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Hintergrund: Maligne Weichgewebstumoren der Extremitäten bei Erwachsenen stellen mit 2-3 Neuerkrankungen pro 100.000 Einwohner/Jahr einen sehr geringen Anteil der malignen Neuerkrankungen dar. Nach Abschluss der multimodalen Therapie besteht aufgrund der hohen Rezidivrate die Indikation zu einer strukturierten Tumornachsorge. Rezidive treten häufig innerhalb der ersten 2 Jahre nach der initialen Therapie auf, werden aber auch noch nach Abschluss des 5. Jahres beschrieben.Grundsätze: Die Planung der Nachsorge sollte bereits im Rahmen des stationären Aufenthalts beginnen. Die Kernpunkte der strukturierten Tumornachsorge sind die Einleitung rehabilitativer und psychosozialer Maßnahmen, die Behandlung von Therapienebenwirkungen nach (neo)adjuvanter Therapie, die Erkennung von Sekundärtumoren, die palliative Behandlung sowie die statistische Erfassung der Therapieverläufe. Die Nachsorge sollte an einem spezialisierten Zentrum für muskuloskeletale Tumoren erfolgen. Die Nachsorgesequenz richtet sich hierbei nach der Entität sowie dem Tumorgrading und wird in zunächst engmaschigen und im Verlauf in längerfristigen Kontrollen über mindestens 10 Jahren empfohlen.Schlussfolgerung: Die tumorchirurgisch tätige Klinik sollte eng in die strukturierte Tumornachsorge eingebunden sein. Wir empfehlen eine 3‑monatige Kontrolle für die ersten 3 Jahre, eine 6‑monatige Kontrolle im 4. bis 5. Jahr und eine jährliche Kontrolle bis zum Abschluss des 10. Jahres bei hochmalignen Weichgewebstumoren der Extremitäten. Bei Low-grade-Weichteilsarkomen sehen wir die Indikation zur halbjährlichen Kontrolle innerhalb der ersten 5 Jahre und hiernach ein jährliches Nachsorgeintervall bis zur Vollendung des 10. Jahres nach initialem Therapieabschluss. [ABSTRACT FROM AUTHOR]

Hintergrund: Weichteilsarkome sind eine seltene maligne Tumorerkrankung, deren Therapie eine hohe Spezialisierung der beteiligten Kliniken notwendig macht. Aufgrund besserer Überlebensraten und damit höherer Lebenserwartung der Patienten sind die Anforderungen an die chirurgische Therapie nicht nur im Hinblick auf die Sicherheit der Resektion, sondern auch den Erhalt der Funktion gewachsen.Grundsätze: Für die Planung der Tumortherapie müssen eine adäquate Bildgebung sowie histologische Sicherung mittels Biopsie vorliegen. Die Therapie wird interdisziplinär geplant. Man unterscheidet kurative von palliativen Operationsmethoden. Die Tumorresektion erfolgt anhand der präoperativen Planung unter strikter Vermeidung der Kontamination des Situs. Es werden weite Resektionsverfahren angestrebt.Operative und rekonstruktive Verfahren: Die Resektion erfolgt durch direkten längsverlaufenden Zugang zum betroffenen Kompartiment. Der Tumor wird unter Ausnutzung anatomischer Trennschichten bedeckt mit gesundem Gewebe reseziert. Es ist auf eine suffiziente Blutstillung zu achten - zusätzlich kann präoperativ eine Tumorgefäßembolisation erfolgen. Verbliebene Muskelanteile werden zur Rekonstruktion refixiert oder eine Funktionsverbesserung durch Tenodesen erreicht. Aufwändige Weichteil- und Nervenrekonstruktionen sollten zweizeitig erfolgen und müssen adjuvante Behandlungsverfahren mit berücksichtigen. Bei größeren knöchernen Defekten kommen modulare Endoprothesen und im Fall des Verlusts großer Muskelanteile auch Arthrodesen zum Einsatz. Im Fall von Amputationen sollte eine optimale Prothesenversorgung und Nachbehandlung angestrebt werden.Multimodale Therapie: Neoadjuvante und adjuvante Therapieverfahren können sowohl engere Resektionsränder ermöglichen als auch die Gesamtprognose verbessern. [ABSTRACT FROM AUTHOR]

Hintergrund: Weichteilsarkome stellen mit einer Inzidenz von ca. 1,8-5,5/100.000 pro Jahr nur etwa 1 % der malignen Tumorerkrankungen bei Erwachsenen dar. Diese Seltenheit bedingt gemeinsam mit der Heterogenität und unspezifischen klinischen Symptomatik die häufig verzögerte Diagnostik und uneinheitliche Therapie. Für ein möglichst gutes Outcome ist jedoch ein standardisiertes diagnostisches und therapeutisches Vorgehen notwendig.Diagnostik: Der Patient stellt sich typischerweise mit einer schmerzlosen Schwellung vor. Je nach genauer Lage können auch Bewegungseinschränkungen und manchmal neurologische Symptome bestehen. Den Goldstandard der Lokalbildgebung stellt aufgrund ihrer guten Kontraste und Reproduzierbarkeit die Magnetresonanztomographie mit Kontrastmittel dar. Nach Komplettierung der lokalen Bildgebung erfolgt die histologische Tumorbestätigung mittels Stanzbiopsie oder offener Biopsie. Nur in Ausnahmefällen sollte eine Exzisionsbiopsie erfolgen. Bei Bestätigung des Malignitätsverdachts ist vor Therapieeinleitung ein Staging des Patienten zur Metastasensuche notwendig. Dieses erfolgt in der Regel mittels Computertomographie (CT) von Thorax und Abdomen, ggf. auch als PET(Positronenemissionstomographie)-CT.Therapiealgorithmus: Das therapeutische Vorgehen wird im Rahmen eines interdisziplinären Tumorboards festgelegt. Für lokal gut resektable Tumoren ohne Metastasen ist die R0-Resektion angezeigt. Diese wird bei High-grade-Sarkomen von einer adjuvanten Strahlentherapie gefolgt. Bei lokal fortgeschrittenen Tumoren oder Metastasen kommen auch neoadjuvante oder adjuvante Chemotherapien sowie die chirurgische Metastasenresektion zum Einsatz.Nachsorge: Die Tumornachsorge beinhaltet die regelmäßige klinische und radiologische Kontrolle der Tumorregion sowie Metastasensuche. Sie sollte möglichst am primär behandelnden Tumorzentrum erfolgen. [ABSTRACT FROM AUTHOR]

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Objective: This study is aimed at evaluating the distribution of metastatic bone disease (MBD), with a particular focus on the humerus, and its association with pathological fractures. Factors for contributing to the underestimation of fracture risk were assessed, including their impact on surgical management., Materials and Methods: We retrospectively reviewed patient records of patients undergoing surgical treatment for MBD at our institution between 2005 and 2023. The analysis included factors such as medical history, tumour type, metastatic status, surgical method, lesion location, and imaging. The images of local and staging studies (CT chest/abdomen/pelvis, CT skeleton body, bone scan, PET/CT) were reviewed by two observers. Group comparisons were made based on lesion localisation., Results: The two most affected bone regions were the proximal femur (39.4%), followed by the proximal humerus (13.5%). Lesions of the proximal humerus were significantly more likely to be associated with pathological fractures compared to those of the proximal femur and other localisations (p < 0.01). Identified potential causes include less frequent depiction of the proximal humerus during staging (29% vs. 79% and 51%; p < 0.01) and overall lower Mirel's scores despite the number of fractures (8 vs. 10 and 9; p < 0.01)., Conclusion: Metastatic bone disease (MBD) in the proximal humerus is less frequently captured in current staging imaging, particularly CT chest/abdomen/pelvis. Additionally, fracture prediction using Mirel's scoring often underestimates the actual risk. Staging investigations should include this region more comprehensively, and even when correctly imaged, better tools are needed to evaluate bone metastases effectively., Competing Interests: Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication: Informed consent was obtained from all individual participants included in the study. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s).)

Background/Objectives : A neck of femur (NOF) fracture is one of the most common fractures, and its treatment in the geriatric population using cemented bipolar hemiarthroplasty (HA) is a standard procedure worldwide. Various surgical approaches have been described for this operation, aiming to reduce complications and improve early mobilization. The present study compares two minimally invasive approaches, the anterolateral minimally invasive approach (ALMIS) and the direct superior approach (DSA), with respect to their intraoperative and early postoperative complications in cemented bipolar HA. Methods : The medical records of all patients undergoing cemented bipolar HA for a NOF fracture between January 2017 and December 2023 were analyzed. The aim of the study was to compare the two surgical approaches. The evaluation focused on intraoperative parameters and early complications. Results : A total of 226 patients were included in the analysis, with 62 undergoing DSA and 164 ALMIS, with an average age of 83.5 years. The two approaches did not differ significantly in terms of stem implantation quality, length of hospital or intensive care unit stay, postoperative mobilization, or the need for transfusions. However, the ALMIS was associated with a significantly shorter operative time (DSA: 89.7 min vs. ALMIS: 77.2 min; p < 0.01). On the other hand, the DSA had a significantly lower complication rate (DSA: 0/61 vs. ALMIS: 11/163; p = 0.04). Conclusions : In a comparison of the two minimally invasive approaches, DSA and ALMIS, for treating a NOF fracture with cemented bipolar HA, the DSA demonstrated a lower complication rate, though it had a slightly longer operating time.

Background: Metastatic bone disease (MBD) and its complications have a significant impact on patients' quality of life. Pathological fractures are a particular problem as they affect patient mobility and pose a high risk of non-union. The pelvis is frequently affected by MBD and its fixation is challenging. We present a case series of three pathological sacral fractures treated with a new minimally invasive bilateral fixed angle locking system., Case Presentation: Case 1 and 2 suffered a pathological transforaminal sacral fracture without adequate trauma in stage 4 carcinomas (gastric cancer and breast cancer). Both were initially treated with non-surgical treatment, which had only a limited effect and led to imminent immobility. Both were operated on with fluoroscopic navigation and underwent transsacral SACRONAIL ® stabilisation according to CT morphology (S1 + S2 and S1 respectively). Immediately after the operation, pain decreased and mobilisation improved. Case 3 had a pathological transalar sacral fracture during the 2nd cycle of chemotherapy due to non-Hodgkin's lymphoma. He soon became immobile and could only move in a wheelchair. The operation was performed with CT navigation due to the very small corridors and an implant was inserted in S1 and S2. The patient reported immediate pain relief and his ability to walk improved over the following months. Despite continued chemotherapy, no wound complications occurred., Conclusions: The cases show the advantages of the minimally invasive bilateral fixed angle locking system SACRONAIL ® in the treatment of patients with pathological sacral fractures. It allows immediate full weight bearing and the risk of secondary surgical complications is low. All cases showed an improvement in pain scores and mobility., (© 2024. The Author(s).)

With the increasing use of next-generation sequencing, highly effective targeted therapies have been emerging as treatment options for several cancer types. Recurrent gene-fusions have been recognized in sarcomas; however, options for targeted therapy remain scarce. Here, we describe a case of a sarcoma, associated with a RET::TRIM33-fusion gene with an exceptional response to a neoadjuvant therapy with the selective RET inhibitor selpercatinib. Resected tumor revealed subtotal histopathologic response. This is the first report of successful targeted therapy with selpercatinib in RET-fusion-associated sarcomas. As new targeted therapies are under development, similar treatment options may become available for sarcoma patients., (© 2022. The Author(s).)

Introduction: Osteosynthesis of femoral neck fractures (FNFs) is an important treatment option, especially for younger patients. We aimed to assess the rate of early implant-related complications in FNF osteosynthesis using the Femoral Neck System (FNS)., Patients and Methods: Consecutive patients diagnosed with displaced or nondisplaced FNFs were treated with FNS in this prospective, observational, multicenter investigation. Patients were followed up for minimally 3 months and up to 12 months if radiologic bone union and no pain was not achieved beforehand. Predefined treatment-related adverse events (AEs, defined as implant failure, loss of reduction, iatrogenic fractures, deep infection, and surgical revision), radiologic bone union, and patient-reported Harris hip score (HHS) and EQ-5D-5L index score were assessed., Results: One hundred and twenty-five patients were included in the study. Thirty-eight (30.4%) fractures were displaced (Garden III and IV), and 37 (29.6%) were vertical fractures (Pauwels type III). Predefined treatment-related AE rate at 3 months was 8 patients, 6.4% (95% CI, 2.8-12.2), and at 12 months, 11 patients, 8.8% (95% CI, 4.5-15.2). Cumulative incidences of bone union were 68% at 3 months, 90% at 6 months, and 98% at 12 months. The mean changes of HHS and EQ-5D-5L index score between preinjury and at 12 months were -7.5 (95% CI, [ - 21.1] to [6.2]) and  - 0.03 (95% CI, [ - 0.21] to [0.15]), respectively; neither were statistically significant., Conclusion: The current study on osteosynthesis of FNFs with the FNS resulted in treatment-related complication rates of 6.4% (95% CI, 2.8-12.2) at 3 months and 8.8% (95% CI, 4.5-15.2) at 12 months. On average, patients returned to preinjury function and quality of life. The current study may also indicate that the conventional wisdom of treating stable FNF in patients aged between 60 and 80 years with osteosynthesis may need to be reconsidered., Registration: The study is registered with ClinicalTrials.gov (registration number: NCT02422355)., (© 2022. The Author(s).)

Background: Denosumab (Xgeva TM ) is a fully human antibody to RANK-Ligand, an important signal mediator in the pathogenesis of giant cell tumour of bone (GCTB). The use of denosumab in the treatment of GCTB has changed the way in which these tumours are managed over the past years., Case Presentation: Described is the case of an acute fracture through a GCTB of the distal radius of a fit and well 32-year-old, non-smoking, female patient following a simple fall onto her outstretched, dominant hand. The aim was to enable joint sparing management for the patient, as opposed to an acute fusion procedure of the carpus. The patient underwent percutaneous k-wire fixation with application of plaster and immediate commencement with denosumab to halt the activity of the GCTB. Bone healing was rapid; plaster and k-wires were removed after 6 weeks. At 6 months denosumab, was ceased and an open curettage and grafting procedure of the tumour bed was undertaken (using MIIG X3, Wright Medical, aqueous calcium sulphate as graft material)., Conclusions: The use of denosumab in the acute setting of pathological fracture through giant cell tumour of bone allowing joint salvage has not been previously described. The treatment was well tolerated and functional outcomes are excellent, with very promising 4-year follow-up. This novel approach may allow for more joint sparing strategies in the future for other patients in this difficult situation. Further cases will need to be gathered to establish this technique as a suitable treatment pathway.

Introduction: The NUT midline carcinoma is a rare tumor mostly reported in the midline of upper aerodigestive tract and mediastinum. Children as well as adolescents are affected without a gender distribution. A standard treatment is not established. So far, there exists no reported case of a pregnant female suffering from NUT midline carcinoma with musculoskeletal manifestation., Case Presentation: A 34-year-old woman was referred to our outpatient clinic by the general practitioner during her 31st week of pregnancy suffering from shoulder pain and dyspnea. So far, dyspnea was interpreted as a typical pregnancy-related symptom. However, a chest X-ray showed a tumor mass in the right lung in close relation to the scapula. Further examinations found metastases in different areas of the body. No pregnancy-related complications were detected by obstetric examination. After an interdisciplinary perinatal case discussion, cesarean section was directly followed by an open biopsy of the right side scapula tumor lesion. A NUT midline carcinoma was diagnosed by immunohistochemistry. Due to disseminated tumor disease in multiple non-resectable locations, a palliative systemical chemotherapy was started by the oncological outpatient clinic., Conclusion: This report presents the case of the very rare NUT midline carcinoma under pregnancy which made interdisciplinary case discussions indispensable for therapy planning.

Background: The number of people living with soft-tissue and bone sarcomas is increasing due to improved individual therapy and changes in demographics. At present, there are no recommendations for psychological co-treatment, occupational and social reintegration following the treatment of soft tissue and bone sarcomas., Methods: Seventy-four patients, 42 males and 32 females, aged between 18 and 80 years (54.58 ± 16.99 yr.) with soft-tissue (62) and bone sarcomas (12) were included to answer five standardized and one personal questionnaire regarding quality of life, function, reintegration and participation after surgical treatment., Results: A number of tumour-specific and patient-specific factors were identified that affected the therapeutic outcome. Patients with sarcoma of the lower extremity described poorer mobility. Patients who underwent amputation reported a higher anxious preoccupation. Patients with a higher range of education were less fatalistic and avoiding. The size of tumours or additive radiation therapy did not affect the post-therapeutic quality of life, coping and function. There was a good correlation between anxiety and depression with occupational reintegration, function, quality of life and coping., Conclusion: Patients with sarcomas of the lower limb have a higher demand for postoperative rehabilitation and need more help in the postoperative occupational reintegration. Furthermore patients that underwent limb-preserving operations reported better postoperative function and quality of life. Risk assessment using patient-specific factors and an intensive psychological co-treatment may have a large role in the co-treatment of patients from the beginning of their cancer therapy.

Introduction: Few case reports describe the development of a hematoma under oral anticoagulation as the cause of an atraumatic carpal tunnel syndrome., Case Report: A 76 years old woman presented an acute atraumatic carpal tunnel syndrome of her left hand under oral anticoagulation with rivaroxaban due to atrial fibrillation. 12 years ago, palmar plate osteosynthesis of a distal radius fracture had been performed on the affected wrist. Open decompression of the carpal canal was performed due to persistent severe pain under intense pain therapy and progressive neurological symptoms. The cause of the pain was a hematoma due to a rupture of the flexor pollicis longus and the second flexor digitorum profundus tendon with concomitant synovitis at the plate's distal rim. After decompression, pain relieved and neurological deficits improved rapidly., Discussion: Ruptures of the flexor tendons occur in palmar plate osteosynthesis in up to 1.5% in the long term postoperative course. Very distal plate positions, like in this case, increase that risk. Under anticoagulation, the rupture induced a hematoma increasing local pressure resulting in an acute carpal tunnel syndrome. Acute nerve compression syndromes should be treated surgically without delay., Conclusion: Therapy with anticoagulants may increase hematoma after tendon rupture, thus supporting the development of an atraumatic acute carpal tunnel syndrome and complicating the surgical therapy. Hardware removal after fracture healing should be advised in patients with Soong grade 2 plate positions especially those taking anticoagulants.

Desmoid tumors are fibroblastic neoplasms that have an intermediate behavior with a highly aggressive infiltrative growth arising from deep muscle or aponeurosis. We present the case of a 34-year-old woman that developed a painless mass in the right popliteal fossa during pregnancy after intracytoplasmic sperm injection and hormonal therapy. The MRI scan showed a hyperintense mass of 6,7 cm × 4,7 cm × 3,8 cm surrounding the lateral head of the gastrocnemius muscle. The open biopsy was done one week after delivery, and the histology showed a desmoid tumor. We performed the resection one week later and found the common peroneal nerve completely surrounded by the tumor. The close resection due to the neurolysis was the reason why an adjuvant radiation with 56 Gy was done. The last clinical examination, 18 month later, did not show any signs of recurrence and an excellent functional outcome. This case demonstrates the possible influences of pregnancy and hormonal therapy on the evolution of desmoid tumors.