Bones Of Lower Extremities Research Articles

Mesenchymal Chondrosarcoma, Clinicopathological Characteristics of an Uncommon Tumor

Mesenchymal chondrosarcomas (MCS) are very rare malignant tumors. They comprise 2–10% of all chondrosarcomas. Approximately 600 cases of MCS have been published, as case reports and small series. In English language medical literature only three series include 20 or more cases have been described. This paper aims to document various histological findings, histological patterns that can be seen in MCS. In addition, demographic features, clinical and radiological findings and survival data are also incorporated to assess prognostic impact of various histological findings. This is a descriptive cross sectional study including cases of MCS diagnosed at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan between 2002 and 2012. The slides were reviewed by two consultant pathologists independently and findings (pattern, cellularity, spindle cell component, necrosis, mitoses, hemangiopericytoma like vessels) were documented on a specially developed form. The clinical information was extracted from case files. Survival data was obtained by contacting the patient or their families in those cases for which contact numbers were available. Data analysis was done using SPSS 20.0. Of the total 18 cases, 10 were males (55.6%) and 8 were females (44.4%). Patients were most commonly in their second or third decades of life. Tumor locations included craniofacial bones (n=5, 28%), ribs and chest wall (n=3, 16%), spine (n=3, 16%), and the lower extremity bones (n=5, 28%). Extraskeletal sites included parapharyngeal region (n=1, 6%) and thigh (n=1, 6%). Histologically biphasic pattern was seen 16 cases (89%). Two cases showed sheets of round to spindle cells with very focal cartilaginous component (11%). Spindle cell component was seen in 14 cases. Necrosis was present in 7 cases (38.9%). Survival data was available for 11 patients (61%). Among these, n=7 (64%) patients developed metastatic disease. The mean survival for cases with metastatic disease was 14.2 months. In patients without metastatic disease, mean survival was 37 months. As the incidence of mesenchymal chondrosarcoma is extremely low, the limited number of patients discussed in most of the studies precludes statistically significant conclusions. MCS should be considered in the differential diagnosis, when pathologists encounter a bone and soft tissue tumor with biphasic pattern composed of round to spindle cell component and hyaline cartilage. Given the diagnostic pitfalls discussed, clinicians may consider obtaining larger biopsy specimens to limit sampling error or confirming the diagnosis with immunohistochemical stains or genetic analysis when a larger biopsy is not possible.

Reduced Muscle Strength in Barth Syndrome May Be Improved by Resistance Exercise Training: A Pilot Study.

Cardioskeletal myopathy is thought to contribute to exercise intolerance, and reduced quality of life (QOL) in Barth syndrome (BTHS). The objectives of this study were to examine: (1) skeletal muscle strength/performance in adolescents and young adults with BTHS and (2) the safety, feasibility, and initial efficacy of 12weeks of progressive resistance exercise training (RET) on muscle strength, mass, and performance, bone mineral density, exercise tolerance, cardiac function, and QOL in individuals with BTHS. Individuals with BTHS (n=9, 23±6years), and age-, sex-, and activity level-matched unaffected Controls (n=7, 26±5years) underwent baseline testing to assess muscle performance, exercise capacity, cardiac structure and function, body composition, and health-related QOL. Subsequently, n=3 participants with BTHS performed 12weeks of supervised RET (60min per session, 3 sessions/week). All testing was repeated post-RET. BTHS had lower strength and lean muscle mass compared to Controls (all p<0.05). BTHS also had diminished lower extremity, upper extremity, thoracic spine, lumbar spine, and pelvic bone mineral density (all p<0.05) and reduced exercise capacity (p<0.001) compared to Controls. RET was well-tolerated and attended, was not associated with any adverse events, and significantly increased muscle strength (p<0.05). Individuals with BTHS demonstrate reduced muscle strength and mass, bone mineral density, and exercise capacity. RET appears safe and well-tolerated in BTHS and promotes increased muscle strength. Larger studies are needed to confirm these improvements and to fully determine the effects of RET in individuals with BTHS.

Megaprosthesis limb salvage surgery: Outcome and challenges in treating advanced bone tumour cases in vast archipelago in Indonesia. A case series

IntroductionLimb salvage is considered as a more popular option in Indonesia, as amputation is considered offensive and taboo for many Indonesian cultures and societies. We evaluated the outcome of a series of LSSs with megaprosthesis and their challenges during treatments in Indonesia as the biggest archipelago nation in the world. MethodsThirty-two patients originated from different islands in Indonesia with advanced lower extremity bone tumours were prospectively reviewed. Data was obtained from surgeries, which was conducted between 2011 and 2015 by two orthopaedic oncologist at Cipto Mangunkusumo Hospital. Functional outcome using musculoskeletal tumour society (MSTS) score and oncological outcome were evaluated manually during every outpatient visit at 3, 6, 12 and 24 months. ResultsEight patients originate from Sumatra, one from Moluccas island, and twenty-three based in the Java island. We documented fourteen osteosarcomas, two cases of metastatic bone disease, fifteen giant cell tumours, and one chondromyxoid fibroma. Compared to preoperative score (mean 5.3, MSTS Score range 0–10), postoperative result (mean 25.2, MSTS Score range 53.3–90) at two year revealed 4.75 fold of improvement. Nearly half of the patient (40.6%) showed excellent score (MSTS Score range 76.6–96.6) after one year. We reported several complications including: infection, knee dislocation, mechanism extensor disturbance, amputation, and nerve injury. Lower MSTS score was correlated with higher serum alkaline phosphatase (SAP) (p = 0,031) and increase intraoperative blood loss (p = 0,033). Complication was found to be associated with tumours that underwent extensive soft tissue reconstruction procedure (p = 0,021). ConclusionFunctional outcome up to 24 months recorded satisfying result. Several complications occurred during our study also passed struggles for our patients during follow up care due to geographical challenges. Nevertheless, for carefully selected patients in Indonesia, LSS with megaprosthesis is an option that technically visible and culturally acceptable.

Effects of recreational football on women's fitness and health: adaptations and mechanisms.

The review describes the fitness and health effects of recreational football in women aged 18-65years. The review documents that 2 × 1h of recreational football training for 12-16weeks causes marked improvements in maximal oxygen uptake (5-15%) and myocardial function in women. Moreover, mean arterial blood pressure was shown to decrease by 2-5mmHg in normotensive women and 6-8mmHg in hypertensive women. This review also show that short-term (< 4months) and medium-term (4-16months) recreational football training has major beneficial impact on metabolic health profile in women, with fat losses of 1-3kg and improvements in blood lipid profile. Lastly, 2 × 1h per week of recreational football training for women elevates lower extremity bone mineralisation by 1-5% and whole-body bone mineralization by 1-2% within 4-12-month interventions. These training adaptations are related to the high heart rates, high number of fast runs, and multiple changes of direction and speed occurring during recreational football training for untrained women. In conclusion, regular small-sided football training for women is an intense and versatile type of training that combines elements of high-intensity interval training (HIIT), endurance training and strength training, thereby providing optimal stimuli for cardiovascular, metabolic and musculoskeletal fitness. Recreational football, therefore, seems to be an effective tool for prevention and treatment of lifestyle diseases in young and middle-aged women, including hypertension, type 2 diabetes and osteopenia. Future research should elucidate effects of football training for elderly women, and as treatment and rehabilitation of breast cancer patients and other women patient groups.

Role of flexible elastic nails in diaphyseal fractures of long bones of lower extremities in children of 5-14 years of age

Femoral and tibial fractures are common long-bone injuries in children. Above five years of age all such fractures, when treated conservatively could lead to loss of reduction, malunion, intolerance and complications associated with plaster. The goals are to stabilize the fracture, to control length and alignment. Flexible Elastic Nailing has become the choice of stabilization in paediatric long bone fractures. The aim of our study was to see the outcome of Flexible elastic nailing system in diaphyseal fractures of children of 5-14 years age. The study included total of 50 children treated with flexible elastic nailing system and they were followed up at 3, 6, 12 and 24 weeks. The average duration of callus formation was 3.8weeks (4.2weeks in Tibia & 3.4 weeks in femur). Radiological union was seen in a mean time of 9.65 weeks. Full weight bearing was possible in a mean time of 10 weeks. According to flynn’s scoring criteria, excellent and satisfactory results were in 90% and 10% respectively. There were 2 cases of post-operative superficial infection which resolved with regular dressing and no cases of physeal injury and implant failure. Flexible elastic nail is a safe and satisfactory mode of treatment and is relatively easy to perform in disphyseal fracture of femur and tibia in children. It avoids the chances of physeal injury, infection and offers early mobilisation and rapid healing.

Evaluating the efficacy of functional electrical stimulation therapy assisted walking after chronic motor incomplete spinal cord injury: effects on bone biomarkers and bone strength

Objectives: To determine the efficacy of functional electrical stimulation therapy assisted walking (FES-T) compared to a conventional aerobic and resistance training (CONV) with respect to bone biomarkers and lower extremity bone strength outcomes among adults with chronic motor incomplete spinal cord injury (SCI). Design: Parallel group randomized controlled trial (www.clinicaltrials.gov - NCT0020196819). Site: Tertiary academic rehabilitation centre in Canada. Methods: Adults with chronic (≥18 months) motor incomplete SCI (C2-T12 AIS C-D) were consented and randomized to FES-T or CONV training for 45 minutes thrice-weekly for 4 months. Osteocalcin (OC), β-cross laps (CTX) and sclerostin were assessed at baseline, and 4 months. Similarly, total hip, distal femur and proximal tibia region bone mineral density (BMD) via DXA (4500A, Hologic Inc. Waltham, MA, USA) and tibia bone quality via pQCT (Stratec XCT-2000, Mezintecknik, Pforzheim, Germany) were assessed at baseline, 4, and 12 months. Between group differences were analyzed using repeated measures general linear models. Results: Thirty-four participants (17 FES-T, 17 CONV) consented and were randomized, 27 participants completed the 4-month intervention and 12-month outcome assessments. Participants in the FES-T arm had a decrease in CTX and a significant increase in OC at intervention completion (P<0.05). Significant biomarker changes were not observed in the CONV group. No within or between group differences from baseline were observed in sclerostin or bone strength. Conclusions: Four months of FES-T improved bone turnover (increase in OC and decrease in CTX) but not bone strength among individuals with chronic SCI. Future, long term FES-T may augment lower extremity bone strength.

Sedentary behaviour and bone health in children, adolescents and young adults: a systematic review\u2013supplementary presentation

Background: Sedentary behaviour (SB) is a potential risk factor for suboptimal bone deposition in youth. Results: Total SB was negatively associated with lower extremity bone outcomes, while no association was observed with total body bone outcomes. Insufficient evidence was found for an association between total SB and lumbar spine bone outcomes. Conclusion: This review highlights the heterogeneity of the available evidence and emphasizes the need for well-designed studies.

Outcome of oscillating saw open osteotomy in two-stage lower extremity bone transport with monolateral frame

IntroductionBone transport techniques have been widely used to solve massive bone defects due to trauma, osteomyelitis or bone tumors. The technique of bone interruption to achieve better new bone formation is a subject of debate. Low-energy osteotomy (LEO) techniques have been proposed as the gold standard. Some authors reject open osteotomy with an oscillating saw (OOS osteotomy), based on the danger of bone tissue thermal necrosis and periosteal damage. To date, however, there is no strong clinical evidence to discourage this high-energy (HEO) bone interruption technique. MethodsThe aim of this study was to determine outcomes in using OOS osteotomy in a series of patients, where monolateral-frame bone transport has been used to resolve segmental bone defects of the lower extremity. The minimum accepted follow-up was 1 year. The primary endpoints were radiographic evidence of regenerated bone quality (Li classification) and final outcome (Cattaneo clinical system assessment). Further, we analyzed associated complications, and compared results with other published series. We hypothesized that OOS osteotomy produces results no less favorable than those achieved with other, low-energy techniques. ResultsA total of 54 patients, with an average bone defect of 8.58cm (CI95% 7.01–10.16), were enrolled in the study. In terms of regeneration quality, 84% of the regenerated segment shapes were associated with good outcomes; only 16% exhibited a shape (hypotrophic) predictive of a poor outcome. Regarding functional assessment, following the Cattaneo system, we found a total of 90% good or excellent results. Finally, the Bone Healing Index (BHI) in our series averaged 21.09 days per cm. The main complication observed was pin-track infection, occurring in 45% of the cases. ConclusionAccording our data, the superiority of an LEO technique over HEO techniques is yet to be confirmed; it appears that any open osteotomy is effective, performed well and in a proper clinical setting, and that many factors other than choice of osteotomy technique must play important roles.

Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis

ObjectiveThis study was to compare the effectiveness of Masquelet technique versus Ilizarov bone transport in the treatment of lower extremity bone defects following posttraumatic osteomyelitis. Patients and methodsWe retrospectively reviewed 39 patients who had been treated at our department for lower extremity bone defects following posttraumatic osteomyelitis. They were 30 males and 9 females with a mean age of 39.18 (range, 12–63 years). The infected bone defects involved 26 tibias and 13 femurs. The mean length of the bone defects after radical debridement was 6.76cm (range, 2.7–15.7cm). Masquelet technique (MT, group A) was used in 20 patients and Ilizarov bone transport (IBT, group B) in 19 ones. The measurements were bone outcomes (union, deformity, infection and leg-length discrepancy) and functional outcomes (significant limping, joint contracture, soft tissue dystrophy, pain and inactivity). ResultsThe mean follow-up after removal of the apparatus was 25.26 months (range, 14–51 months). The mean finite fixator time was 10.15 months (range, 8–14 months) in group A versus 17.21 months (range, 11–24 months) in group B. The bone outcomes were similar between groups A and B [excellent (5 vs. 7), good (10 vs.9), fair (4 vs. 2) and poor (1 vs. 1)]; group A showed better functional outcomes than group B [excellent (8 vs. 3), good (9 vs. 6), fair (3 vs. 8) and poor (0 vs. 2)]. ConclusionsIn the treatment of segmental lower extremity bone defects following posttraumatic osteomyelitis, both IBT and MT can lead to satisfactory bone results while MT had better functional results, especially in femoral cases. IBT should be preferred in cases of limb deformity and MT may be a better choice in cases of periarticular bone defects.

Combined free anterolateral thigh flap and tibial bone transport for resurfacing large segmental bone and soft tissue defect of lower extremities

Objective To investigate the clinical efficacy of free anterolateral thigh flap transport combined with tibia bone transport in reconstruction of large segmental bone and soft tissue defect of lower extremities. Methods This retrospective case series review included 27 patients sustaining large segmental bone and soft tissue defect of lower extremities admitted between August 2006 and April 2016. There were 22 males and 5 females, with a mean age of 36 years (range, 16-56 years). Eleven patients were identified with Gustilo ⅢB type open injury, 14 Gustilo ⅢC type open injury, and 2 large bone and soft tissue defects after internal fixation of the closed lower extremity fractures. Size of soft tissue defect was 10.0 cm×5.5 cm-21.0 cm×10.0 cm. Size of the flaps was 13.0 cm×7.5 cm-23.0 cm×11.0 cm. Length of bone defect was 5.5~18 cm and length of bone transport was 6~21 cm. Anterolateral thigh flaps were employed for limb salvage. After wound healing, bone transport with the use of an Ilizarov ring external fixator was done to treat tibial bone defect. Flap survival, wound healing time, bone transport time, bone healing index and time of external fixator removal were recorded. Mineralization of regenerate bone was assessed using the bone healing index. Results were evaluated using the Paley scoring system. Results Mean follow-up period was 4 years (range, 1-8 years). All flaps survived and the wounds were healed without ulceration or infection. Mean time for wound healing was 4.5 months (range, 1-18 months). Time interval between wound healing and bone transport was 1-4 days (mean, 1.5 months). Mean bone healing index was 55 days (range, 45-65 days), demonstrating good bone mineralization. Mean time of external fixator removal was 24.5 months (range, 10-39 months). Shape of the tibia was satisfied. All patients were able to ambulate without use of an aid. According to the Paley scoring system, results were excellent in 21 patients and good in 6 patients. Conclusion Combined free anterolateral thigh flap and tibial bone transport provides enough bone and soft tissue and satisfactory recovery of limb function and morphology, indicating an effective treatment for large segmental bone and soft tissue defect of lower extremities. Key words: Surgical flaps; Ilizarov technique; Tibial fractures; Soft tissue injuries; Bone defect

Tissue flap combined with sequential bone lengthening technique for repairing severe soft tissue and bone defects of lower extremity after burn injury

To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.

Feasibility and tolerability of whole-body, low-intensity vibration and its effects on muscle function and bone in patients with dystrophinopathies: a pilot study.

ABSTRACTIntroductionDystrophinopathies are X‐linked muscle degenerative disorders that result in progressive muscle weakness complicated by bone loss. This study's goal was to evaluate feasibility and tolerability of whole‐body, low‐intensity vibration (WBLIV) and its potential effects on muscle and bone in patients with Duchenne or Becker muscular dystrophy.MethodsThis 12‐month pilot study included 5 patients (age 5.9–21.7 years) who used a low‐intensity Marodyne LivMD plate vibrating at 30–90 Hz for 10 min/day for the first 6 months. Timed motor function tests, myometry, and peripheral quantitative computed tomography were performed at baseline and at 6 and 12 months.ResultsMotor function and lower extremity muscle strength remained either unchanged or improved during the intervention phase, followed by deterioration after WBLIV discontinuation. Indices of bone density and geometry remained stable in the tibia.ConclusionsWBLIV was well tolerated and appeared to have a stabilizing effect on lower extremity muscle function and bone measures. Muscle Nerve 55: 875–883, 2017

A Review on Functional Electrical Stimulation Cycle Ergometer Exercise for Spinal Cord Injured Patients.

The purpose of this collective review on functional electrical stimulation (FES) cycle ergometer training is to describe the pathologic effects of spinal cord injury (SCI) and the structure and function of the FES cycle ergometers, which reverse the devastating systemic and life-threatening effects of SCI. The pathophysiologic consequences of SCI include diminished cardiopulmonary and circulatory function as well as lower extremity muscle atrophy and bone mass reduction. Clinical studies have demonstrated that the two FES cycle ergometers offer promise in reversing these devastating consequences of SCI, which can shorten patients' lives. On the basis of this collective review, it is recommended that all patients with SCI have the benefits of this potentially life-sustaining clinical modality.

A method of transport immobilization of the injured

Relevance. Patients with fractures of long tubular bones and the pelvis represent the largest group of the injured or affected in need of reliable transport immobilization. Conventional devices for transport immobilization do not provide rigid fixation, especially for fractures of long tubular bones of lower extremities. Immobilization of unstable pelvic injuries at the prehospital stage poses challenges due to the lack of a regular immobilizing device. Objective. Propose a new method of transport immobilization using a multifunctional evacuation-transport immobilizing device (METID). Methods. Rates of transport immobilization, as well as advantages and disadvantages of the existing transport devices have been analyzed. The experience with METID in medical military formations was studied. Results and Discussion. The set of constructive solutions implemented in this device significantly increases reliability and safety of immobilization for monitoring vital functions of victims and providing respiratory and infusion support. The device can be placed in mobile medical complexes equipped with transport-sanitary sets using the standard on-board network and external sources of oxygen. Conclusion. METID device proposed for transport immobilization and transportation of the wounded and injured can be actively used in units the Russian Defense Ministry and the Emercom for medical assistance.

Reconstruction Using Expandable Endoprostheses for Skeletally Immature Patients With Sarcoma

Expandable endoprostheses have become an acceptable modality to address the issue of limb-length inequality in limb-sparing procedures for skeletally immature patients afflicted with lower extremity bone sarcomas. This study retrospectively analyzed postoperative outcomes and complications for 7 patients (8 limbs) who underwent minimally invasive or noninvasive reconstruction during a 12-year period. Musculoskeletal Tumor Society (MSTS) scores and complication rates were reported. Mean functional outcome (MSTS scores) at final follow-up was 93.3%. Functional outcomes for the noninvasive and minimally invasive expandable prostheses were 97% and 85%, respectively. Complications included temporary peroneal nerve palsy (2 limbs), infection (2 limbs), prosthesis revision (3 limbs), stiffness (3 limbs), and wound healing problems (3 limbs). None of the patients required amputation. Both minimally and noninvasive expandable prostheses appear to be safe and reliable means of reconstruction that permit limb salvage in skeletally immature patients and provide good functional results considering the alternative is above-knee amputation or hip disarticulation. Although complications are frequent (range, 13%-38%), they often can be managed successfully without amputation, thus providing a good quality of life and functional limb. The noninvasive prosthesis may prove to be a more attractive option by potentially negating additional surgeries and reducing infection rates; however, the short-term experience with this prosthesis warrants further investigations with more patients and longer follow-up. [Orthopedics. 2017; 40(1):e157-e163.].

Percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones

Objective To evaluate the curative effects of percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones. Methods A retrospective analysis was performed of the 32 patients who had been treated using osteoperiosteal decortication combined with distraction osteogenesis from September 2011 to December 2014 for nonunion of lower-extremity fractures. They were 23 males and 9 females, with a mean age of 33.4 years (range, from 15 to 62 years). After their former internal or external fixators were removed, the 2 fracture ends were fixated by a retractile monolateral or circular external fixator. Under radiographic monitoring, a percutaneous incision was made with a 5 mm sharp chisel, down to the bone. Scar and ossified tissue between the fracture ends were debrided and cut along the fracture line. After the marrow cavity was reamed, a new irregular wound was created at sclerotic fracture ends. Scale-shaped chips (1 mm thin and 5 mm in diameter) were elevated using a chisel on surface of the cortical bone within 2 cm from the fracture ends. The external fixators were adjusted to compress the fracture sites. On the 8th day after operation, the eternal fixators were applied to distract and compress at nonunion sites to stimulate the osteogenesis. Results All the patients were followed up for an average of 12.5 months (range, from 8 to 42 months). Primary union was successfully achieved in 28 patients while delayed union occurred in 3 patients who finally achieved union after adjuvant therapies like shock wave and or local injection of bone marrow blood. The average time for union was 4.6 months(range, from 4 to 7 months). The mean time for external fixation was 6.2 months (range, from 5 to 8 months). One patient encountered nonunion of lateral tibial cortical bone 6 months after surgery but eventually achieved union by au-tologous ilium grafting. Joint functions in all postoperative patients were similar to those before operation. Conclusion Percutaneous osteoperiosteal decortication combined with distraction osteogenesis is a simple, minimally invasive and effective treatment for nonunion of lower-extremity bones, avoiding disadvan-tages brought by traditional surgery, like massive trauma and excessive bleeding. Key words: Bone lengthening; Fractures, ununited; Surgical procedures, minimally invasive; Percutaneous decortication

Surgery for bone sarcomas of the lower extremity

Surgery for lower extremity bone sarcomas encompasses a wide array of surgical options beyond the classic treatment of amputation. Limb salvage surgery (LSS) in the form of arthroplasty, arthrodesis, or allograft reconstruction is now possible for most patients. Patient function, in addition to survival, has been increasingly emphasized as the 5-year survival is now typically over 60%. Recent research looking at the activity levels of patients after endoprosthetic reconstruction is reviewed. Advances in surgical navigation, expandable endoprostheses, and in treating infected allografts and endoprostheses are summarized. Long-term functional outcomes and neurologic plasticity in patients with rotationplasties are examined as well. Surgery for bone sarcomas remains a high-risk, high-reward endeavor that continues to improve through innovation.

Soft tissue reconstruction after lower extremity limb-sparing pediatric sarcoma resection

Aim: Limb salvage is the treatment of choice for lower extremity bone sarcomas in children. To date, peers have not described algorithms for soft tissue reconstruction of these defects. This paper is to report a large single center series of lower extremity salvage after sarcoma treatment, with algorithm.

Infant lower extremity long bone growth rates: comparison of contemporary with early 20th century data using mixed effect models.

Modern reference standards for long bone growth are lacking for infants (≤1 year). This study develops a quantitative framework to characterize lower extremity bone shaft growth during infancy based on radiographic images, and compares it to data from the 1930s. Femoral, tibial, and fibular shaft length measurements (diaphysis plus metaphysis) were collected retrospectively from 70 infants on initial and follow-up skeletal surveys performed for suspected abuse (7/2005-2/2013). These serial skeletal survey data (SSSD) were compared to the Denver Child Research Council data (DCRCD), a 1930's longitudinal dataset from 80 infants. Mixed effects regression models were developed to estimate growth trajectories from these data. Growth trajectories and short-term (≤2 months) growth rates were compared. Statistically distinct models described the contemporary (SSSD) and historic (DCRCD) datasets; however, there was substantial overlap (77-90%) between their confidence bands for the three measured bones. Based on developed models, the average long bone shafts of the DCRCD are shorter at birth than SSSD (femur: 77.0 vs. 82.3 mm; tibia: 64.4 vs. 68.2 mm; fibula: 61.0 vs. 64.4 mm), but the DCRCD long bone growth rates are faster than SSSD (femur: 0.21 vs. 0.17 mm/day; tibia: 0.16 vs. 0.14 mm/day; fibula: 0.15 vs. 0.14 mm/day). Short-term growth rates of these bones decreased with age. The effect of sexual dimorphism on long bone growth during infancy was non-significant. This study provides reference standards for long bone growth rates during the dynamic period of infancy that may aid clinical assessment, and also inform research studies of disorders associated with altered skeletal growth.

Impaired Vestibular Function and Low Bone Mineral Density: Data from the Baltimore Longitudinal Study of Aging.

Animal studies have demonstrated that experimentally induced vestibular ablation leads to a decrease in bone mineral density, through mechanisms mediated by the sympathetic nervous system. Loss of bone mineral density is a common and potentially morbid condition that occurs with aging, and we sought to investigate whether vestibular loss is associated with low bone mineral density in older adults. We evaluated this question in a cross-sectional analysis of data from the Baltimore Longitudinal Study of Aging (BLSA), a large, prospective cohort study managed by the National Institute on Aging (N=389). Vestibular function was assessed with cervical vestibular evoked myogenic potentials (cVEMPs), a measure of saccular function. Bone mineral density was assessed using dual-energy X-ray absorptiometry (DEXA). In two-way t test analysis, we observed that individuals with reduced vestibular physiologic function had significantly lower bone mineral density. In adjusted multivariate linear regression analyses, we observed that older individuals with reduced vestibular physiologic function had significantly lower bone mineral density, specifically in weight-bearing hip and lower extremity bones. These results suggest that the vestibular system may contribute to bone homeostasis in older adults, notably of the weight-bearing hip bones at greatest risk of osteoporotic fracture. Further longitudinal analysis of vestibular function and bone mineral density in humans is needed to characterize this relationship and investigate the potential confounding effect of physical activity.