Romanian Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Reconstructive Surgery in Nose Tumors","authors":"S. Parasca, B.F. Iosif, A. Costeschi, O. Popescu, M. Roznovanu","doi":"10.2478/rojost-2018-0057","DOIUrl":"https://doi.org/10.2478/rojost-2018-0057","url":null,"abstract":"Abstract Introduction. Cutaneous malignancies localized on the nasal pyramid are one of the most frequent non-melanocytic skin cancers with a great psychosocial impact. A predominant pathology of the elderly is distinguished by slow development, with a tendency to ulceration and addressability to medical services in advanced local stages. Reconstruction after oncologic intervention is diverse, locoregional flaps, grafting, and simple direct sutures can be made, the case per se dictating the appropriate attitude. The variables to be considered are location, size of the remaining defect and quality of potential donor areas. The following are also taken into account: reduction of morbidity, increasing quality of life, patient’s psychological impact. Materials and methods. 7 cases of basocellular carcinoma of the nose addressed between 2017- 2018 are described throughout an observational analysis based in the Emergency Hospital for Plastic Reconstructive Surgery and Burncare in Bucharest, referred to by various reconstructive methods, depending on the particularities encountered. Locoregional flaps-bilobed, nasogenian, frontal, dorsal nasal - as well as full-thickness skin grafts and simple direct sutures were performed. Results. Carcinoma excision was complete and safety margins were confirmed histopathologically. Evolution of postoperative patients was favorable without complications. Conclusion. There are numerous surgical options for repairing nose defects. Oncological radicality and satisfactory aesthetic and functional outcome are the main objectives in choosing the method. The aims of reconstructive surgery are functionality of the nose, aesthetic appearance with finer scars, preserving the aesthetic subunits of the nose, but also the relationship with the neighboring structures.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133388574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Denosumab Treatment in a Rare, Neglected Giant Cell Tumor (GCT) of the Femoral Neck: Case Report and Literature Review","authors":"R. Marinescu, D. Lăptoiu, I. Botezatu, S. Ciumeica, A. Bunea, G. Stefan","doi":"10.2478/ROJOST-2018-0074","DOIUrl":"https://doi.org/10.2478/ROJOST-2018-0074","url":null,"abstract":"Abstract Introduction. GCT resembles an aggressive benign tumor of bone and its evolution based on the histological features is unpredictable. About 50% of the cases are located around the knee (proximal femur and distal tibia), with the proximal humerus and distal radius representing the third and fourth most common sites. Femoral neck location is unusual. We report a case of GCT located at the femoral neck level, in a 19-year-old female. Case presentation. Onset was hidden by pathologic femoral neck fracture and, due to insidious symptoms, proper diagnosis and treatment were neglected for almost six months. After 6 months, the case was referred to our clinic and re-evaluated with complete examination and biopsy. Wide resection and tumoral arthroplasty of the hip was performed. Postoperative complete recovery was achieved and the patient returned to previous activities. After 2 years of normal clinical evolution, a neurological severe issue appeared; at this time, a cerebral metastasis was diagnosed. Once the positive diagnosis was achieved, 120 mg Denosumab treatment was initiated monthly. At 16 months follow-up, the patient was symptom free and continued Denosumab treatment. Discussion. Denosumab is a human monoclonal IGG2 antibody inhibiting osteoclast differentiation, activation, and survival with applicable suppression of bone turnover in patients with multiple myeloma, osteolytic bone disease, and bone metastases from breast and prostate cancer. It is also a useful drug for managing the GCT of bone and one excellent option in metastatic GCT. The long time safety and complications, especially in young female patients, are to be proven. Conclusions. Early diagnosis and accurate management of GCT are mandatory in order to achieve good long-term clinical results. Denosumab treatment may be necessary in order to avoid secondary metastasis or local recurrence.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131660715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modular Reconstruction Systems – Final Solution for Critical Bone Defects Treatment","authors":"M. Nica, R. Ene, Z. Panti, M. Popa, M. Pleniceanu, M. Cirstoiu, C. Cirstoiu","doi":"10.2478/ROJOST-2018-0024","DOIUrl":"https://doi.org/10.2478/ROJOST-2018-0024","url":null,"abstract":"Abstract Introduction. The management of critical bone defects has experienced an unprecedented improvement in the last few decades. A good primary mechanical stability and versatility of the modular reconstruction systems allowed the conversion to universal setups and the expansion of indication. The progression and reliability of the reconstruction possibilities available nowadays are outlined using the experience of our department. Material and method. A retrospective review of critical bone defect cases and the reconstruction management using endoprosthetic systems is presented. Ten reconstruction surgeries performed in the last 18 months in our department were observed. The patients were 3 males and 7 females with a mean age of 45.3 (range 19 to 75). Modular systems were used for the reconstruction of bone defects subsequent to resections of benign or malignant musculoskeletal tumors (76%) and to non-neoplastic conditions (24%). Results. On the latest follow-up, all the patients were alive, with one case of tumoral recurrence. No aseptic loosening, soft tissue or structural failure were recorded following surgery, with one case under treatment for infection after it required an open procedure for a prosthetic hip dislocation. The early functional results were adequate in all cases, with good secondary stability and satisfactory quality of life. Conclusion. The evolution of endoprosthetic reconstruction surgery has improved the prognosis for many patients diagnosed with critical bone defects. Continuous advances in implant design, fixation, and soft tissue attachment combined with the improvement of surgical techniques will ensure a bright future for this type of procedures.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129473955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft Tissue Sarcomas of Extremities - MRI Role in the Diagnostic Evaluation","authors":"A. Bratu, I. Sălcianu, C. Zaharia, G. Iana, A. Marinescu","doi":"10.2478/rojost-2018-0056","DOIUrl":"https://doi.org/10.2478/rojost-2018-0056","url":null,"abstract":"Abstract Introduction. Soft tissue sarcomas (STS) are rare entities of soft tissue cancers. Their incidence is low, of only 1% of the malignant tumors. In terms of localization, most of the STS affect the extremities, and their incidence is much higher in children than in adults. Material and method. The present paper is a retrospective study that includes tumors with lower limb localizations, including the bony pelvis, over a 3-year period (2013-2016). The study group consisted of 29 patients who, following the MRI examination, were diagnosed with softtissue tumors. Of the 29 patients, 17 patients had a MRI (magnetic resonance imaging) and an anatomopathological diagnosis of leiomyosarcoma. The location of the tumor, its characteristics, and the relationship with the adjacent anatomical structures were analyzed in all cases. Results. The ages of the final group of 17 patients ranged between 28 and 84 years, with female predominance. In terms of localization, one showed a muscle tumor in the pelvis, namely left oblique muscle, other cases being located in the thigh and knee. A special importance was given to the superficial and profound location. In 5 cases, the tumor was localized in subcutaneous fatty tissue, thus superficial. In terms of the contours of the tumor, well-defined margins were present in 11 cases, and poorly defined contour in 6 cases. Regarding the size, the leiomyosarcomas in our study had dimensions between 5.2 cm and 18 cm, and their structure was inhomogeneous, with the presence of necrosis and calcifications. Necrosis was found in 14 cases, and calcifications were present in 68%, being more frequent than necrosis. Except for the necrotic areas, the contrast enhancement was intense. Conclusions. Although the diagnosis is always histopathological, the MRI plays an important role in defining a precise localization and tumor characteristics.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125660219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of extreme genu varum and genu valgum on postoperative outcomes using mini-subvastus approach in TKA","authors":"B. Crețu, C. Dragosloveanu, D. Cotor, Ș. Dragosloveanu, C. Stoica","doi":"10.2478/rojost-2018-0008","DOIUrl":"https://doi.org/10.2478/rojost-2018-0008","url":null,"abstract":"Abstract Increasing interest in using minimally invasive approaches in TKA has led to the question: how much deformity is accepted for using MIS in TKA? A single surgeon performed 87 consecutive TKAs with mini-subvastus approach, using unconstrained prosthesis in 84 knees and constrained prosthesis in 3 knees. We conducted a prospective study in which patients were divided into two groups according to preoperative tibiofemoral axes (TFM), one group with 160°<TFM<195° and the second group with 160°≥TFM≥195°. Clinical and radiographic outcomes were compared. Postoperative ROM and knee score were improved in both groups, with similar results (p<0.01). Postoperative radiographic analyses showed that TFM was improved in both groups (p<0.01) with the coronal alignment inferior in 160°≥TFM≥195° group than the 160°<TFM<195° group. The results of this study suggest that mini-subvastus approach is a proper technique to use in primary TKA in patients with a TFM angle less than 160° and more than 195° with similar results with TFM angle between 160° and 195°, and for the use of constrained prosthesis designs with promising results. Preoperative TFM angle less than 160° and greater than 195° increases the risk of component malposition in coronal plane.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122636051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Neoplasms of Bone and Articular Cartilage –Hospital Burden in Romania","authors":"D. Mincă, C. Cirstoiu, F. Furtunescu, R. Costea","doi":"10.2478/rojost-2018-0054","DOIUrl":"https://doi.org/10.2478/rojost-2018-0054","url":null,"abstract":"Abstract Introduction. Cancers of bone and articular cartilage are relatively rare, and a global analysis was not performed up to present in Romania due to the lack of a national registry for these diseases. This study aimed to explore the hospital burden due to malignant neoplasm of bone and articular cartilage in Romania and the general characteristics of the hospitalized cases. Materials and methods. We used the data reported in the routine statistic system during 2012 and 2016 and we analyzed the number of cases discharged from hospitals by age group, gender, and duration of hospitalization. Results. The number of hospitalized cancers of bone and articular cartilages decreased by 17% in the last five years (2012-2016) but this decrease was higher in other/ unspecified cancers (22%) and lower in limb cancers (10%). Among the 1872 cases reported in 2016, 47% were limbs’ cancers and the rest, cancers of others/ unspecified sites. Males accounted for 62% of all cancers (58% of limbs cancers and 65% of other cancers, p=0.001, Chi2 test). Distribution by age showed that 17%, 62% and 21% of the cancers occurred in age-groups 0-14, 15-64 and 65+ respectively, but limbs cancers occurred in a significantly higher proportion in children (29% vs. 7% of other cancers, p<0.001). 16983 days of hospitalization were reported in 2016 for this pathology, with an average length of stay of 9.07 days (9.37 and 8.81 days in limbs and other cancers respectively). Conclusions. More detailed analysis of routine reported data is required for understanding the characteristics and trends of bone cancers in Romania.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114213792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scapular Metastasis by Rcc. Case Presentation","authors":"A. Nicula, A. Marinescu, G. Iana","doi":"10.2478/rojost-2018-0034","DOIUrl":"https://doi.org/10.2478/rojost-2018-0034","url":null,"abstract":"Abstract Bony metastasis is a frequent occurrence in malignancies. We present the case of a 75-year-old male patient who was investigated for a lytic lesion in the right scapula and was eventually diagnosed with metastatic renal cell carcinoma (RCC). The main indications for embolization are reducing the risk of bleeding during and after surgery of hypervascular tumors, simplifying the manipulation of tumors, palliation of pain, bleeding, fever, and hypercalcemia-like symptoms in inoperable tumors, preventing further dissemination of a tumor, and increasing the response to chemotherapy and radiotherapy. Embolization may be a therapeutic alternative to surgery in cases in which surgery is inappropriate or associated with high risk. In the case presented, CT examinations had a crucial role both in the diagnostic orientation and in the subsequent therapeutic decisions and proper monitoring under therapy.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124509009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Approach in the Treatment of Malignant Bone Tumors","authors":"L. Marinca, D. Pop, O. Moraru, I. Stoica","doi":"10.2478/rojost-2018-0059","DOIUrl":"https://doi.org/10.2478/rojost-2018-0059","url":null,"abstract":"Abstract Introduction. There are two types of tumor lesions at bone level: primary tumors and bone metastasis. These lesions cause a decrease in the structural strength of the bone that may lead to fracture. The goal of the orthopedic treatment is to resect the tumor, alleviate symptomatology, and restore the function of the limb. The orthopedic treatment consists of two phases: tumor resection and limb reconstruction. Treatment of such lesions implies extensive preoperative investigations to determine the local and general extent of the tumor and procedures aimed to facilitate resection. Case presentation. We present the case of a 58-year-old male, diagnosed with clear cell renal carcinoma three years before and treated by nephrectomy. Two months after surgery, the patient started reporting moderate pain in the hip, which gradually intensified. He was first seen in Foişor Hospital in December 2018 when a pathologic bone fracture in the trochanteric region of the right femur was discovered at the radiologic exam. This was supposed to be a bone metastasis from the previously operated renal cell carcinoma. The MRI investigation showed the presence of a large, polylobed bone tumor with an inhomogeneous structure, sized 80/ 72/ 82 mm extending in the adjacent soft tissue. Bone scintigraphy of entire skeleton revealed no other lesions and abdominal MRI exam revealed neither the recurrence of the tumor or the presence of abdominal metastasis. Significant vascularization of the tumor, from branches of the deep femoral artery, was evidenced on the Angio Computer Tomography. Due to the known profuse bleeding of such lesions, an angiography with embolization was also performed. Embolization was done with PVA particles, with a lack of post-embolization load. The Angio Computer Tomography scan performed at three weeks after embolization showed a reduction in size of the tumor. In March 2018 patient underwent bone resection and reconstruction with a G.M.R.S. tumor prosthesis. Resection was performed in a complex team involving also two vascular surgeons. The pathology exam confirmed it was a renal cell carcinoma bone metastasis. Results. At one week after the surgical procedure, the operative wound was healing, the patient had no pain, and he was gradually regaining ambulation. Conclusion. Surgical treatment of such neoplastic pathology is difficult and involves a multidisciplinary approach consisting of disciplines such as oncology, orthopedics, vascular surgery, and pathology. It also implies a significant contribution from radiology and interventional radiology.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124680385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Treatment of Malignant Tumors of Long Bones","authors":"G. Stan, H. Orban, N. Gheorghiu, M. Drǎguşanu","doi":"10.2478/rojost-2018-0064","DOIUrl":"https://doi.org/10.2478/rojost-2018-0064","url":null,"abstract":"Abstract Introduction. With the advances in chemotherapy, the life expectancy of patients with malignant tumors of bones begins to rise and creates the opportunity for a more conservative treatment of such cases. The main complications after using reconstruction with bone graft are represented by mechanical failure, due to the lack of strong fixation, or biological failure of graft integration. Infection is another complication, patients being usually immunosuppressed. The aim of this study was to investigate a retrospective single center experience of surgically treated malignant bone tumors of long bones, respectively oncological, surgical, and functional outcome differences after biological reconstruction. Materials and methods. Between 2007 and 2017, we conducted a retrospective study, with patients from Elias Orthopaedic Department. 70 patients with malignant tumors were treated. Only in 20 cases, resection-reconstruction was possible. Results. Survival rate at 8-year follow up was 35%. Mechanical failure rate was 20%, graft resorption rate was 25%, and infection rate was 15%. Discussion. Primary malignant tumors of bones are very rare, less than 1% of cancer cases, and yet there is no strict rule for treating these patients in specialized centers. Because of the small sample of patients, the heterogeneity of reconstruction methods and multiple types of grafts, this study also had some limitations. The mechanical or biological complication rate is higher in resectionreconstruction cases. Non-unions, fractures and infections are the most common complications.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121600018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Giant-Cell Tumors of the Distal Epiphysis of the Radius","authors":"D. Rădulescu, A. Bădilă, O. Nutiu, R. Manolescu, T. Ciobanu, I. Japie, R. Rădulescu","doi":"10.2478/ROJOST-2018-0030","DOIUrl":"https://doi.org/10.2478/ROJOST-2018-0030","url":null,"abstract":"Abstract Introduction. Giant-cell tumor of the bone is a benign tumor, but with high local aggressiveness, even with risk of remote metastasis. Material and methods. We present the case of a 57-year-old woman, without significant pathological history, who, after clinical, imagistic and anatomopathological investigations, was diagnosed with giant cell tumor of the right distal radius. The patient underwent surgery and due to the size of the tumor and destruction of the surrounding cortical bone, segmental resection of the tumor in oncological limits was performed. The bone defect was filled with the proximal one third of the ipsilateral fibula, fixed to the remaining radius diaphysis with a plate and screws. Also, the autograft was stabilized to the proximal row of the carpal bones with 2 k-wires for 6 weeks. Postoperatively, clinical and X-ray check-ups were performed at 6, 12, 24 weeks and 1 year after surgery. Results. According to Mayo functional assessment score, the results were good. At 1 year after surgery, the patient gained 85 points, representing a good functional outcome of the surgery. This way, the wrist joint mobility and the carpal cartilage were preserved, providing a barrier against distal migration of any remaining tumoral cells, as well. Conclusions. It can be stated that in aggressive giant cell tumors located at the distal radius, the best therapeutic option is a segmental resection of the lesion followed by the replacement of the bone defect with a proximal fibular autograft. This method provides the best postoperative functional results with a lower risk of local recurrence and does not require microvascular surgery or access to a bone bank.","PeriodicalId":122325,"journal":{"name":"Romanian Journal of Orthopaedic Surgery and Traumatology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122142529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}