Advances in Orthopedics最新文献

{"title":"Operative Fixation of Pediatric Forearm Fractures: Does the Fracture Location Matter?","authors":"Ahmed Elabd,&nbsp;Ramy Khalifa,&nbsp;Zainab Alam,&nbsp;Ehab S Saleh,&nbsp;Ahmed M Thabet,&nbsp;Amr Abdelgawad","doi":"10.1155/2021/9973449","DOIUrl":"https://doi.org/10.1155/2021/9973449","url":null,"abstract":"<p><strong>Background: </strong>Flexible intramedullary nails (FNs) are successfully used to treat pediatric forearm fractures, especially midshaft fractures. Distal forearm fractures have been described as \"difficult to manage\" with FN insertion. The purpose of this study was to report the clinical and radiographic outcomes of using flexible nails in pediatric forearm fractures and the impact of fracture location on the outcome of the procedure.</p><p><strong>Methods: </strong>This is a retrospective review of pediatric patients who presented with forearm fractures that were surgically treated with flexible nails between 2009 and 2018. Patient demographics, fracture location, and classification were reported. Intraoperative and postoperative complications were reported. The primary outcomes were fracture radiographic union, intraop and postop complications, and the need for additional surgical procedures.</p><p><strong>Results: </strong>Fifty-nine patients were included, with a mean age of 11 years. All fractures healed with patients regaining full range of motion. The authors were able to use flexible nails successfully in 48/59 (81%) patients. In eleven cases (19%), FN fixation was not able to provide adequate fixation to maintain reduction. The method of fixation was changed from FN insertion to another method in nine cases. In two cases, FN fixation was augmented with another fixation method. Fractures within 3 inches of the distal articular surface were at a higher risk of intraoperative change/augmentation of the fixation method (29%) compared with fractures that occurred more than 3 inches from the distal articular surface (11%).</p><p><strong>Conclusion: </strong>The majority of pediatric forearm fractures can be treated successfully with flexible nails. Surgeons involved in treating these fractures should pay attention to distal third fractures. Stabilizing the distally located fractures using FN fixation can be challenging. Surgeons should be prepared to use an alternative fixation method when needed.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"9973449"},"PeriodicalIF":1.3,"publicationDate":"2021-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8541845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39560601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic Topical Antibiotics in Fracture Repair and Spinal Fusion.","authors":"Eric K Kim,&nbsp;Claire A Donnelley,&nbsp;Madeline Tiee,&nbsp;Heather J Roberts,&nbsp;Ericka Von Kaeppler,&nbsp;David Shearer,&nbsp;Saam Morshed","doi":"10.1155/2021/1949877","DOIUrl":"10.1155/2021/1949877","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this systematic review with meta-analysis is to determine whether prophylactic local antibiotics prevent surgical site infections (SSIs) in instrumented spinal fusions and traumatic fracture repair. A secondary objective is to investigate the effect of vancomycin, a common local antibiotic of choice, on the microbiology of SSIs.</p><p><strong>Methods: </strong>An electronic search of PubMed, EMBASE, and Web of Science databases and major orthopedic surgery conferences was conducted to identify studies that (1) were instrumented spinal fusions or fracture repair and (2) had a treatment group that received prophylactic local antibiotics. Both randomized controlled trials (RCTs) and comparative observational studies were included. Meta-analysis was performed separately for randomized and nonrandomized studies with subgroup analysis by study design and antibiotic.</p><p><strong>Results: </strong>Our review includes 44 articles (30 instrumented spinal fusions and 14 fracture repairs). Intrawound antibiotics significantly decreased the risk of developing SSIs in RCTs of fracture repair (RR 0.61, 95% CI: 0.40-0.93, <i>I</i> ² = 32.5%) but not RCTs of instrumented spinal fusion. Among observational studies, topical antibiotics significantly reduced the risk of SSIs in instrumented spinal fusions (OR 0.34, 95% CI: 0.27-0.43, <i>I</i> ² = 52.4%) and in fracture repair (OR 0.49, 95% CI: 0.37-0.65, <i>I</i> ² = 43.8%). Vancomycin powder decreased the risk of Gram-positive SSIs (OR 0.37, 95% CI: 0.27-0.51, <i>I</i> ² = 0.0%) and had no effect on Gram-negative SSIs (OR 0.95, 95% CI: 0.62-1.44, <i>I</i> ² = 0.0%).</p><p><strong>Conclusions: </strong>Prophylactic intrawound antibiotic administration decreases the risk of SSIs in fracture surgical fixation in randomized studies. Therapeutic efficacy in instrumented spinal fusion was seen in only nonrandomized studies. Vancomycin appears to be an effective agent against Gram-positive pathogens. There is no evidence that local vancomycin powder is associated with an increased risk for Gram-negative infection.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"1949877"},"PeriodicalIF":1.3,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39552458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder Arthrodesis versus Upper Trapezius Transfer for Traumatic Brachial Plexus Injury: A Proportional Meta-Analysis.","authors":"Dafang Zhang, Rohit Garg, Brandon E Earp, Philip Blazar, George S M Dyer","doi":"10.1155/2021/4445498","DOIUrl":"10.1155/2021/4445498","url":null,"abstract":"<p><p>Shoulder arthrodesis and upper trapezius transfer are two surgical options for secondary shoulder reconstruction for traumatic brachial plexus injury (BPI). There is a lack of comparative evidence to guide the choice for one procedure over the other. The objectives of this study were to compare (1) rates of complications and reoperation and (2) shoulder range of motion and functional outcome scores following shoulder arthrodesis versus upper trapezius transfer for traumatic BPI. A systematic review and meta-analysis were conducted by a search of four databases of studies assessing shoulder arthrodesis and/or upper trapezius transfer for shoulder reconstruction following adult traumatic BPI. A proportional meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The final meta-analysis included 374 patients from 17 studies, including 232 patients from 11 studies on shoulder arthrodesis and 142 patients from 6 studies on upper trapezius transfer. Shoulder arthrodesis had higher rates of complications and reoperations than upper trapezius transfer for traumatic BPI, but these differences did not reach a statistical significance. Due to the limited sample size, variations in reporting, and study heterogeneity in the published literature, we were not able to draw conclusions regarding shoulder range of motion and functional outcome scores between these two procedures. Shoulder arthrodesis and upper trapezius transfer are both viable options for secondary shoulder reconstruction for traumatic BPI, but with different complications and reoperation profiles. Patients should be counseled on the risk of nonunion and humerus fracture following shoulder arthrodesis.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"4445498"},"PeriodicalIF":1.3,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39552459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutionally Adopted Perioperative Blood Management Program Significantly Decreased the Transfusion Rate of Patients Having Primary Total Hip Replacement Surgery.","authors":"Hargita Dömötör,&nbsp;Ádám L Varga,&nbsp;Róbert Sződy,&nbsp;Ferenc Tóth,&nbsp;Gábor Nardai","doi":"10.1155/2021/2235600","DOIUrl":"https://doi.org/10.1155/2021/2235600","url":null,"abstract":"<p><p>Perioperative transfusion in patients undergoing orthopedic surgery increases the number of postoperative complications. Thus, we have introduced an institution-tailored perioperative blood management program (PBM) to decrease the amount of blood transfused in patients going through primary total hip replacement (THR) surgery. We have conducted a before-after observational cohort study in two predetermined observational periods. Demographic and clinical data, ASA scores, laboratory parameters, features of surgical procedure, and anesthesia were registered. Parameters of perioperative fluid administration, transfusion rate, and postoperative complications were also assessed. One hundred patients in the first and 108 patients in the second observational period were enrolled. Eventhough the ratio of posttraumatic THR procedures increased (9% vs. 17%), the PBM protocol has been utilized effectively and a significant decrease in perioperative blood transfusion rate has been observed (61% vs. 21%). The abolishment of routine preoperative LMWH prophylaxis (90% vs. 16%), intraoperative use of tranexamic acid (10% vs. 84%), and the encouraged exploitation of our postoperative observational facility (5% vs. 39%) were abided by our colleagues. Patients still requiring transfusion had lower preoperative hemoglobin levels (129 vs. 147 g/l), scored higher in ASA (ASA III: 46% vs. 19%), and more often presented postoperative hypotension (40% vs. 7%), oliguria (23% vs. 5%), and infections (9% vs. 2%). We conclude that the individualized perioperative blood management protocol was successfully implemented and yielded a lower transfusion rate and better outcomes. Our study suggests that a partial, institution-tailored PBM program may be suitable and beneficial in countries where the modalities of perioperative blood management are limited.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"2235600"},"PeriodicalIF":1.3,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39503036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Total Hip Arthroplasty Comparison in FNF and OA Patients.","authors":"Jakub Szczesiul,&nbsp;Marek Bielecki","doi":"10.1155/2021/5563500","DOIUrl":"10.1155/2021/5563500","url":null,"abstract":"<p><strong>Background: </strong>Worldwide, total hip arthroplasty (THA) has become one of the most commonly performed surgical procedures. Femoral neck fracture (FNF) and osteoarthritis (OA) are two of the medical conditions necessitating a hip replacement, most frequently carried out. The preoperative and postoperative pathways for patients suffering from these two diseases differ, yet worldwide, many national healthcare systems underestimate or misinterpret the (more than nuanced) care plan differences of the two. <i>Factors and Criteria</i>. Analyzed material was gathered from studies published between 2013 and 2019. Various strands of data demographics, comorbidities, and complications, as well as treatment outcomes, were tabulated to compare and contrast THA patients suffering from FNF and OA to collate their findings. Outcomes were cross-checked and validated for reliability and then were presented in a table format.</p><p><strong>Results: </strong>All five retrospective cohort studies fitted the required criteria for inclusion in this work, four US-based study groups and one European-based study group. Data were gathered from three separate databases. The \"average\" FNF patient is 76.8 years old. There was a 68.96% female probability. The \"average\" OA patient is 69.15 years old. There was a 5.24% female probability. 59.57% operated for athrosis, and only 34.63% operated for fracture which received grade lower than the third in the American Society of Anaesthesiologist (ASA) classification. There was more than 3 times higher prevalence of complications in the trauma group. FNF patients' hospitalization was approximately 3 days longer. On average, 3.7% of patients operated for trauma and 1.5% of patients with elective THA required a second surgery. 6.57% FNF and 2.93% OA patients had unplanned readmission.</p><p><strong>Conclusions: </strong>In general, patients who suffer a femoral neck fracture are an extremely fragile group. They require additional perioperative and postoperative care. To meet these desired expectations, more FNF cost-comprehensive systems need to be initiated.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"5563500"},"PeriodicalIF":1.3,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver and Intraobserver Reliabilities of Three-Dimensional Postoperative Evaluation Software in Total Hip Arthroplasty.","authors":"Kenta Konno,&nbsp;Shigeo Hagiwara,&nbsp;Junichi Nakamura,&nbsp;Yuya Kawarai,&nbsp;Sumihisa Orita,&nbsp;Yawara Eguchi,&nbsp;Seiji Ohtori","doi":"10.1155/2021/3705789","DOIUrl":"https://doi.org/10.1155/2021/3705789","url":null,"abstract":"<p><strong>Background: </strong>In primary and revision total hip arthroplasty, to prevent perioperative complications, the prediction of the optimal implant size is essential. Using three-dimensional computed tomography-based postoperative evaluation software, we explored the accuracy and the precision of measurement of the size, alignment, and position of the prosthetic components after total hip arthroplasty.</p><p><strong>Methods: </strong>Using postoperative evaluation software, the postoperative computed tomography data from 20 hips in 20 patients were evaluated. The component size, alignment, and three-dimensional positioning of the cup and stem were assessed. The concordance rates of the component, repeatability (intraobserver reliability), and reproducibility (interobserver reliability) of postoperative evaluation were calculated. The radiographic inclination and radiographic anteversion of the cup, anteversion, varus-valgus angle, and flexion-extension angles of the stem were measured for alignment. The implant positioning was measured along three axes, namely, <i>X</i>-axis (transverse), <i>Y</i>-axis (sagittal), and <i>Z</i>-axis (longitudinal).</p><p><strong>Results: </strong>The concordance rates of all parts are above 94%. The intraobserver and interobserver intraclass correlation coefficients of alignment measurement were very good for both cup (0.879-0.964) and stem (0.973-0.996). The intraobserver and interobserver intraclass correlation coefficients of cup positioning were very good (0.961-0.987) for all axes. The intraobserver and interobserver intraclass correlation coefficients of implant positioning were very good for the stem (0.879-0.995) for all axes.</p><p><strong>Conclusions: </strong>Computed tomography-based postoperative evaluation software was able to evaluate the size and position of total hip implants with high reproducibility.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"3705789"},"PeriodicalIF":1.3,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery Pathway in Adults Undergoing Elective Posterior Thoracolumbar Fusion Surgery: Outcomes Compared with a Traditional Care Pathway.","authors":"Khalid AlSaleh,&nbsp;Khalid Murrad,&nbsp;Abdulmajeed AlZakri,&nbsp;Osama Alrehaili,&nbsp;Waleed Awwad","doi":"10.1155/2021/6204831","DOIUrl":"https://doi.org/10.1155/2021/6204831","url":null,"abstract":"<p><strong>Introduction: </strong>Spine fusion surgery is an increasingly popular procedure, but the patient experience is variable and the cost is high. Enhanced recovery after surgery (ERAS) pathways can provide a standardized plan for spine fusion cases, improving quality of care and reducing costs. We report an early attempt at the implementation of such a pathway and compare it to a historical cohort.</p><p><strong>Methods: </strong>All adult patients undergoing elective posterior thoracolumbar spine fusion in 2019 and 2020 were included in the study. The ERAS protocol implementation started in January 2020. The study cohort was all cases performed in 2020-after implementation of ERAS-while the historical cohort was cases from 2019. Demographic and clinical data were collected and compared between the groups.</p><p><strong>Results: </strong>Ninety-three patients were included in the study. The study cohort (ERAS) included 42 patients, while the comparison group (pre-ERAS) included 51 patients. Demographic and preoperative clinical data were similar between the two groups. However, postoperative clinical data showed that ERAS resulted in less reliance on analgesics, earlier mobilization, and a reduced length of stay. Complication and readmission rates were unchanged.</p><p><strong>Conclusion: </strong>ERAS can reduce costs while maintaining or improving clinical outcomes for spinal fusion surgery.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"6204831"},"PeriodicalIF":1.3,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Comparison of Inflammatory Cytokines between Spinal and General Anesthesia following Changes in Ischemic Reperfusion due to Tourniquet during Lower Limb Surgery.","authors":"Mahmoud Ganjifard,&nbsp;Samaneh Kouzegaran,&nbsp;Reza Abdi,&nbsp;Mohsen Naseri,&nbsp;Elahe Allahyari,&nbsp;Amir Sabertanha,&nbsp;Batool Zeinali","doi":"10.1155/2021/2027421","DOIUrl":"https://doi.org/10.1155/2021/2027421","url":null,"abstract":"<p><strong>Methods: </strong>In this randomized controlled clinical trial, 34 patients with lower limb surgery admitted at the orthopedic ward of Imam Reza Hospital, Birjand, Iran, were selected by the available sampling method. They were randomly divided into two groups as follows: general anesthesia (<i>n</i> = 17) and spinal anesthesia (<i>n</i> = 17). Venous blood samples were taken from the patients of both groups at baseline (before the use of tourniquet) and 12 and 24 hours after reperfusion. Interleukin-6 (IL-6), tumor necrotizing factor-<i>α</i> (TNF-<i>α</i>), high-sensitivity C-reactive protein (hs-CRP), and ferritin were measured and recorded. The data were analyzed using independent <i>t</i>-test, chi-square, and repeated measure at the significant level of 0.05.</p><p><strong>Results: </strong>The results showed that hs-CRP and IL-6 significantly increased during the study (<i>p</i> < 0.001); however, the mean changes of TNF-<i>α</i> and ferritin were not significant during the study. Moreover, none of the inflammatory cytokines indicated significant differences between these two study groups (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>According to the results, the use of tourniquet can lead to inflammation, and the inflammation is similar in both groups.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"2027421"},"PeriodicalIF":1.3,"publicationDate":"2021-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39503035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposed Geometrical Tool for Cases of Laterally Adapted Tibial Tubercle during Total Knee Replacement.","authors":"Umaima R Khairy,&nbsp;Sadiq J Hamandi,&nbsp;Ahmed S Abid Ali","doi":"10.1155/2021/5244034","DOIUrl":"https://doi.org/10.1155/2021/5244034","url":null,"abstract":"<p><p>The alignment of tibial component in total knee replacement operation must be achieved in three planes to ensure optimum results. In coronal plane, the alignment depends on three anatomical landmarks. These landmarks are tibial tuberosity, leg shin, and midtalar point. In eastern community, people get used to sit cross-legged which causes additional tension in the quadriceps muscle which is attached distally to the tibial tuberosity. This tension causes adaptation of the tuberosity laterally. Tuberosity adaptation causes the three anatomical landmarks being not collinear. In this work, eight cases of lateral adapted tubercle were diagnosed of this condition before the surgery and their X-ray images after the surgery were checked regarding tibial alignment. Tibial alignment has been checked by measuring the medial proximal tibial angle (MPTA) which is the angle between the mechanical tibial axis and the tibial component plateau. MPTAs for the eight cases were (86.9°-93.6°). Three cases had MPTA less than 90° indicating varus alignment and five of them had MPTA more than 90° indicating valgus alignment. A geometrical tool was designed using the DesignSpark Mechanical software as a proposed solution to solve the adaptation problem. The tool can give a method for fixing the tibial component precisely without any varusvalgus malalignment.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"5244034"},"PeriodicalIF":1.3,"publicationDate":"2021-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39329110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double Endoprosthesis in the Management of Refractory Metastatic Primary Bone Tumors in Children and Young Adults.","authors":"Anna Raciborska,&nbsp;Iwona Malesza,&nbsp;Katarzyna Bilska,&nbsp;Tomasz Koziński,&nbsp;Bartosz Pachuta","doi":"10.1155/2021/9944702","DOIUrl":"https://doi.org/10.1155/2021/9944702","url":null,"abstract":"<p><strong>Background: </strong>Although not all children can be cured yet, much more emphasis is placed on the quality of life during and after cancer treatment. In the case of recurrence, mutilating treatment is still the prevalent option. In our study, we explored the role of limb salvage surgery for young patients with metastatic malignant bone tumors after endoprosthesis reconstruction during the first line of treatment and evaluated the impact of the local control modality in disease control and functional outcomes.</p><p><strong>Materials and methods: </strong>Eleven patients with bone tumor treated between 2007 and 2018 were included in this study. Both during primary treatment and during recurrence, limb salvage surgery was performed using a modular or expandable custom-made replacement system. Peri- and postoperative care for both surgeries were similar. All patients were given chemotherapy before and after both surgeries, according to the oncological guidelines.</p><p><strong>Results: </strong>Seven patients (63.6%) are alive with a median follow-up of 6.5 years from diagnosis. None had local recurrence. Five-year estimates of event-free survival and overall survival were 36.27% and 79.55%, respectively. Median time between the first and second surgery was 2.7 years. Three patients presented with postoperative complications following both surgeries and required resurgical intervention. Three months following the second surgery, the Musculoskeletal Tumor Society Scale (MSTS) scores were 15-27 points (21 points on average-60%).</p><p><strong>Conclusions: </strong>Limb salvage surgery is feasible and offers good chance of cure with a reasonable rate of complications and good function in patients with recurrent bone sarcoma after endoprosthesis reconstruction during the first line of treatment.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2021 ","pages":"9944702"},"PeriodicalIF":1.3,"publicationDate":"2021-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39273866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}