. The diagnostic accuracy of clinical and MRI diagnosis of meniscal lesions is high. Their reliability in diagnosing meniscal lesions is evident. lesion, clinical diagnosis, MRI, arthroscopy.

Unlabelled: The aim of this study is to improve 3-years survival rates and functional outcome in high-grade osteosarcoma patients treated with amputations and limb-sparing surgery, introducing Scandinavian Sarcoma Group chemotherapy protocol (SSG XVI)., Patients and Methods: During the period 2000-2005, thirty seven patients with high-grade, non-metastatic osteosarcoma on the extremities were treated at the Clinic for Orthopaedic Surgery in Skopje. Mail patients were 21 (57%) and female were 16 (43%). Patients age varied from 8 to 63 years (mean 18 +/- 13). Seven patients (7/37) did not comply with including criteria and were excluded from the study. The rest 30 patients were introduced to two courses of pre-operative chemotherapy (high doses of Methotrexate, Cisplatin and Adriamycin). Surgical treatment was in 9-th week of the protocol. In 27/30 (90%) of the patients limb-sparing surgery was done, and in 3/30 (10%) amputations were performed. Histopathological assessment of the tumour after the neo-adjuvant chemotherapy divided the patients into group with bad and group with good response. All the patients had 3 more courses of chemotherapy after surgery (same as the preoperative). Patients with bad response were introduced to 3 more cycles of 5 days with high-dose of Ifosfamide. Follow-up was from 2 to 8 years, mean 51 months., Results: Histopathological assessment showed that 57% of the patients had bad response to neo-adjuvant chemotherapy, but there was no statistical significance in the survival time of the groups (p = 0.06). Three-years survival time was 40% of the patients with local recurrence in comparison with 80% of the patients with no local recurrence. Three-years survival time was 20% of the patients with distant metastases in comparison with 92% of the patients with no metastases. Overall survival time (OS) was 80%. After 3 years 60% of the patients were disease-free (DFS)., Conclusion: High-grade osteosarcoma of the extremities treated with modern chemotherapy protocols enables limb-sparing in the same time with improved survival time of the patients. Introducing high-dose Ifosfamide in treatment of patients with bad response after neo-adjuvant chemotherapy improves their functional results as well as the survival time. Key words: osteosarcoma, neo-adjuvant chemotherapy, limb-sparing.