{"title":"Bone and soft tissue tumours: non-surgical management","authors":"Lesley Speed","doi":"10.1016/j.mporth.2025.03.004","DOIUrl":"10.1016/j.mporth.2025.03.004","url":null,"abstract":"<div><div>The majority of patients with a malignant bone lesion will have bone metastases from a distant primary tumour. This could be present at the time of diagnosis of malignancy or develop later in the course of the disease. Some primary tumour types are more likely than others to develop bone secondaries. This common clinical problem requires a multidisciplinary approach in order to reduce skeletal events and symptoms for patients, and maintain their quality of life. Almost all patients with metastatic bone disease will have incurable cancer and this needs to be acknowledged when considering treatment options. Conversely primary malignant bone tumours are relatively rare conditions that need to be managed by specialist centres, often requiring intensive multimodality, multi-professional treatment. Patients with localized disease can be cured but there remains a high risk of both local recurrence and metastases. Soft tissue sarcomas will often require radiotherapy and surgical treatment as primary management. Chemotherapy plays more of a role when treating metastatic disease.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 157-164"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138504","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}
Farhan Eitezaz, Kathryn H Steele, Nicholas Eastley
{"title":"Soft tissue sarcomas for trauma and orthopaedic exam candidates","authors":"Farhan Eitezaz, Kathryn H Steele, Nicholas Eastley","doi":"10.1016/j.mporth.2025.03.002","DOIUrl":"10.1016/j.mporth.2025.03.002","url":null,"abstract":"<div><div>Soft tissue sarcomas (STS) represent a diverse group of malignant tumours for which surgery is the cornerstone of curative treatment. All STS patients should be managed by a specialized sarcoma multidisciplinary team (MDT). For non-metastatic STS, the surgical aim of treatment is the wide excision of the tumour. Amputations are infrequently employed as a first-line treatment, although may be required in complex or recurrent cases. Wound complications following STS surgery are not uncommon, and reconstructive surgery is key to promote healing. Radiotherapy may be utilized for large, high-grade STS, or those close to essential anatomical structures that necessitate a marginal resection. This radiotherapy may be delivered pre- (neoadjuvant) or post- (adjuvant) operatively, with the aim of reducing local recurrence rates. Systemic treatments such as chemotherapy are generally not utilized for localized STS, other than for a few, specific subtypes. In metastatic patients, systemic treatment may be employed with palliative intent. The management of localized STS recurrence follows the same principles as those of primary disease, with emphasis placed on re-staging all patients to rule out metastatic disease. Long-term patient follow-up is crucial to detect disease recurrence (local or systemic) and any significant treatment-related complications.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 144-150"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138502","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}
Thomas DA Cosker, Christopher Anthony, Raja Bhaskara Rajasekaran, Christopher LMH Gibbons
{"title":"Surgical management of primary bone sarcomas","authors":"Thomas DA Cosker, Christopher Anthony, Raja Bhaskara Rajasekaran, Christopher LMH Gibbons","doi":"10.1016/j.mporth.2025.03.003","DOIUrl":"10.1016/j.mporth.2025.03.003","url":null,"abstract":"<div><div>This article aims to address the principles of surgical treatment of primary bone sarcomas including chondrosarcoma, osteosarcoma and Ewing's sarcoma of bone. This piece aims to serve as a guide to experienced orthopaedic surgeons who have limited knowledge of managing musculoskeletal tumours especially primary bone sarcomas. Important principles surrounding surgery involving bone sarcomas, principles of biopsy of such lesions and reconstruction techniques have been discussed. Limb salvage is the expectation in today's era and though endoprosthesis replacement is an important tool in a surgeon's armoury, biological methods of reconstruction have also shown to be effective in many settings. Chemotherapy and radiotherapy are vital adjuvant therapies associated with these sarcomas, and they have been discussed in this article.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 151-156"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138503","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":"Recent advances in metastatic bone disease","authors":"Jason Mavrotas, Amit Kumar","doi":"10.1016/j.mporth.2025.03.005","DOIUrl":"10.1016/j.mporth.2025.03.005","url":null,"abstract":"<div><div>Metastatic bone disease (MBD) is a common sequela of malignancy and can lead to significant morbidity on patients. Systemic medical therapies and oncology surgery have greatly enhanced cancer survival rates over recent decades. Orthopaedic surgeons occupy a key position within the multidisciplinary team and coordinate surgical care for bone metastases where appropriate. This review describes the investigations for, and management of, patients with metastases to the appendicular skeleton. National British Orthopaedic Association Standard (BOASt) guidelines exist to help orthopaedic clinicians and departments optimize patient care. We outline and illustrate the freely available OPTIModel app, which is an innovative, straightforward and useful tool for prognostic evaluation and suggestion of loco-regional treatment options for patients with symptomatic long bone metastases.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 172-183"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137719","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 basic science of musculoskeletal tumours","authors":"Kenneth S Rankin","doi":"10.1016/j.mporth.2025.03.006","DOIUrl":"10.1016/j.mporth.2025.03.006","url":null,"abstract":"<div><div>The basic science of musculoskeletal tumours is a complex subject and has been historically related to pathological descriptions of the lesions. Our understanding of these conditions has increased rapidly with the advent of genetic sequencing and molecular diagnostic techniques. This article covers the main topics and touches on the relevant research strategies which seek to open up further management options, particularly for the sarcomas.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 184-190"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137720","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":"Amputations of the lower limb: an overview of principles with surgical tips and advances","authors":"Heledd Havard, Sanjay Gupta","doi":"10.1016/j.mporth.2025.04.001","DOIUrl":"10.1016/j.mporth.2025.04.001","url":null,"abstract":"<div><div>Amputations are an operation that can strike fear into the heart of a trauma and orthopaedic surgeon with a sense of doom and gloom on occasion for both the surgeon and the patient. At one extreme there may be the emergency life-saving setting, and on the other the more controlled elective setting often following multiple attempted limb-salvage procedures. Either way, there can be a feeling of failure at the end of the treatment road. This need not be the case. Patients coming out of a protracted treatment pathway sometimes wonder why they did not have the limb removed sooner and are usually grateful for the sense of freedom that the operation has given them. This review aims to provide a brief historical perspective through to an update on current techniques with a dedicated discussion around osseointegration. There are suggested techniques, that will provide at the very least a refresher or indeed an alternative thought process to approach both the operation and the patient. Amputations are often the beginning of a new life, but not necessarily the end of the old one.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 165-171"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138505","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":"Benign and intermediate soft tissue tumours for trauma and orthopaedic exam candidates","authors":"Thomas Robert William Ward, Nicholas Eastley","doi":"10.1016/j.mporth.2025.03.001","DOIUrl":"10.1016/j.mporth.2025.03.001","url":null,"abstract":"<div><div>A soft tissue swelling is a common clinical presentation, and although the majority of causes are benign, an intermediate or malignant diagnoses must be ruled out. A thorough history and examination are key to highlight any red flags such as rapid growth, a large tumour size (>5 cm), a deep location, pain or recurrence. These flags should be investigated thoroughly, and if there is any diagnostic uncertainty patients should be discussed with a sarcoma multidisciplinary team (MDT) prior to treatment, and biopsy considered. The inadvertent resection of a malignant soft tissue sarcoma (termed a ‘whoops’ procedure) must be avoided at all costs. Ultrasound is a cheap and easily accessible first-line imaging modality that in specialist hands can identify or rule out aggressive features accurately. Magnetic resonance imaging is the gold standard cross-sectional imaging modality for soft tissue tumours, and allows a detailed anatomical assessment key for surgical planning. Most benign lesions can be managed conservatively or with active surveillance, although symptomatic patients may benefit from a surgical excision. Intermediate tumours should be managed in conjunction with a sarcoma MDT given their rarity and complexity, and will usually require an excision.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 138-143"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138501","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":"CME questions on Orthopaedic Oncology","authors":"","doi":"10.1016/j.mporth.2025.03.008","DOIUrl":"10.1016/j.mporth.2025.03.008","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Pages 191-192"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137721","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":"Answers to the CME questions on Major Trauma","authors":"","doi":"10.1016/j.mporth.2025.03.007","DOIUrl":"10.1016/j.mporth.2025.03.007","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 3","pages":"Page 193"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137723","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":"Management of the spine in the polytrauma victim","authors":"M Zaki B Choudhury, Athanasios I Tsirikos","doi":"10.1016/j.mporth.2025.01.002","DOIUrl":"10.1016/j.mporth.2025.01.002","url":null,"abstract":"<div><div>Major trauma is a common occurrence globally and a leading cause of death in younger patients. Its definition and epidemiology is described in depth elsewhere in the symposium. In the UK there are approximately 22,000 cases presenting per year. Overall management strategy dictates that major trauma is directed to centres experienced in its management. It is, however, important that all clinicians recognize and are aware of it, with implications for resource utilization. The spine can be injured through a variety of mechanisms but importantly in major trauma it is unusual for the spine to be injured in isolation, unless a direct impact is sustained. Conversely, it is critical to be aware of the possibility of vertebral and spinal cord injury which may be masked by distracting injury. Strategies and guidelines for the management of the spine in major trauma will be discussed, and some case examples will be shown in order to demonstrate key concepts and pitfalls.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 95-104"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791582","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}
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
