Ischial Bone Research Articles

A case of long-term use of denosumab for giant cell tumor of bone

Giant cell tumor of bone is a locally aggressive primary bone neoplasm affecting patients aged 20–50 years. Neoplastic stromal cells have a phenotype of immature osteoblasts synthesizing various cytokines and molecular factors leading to excessive activation of osteoclastogenesis and increased osteolysis in giant cell tumor of bone. Long-term treatment with denosumab is recommended for unresectable or disseminated disease.A clinical case of long-term treatment with denosumab of initially generalized giant cell tumor of the right ischial bone with metastases to the lungs is presented. Stabilization of the process was first recorded 3 months after the start of therapy and has been maintained to date. The patient was transferred to a maintenance regimen 3 years after the start of treatment. The treatment was not accompanied by adverse events characteristic of bone-modifying agents.Long-term use of denosumab allowed effective control of the tumor process and maintenance of satisfactory quality of life of the patient. Maintenance regimen of denosumab administration was not accompanied by a decrease in treatment effectiveness.

Combined Pubic Arch and Ischial Bone Resection for Metachronous and Frequent Local Recurrences of Rectal Cancer.

Complete surgical resection with negative margins remains the cornerstone for curative treatment of rectal cancer; however, local recurrence can pose a significant challenge. Herein, we aimed to introduce a novel surgical technique for combined resection of the pubic arch and ischial bone in the context of treating recurrent rectal cancer. We present a case of a patient with a fourth local recurrence of rectal cancer, with no evidence of distant metastasis. The tumor directly invaded the posterior wall of the pubic arch. To achieve complete tumor resection, an osteotomy was performed using a thread wire saw at the bilateral pubic rami and ischial bones. Intraoperative frozen section analysis (rapid tissue examination) was conducted on tissue samples from the lateral margins of the planned osteotomy line. Samples were negative for adenocarcinoma (cancerous cells). The combined resection of the pubic arch and ischial bone was successfully performed with negative margins for adenocarcinoma, as confirmed by frozen section analysis. Mastery of the surgical technique for combined resection of the pubic arch and ischial bone may be clinically significant for achieving complete resection in cases of multiple resections for locally recurrent rectal cancer.

Clinical development of ileofemoral thrombosis caused by malposition of the ileosacral screw

Introduction Treatment of unstable injuries of the pelvic bones is one of the unsolved problems in modern traumatology. The instability of the injuries is determined by the nature of the destruction of the posterior semi-ring of the pelvis. The most used technique for osteosynthesis of sacral fractures for unstable pelvic injuries is ileosacral screw fixation.The purpose of the work was to demonstrate a clinical case of an iatrogenic complication: ileofemoral thrombosis caused by compression of the internal iliac vein due to malposition of the ileosacral screw.Materials and methods Medical records of a 34-year-old patient injured in a traffic accident (front seat passenger) were studied, who was referred from a district hospital on the fourth day after the injury diagnosed with a fracture of the transverse process of L2 vertebra on the left, closed fracture of the pubic and ischial bones on the left, fracture of the lateral mass of the sacrum on the right. Alcohol intoxication. Traumatic shock stage 1. Treatment results were monitored throughout the inpatient and outpatient treatment periods. Long-term follow-up was 6 months.Results Timely suspicion of the complication based on physical examination data with CT angiography that assisted to exclude internal bleeding and urgently carry out repeated surgical intervention to correct the implant malposition, reosteosynthesis of S1 body without loss of reduction, to achieve regression of the clinical picture of ileofemoral thrombosis, and also to mobilize the patient in the shortest possible time. During inpatient treatment, regression of the symptoms of the complication was achieved, the patient was fully activated, and was discharged for outpatient follow-ups.Discussion Variability in the anatomy of the sacrum and the characteristics of fractures hinder the navigation while inserting iliosacral screws, which in some cases result in malposition. Compression of the common iliac vein without damaging it causes difficulty in blood outflow and the development of a clinical picture of ileofemoral thrombosis in the early postoperative period.Conclusion This clinical case shows that X-ray images in standard views are not a reliable method for diagnosing sacral injuries and are not sufficient for preoperative planning. The use of standard C-arm did not provide sufficient intraoperative visualization to correctly assess the position of the iliosacral screw, especially in cases with sacral dysmorphia. The 3D volumetric image reconstruction significantly influenced the correct perception of the anatomical structure of the bony structures of the pelvis. Malposition of the screw and its exit to the anterior surface of the sacrum caused disruption of the iliac vein outflow and development of thrombosis in the early postoperative period.

Anatomical Relationships of the Sciatic Nerve and Pudendal Nerve to the Ischial Spine as They Exit the Greater Sciatic Foramen

Deep gluteal syndrome is a clinical condition in which discomfort may arise due to the pathoanatomy of the subgluteal space. In this study, we conducted an anatomical exploration to categorize the relationship of the piriformis muscle, sciatic nerve, and pudendal nerve to the ischial spine and sacrospinous ligament.Twenty-two cadavers were analyzed. The piriformis muscle, sciatic nerve, and pudendal nerve were exposed either through a transgluteal approach or a gluteal flap. The relationship of the neural structures to the ischial spine, sacrospinous ligament, and ischial bone as they exit the greater sciatic foramen was observed and the exit zones were classified as either: zone A medial to the ischial spine (entirely on sacrospinous ligament), zone B on the ischial spine, and zone C lateral to the ischial spine (entirely on ischial bone).The sciatic nerve was observed either in zone B or zone C in all specimens. The pudendal nerve was found to be either in zone A or B in 97.6% of specimens. The most common combinations were sciatic nerve in zone B and pudendal nerve in zone A (Type I), and sciatic nerve in zone C and pudendal nerve in zone B (Type II).The results from this study show clear anatomical differences in the sciatic nerve-pudendal nerve relationship, which may play a role in pain seen in deep gluteal syndrome. Moreover, classification of the sciatic nerve-ischial spine and pudendal nerve-ischial spine relationships described in this manuscript will help describe different pathologies affecting the deep gluteal area.

Periprosthetic Comminuted High Energy Fracture of The Proximal Femur Three Months After Primary Total Hip Arthroplasty in Young Male. A Case Report

A 40 years old male patient had surgery on his right hip in 2010. when primary total cementless hip prosthesis was implanted because of posttraumatic arthrosis. Three months later he had a car accident and he got dislocation of the hip prosthesis with multiple femoral fractures of the proximal part of the femur around and below the femoral stem. The stem of the prosthesis was loose while acetaulum was stable. The patient had also fracture of the left acetabulum and ishial bone, without big dislocations. He underwent a new surgery on the right hip. Revisional long uncemented femoral stem was implanted, with cerclages and screws on multiple bone fragments. We met patient 8 years later with a very good function of his right hip. He has a problem with his left hip because of pseudarthrosis of the upper and lower part of the ischial bone. We think that this is an interesting case of periprosthetic femoral fracture, because of so many bone fragments around and below the femoral stem of the hip prosthesis, resulting in a very good function.

Triple osteotomy for patients with Legg-Calve-Perthes disease

OperationszielDurch die Osteotomie des Ischium‑, Pubis- und Iliumknochens kann das Acetabulum über den Hüftkopf geschwenkt werden, sodass der meist anterolateral vorstehende Anteil des Hüftkopfes wieder überdacht wird. Das Ziel ist der Erhalt des Containments der Hüfte, hiermit ist die Wiederherstellung der Kongruenz zwischen dem lateralisierten Hüftkopf und dem Acetabulum gemeint. Das Acetabulum wirkt so als eine Art Schablone für den Hüftkopf, um eine möglichst sphärische Ausheilung des Hüftkopfes zu erreichen.IndikationenSchwere Morbus-Perthes-Erkrankung mit radiologisch sichtbarer Lateralisation des Hüftkopfes und Head-at-risk-Zeichen. Voraussetzung ist, dass der Hüftkopf sich konzentrisch reponieren lässt (Abduktionsaufnahme oder Arthrographie).Kontraindikationen„Hinged abduction“. Keine konzentrische Reposition des Hüftkopfes möglich.OperationstechnikArthrographie des Hüftgelenkes zur Bestätigung der Operationsindikation. Darstellung und Osteotomie des Ischiums über einen modifizierten Ludloff-Zugang, Osteotomie des Iliums und Pubis über einen modifizierten Smith-Petersen-Zugang. Verbesserung der Hüftkopfüberdachung durch Schwenken des Acetabulums über den Hüftkopf. Fixation des azetabulären Fragmentes mit Vollgewinde-Kirschner-Drähten oder 3,5-mm-Kortikalisschrauben.WeiterbehandlungMobilisation an Gehstöcken (kleine Kinder im Rollstuhl). Abstellen des Fußes erlaubt. Teilbelastung für 4 bis 6 Wochen (je nach Alter des Patienten). Danach bei im Röntgen guten Konsolidationszeichen Belastungsaufbau innerhalb 1 bis 2 Wochen.ErgebnisseSehr gute Ergebnisse hinsichtlich Operationstechnik und Ausheilung in der eigenen Klinik. In einer eigenen noch nicht veröffentlichten Studie mit einem durchschnittlichen Untersuchungszeitraum von 5 Jahren zeigten sich bei 30 Patienten sehr gute klinische und radiologische Ergebnisse nach Tripleosteotomie bei Morbus Perthes.

Difffferential Diagnosis of Extraskeletal Accumulation of Osteotropic Radiopharmaceutical in Patient with Prostate Cancer with Suspected Ischial Bone Lesions by SPECT/CT

Purpose: To show the additional clinical importance of SPECT/CT method in the complex diagnosis of skeletal system.Material and methods: Patient: male, 75 years. Medical history: At the beginning of July 2021 the patient noticed the presence of blood in urine, and after that he seeked medical assistance from urologist. During medical check up — suspicion on prostate tumor. 09.07.21 PSA > 100 ng/ml. The patient was directed to N.N. Blokhin National Medical Research Center of Oncology for further examination and treatment. Whole body bone scan revealed multiple foci of increased activities of the radiopharmaceutical in the lumbar spine, sacral vertebrae and in the projection of groin and scrotum. After bone scan, SPECT/CT was performed. Metastatic lesions of bone tissue were not confirmed, however, an inguinal scrotal hernia and a nodus in the pelvic cavity (probably of a metastatic) were detected.Conclusion: The use of SPECT/CT made it possible to detect additional changes in the study area. Information about the presence of an inguinal hernia will help prevent complications.

Recurrent Multi-territorial Acute Ischemic Stroke due to Cardiac Angiosarcoma.

A 64-year-old man with hypertension, hyperlipidemia, and diabetes mellitus presented on 2 separate occasions with recurrent acute ischemic strokes in multiple vascular territories (Figure 1). Transthoracic echocardiogram revealed a 4.2 × 2.1 cm left atrial mass with heterogenous contrast enhancement on heart MRI (Figure 2). A PET scan showed corresponding avid uptake in the left atrium with widespread bone, skin, and pulmonary metastases. Left ischial bone biopsy was consistent with angiosarcoma.

Iatrogenic ischiofemoral impingement due to high tibial osteotomy with overvalgization: a case report

BackgroundOpen wedge high tibial osteotomy is a standard procedure for frontal realignment. It is indicated in varus knee with reduced mechanical medial proximal tibia angle. Overcorrection producing a mechanical medial proximal tibia angle out of the normal range (85–90°) is not recommended because this would lead to unphysiological joint-line orientation. Osteotomies around the knee also influence the adjacent ankle and hip joints. For the hip, it is known that frontal alignment of the leg influences the ischiofemoral space. A decreased ischiofemoral space can lead to painful impingement between the ischial bone and the lesser trochanter.Case presentationA 53-year-old German woman presented with severe ischiofemoral impingement symptoms and valgus malalignment of the left leg after open wedge high tibial osteotomy, which was indicated and performed by an orthopedic surgeon with intention to treat medial knee pain due to degenerative arthritis of the medial compartment years after medial meniscectomy. The mechanical medial proximal tibia angle was 100.5°. We performed closed wedge high tibial osteotomy producing a mechanical medial proximal tibia angle of 90.0° and normal joint-line orientation. The hip pain was gone immediately after the surgery, and the patient had no signs of ischiofemoral impingement or hip pain at last follow-up 12 months after closed wedge high tibial osteotomy.ConclusionsFrontal realignment osteotomy around the knee can create problems at adjacent joints. Overvalgization of the proximal tibia made the patient compensate by hyperadduction of the hip to enable full foot sole contact with the floor. Hyperadduction of the hip decreased the ischiofemoral space, leading to severe impingement. Therefore, meticulous planning of osteotomies is important not to produce unphysiological situations or unwanted negative effects at the level of an adjacent joint.

A Development of the Self Shape Adjustment Cushion Mechanism for Improving Sitting Comfort

The seat comfort of automobiles is one of the significant factors for determining the driver’s fatigue, emotional experience, and individual space (which captures their individuality, rather than just a means of transportation in modern society). Conventional automobile seats could not provide seating comfort suitable for all drivers, in the form of seats that fit each driver’s body type and the difficulty of meeting individual needs. This study proposes self-shape adjustable (the SSA seats) seats that improve the sitting comfort, safety, and secure the stability, by adjusting shape fit to the driver’s body type. The SSA seats transforms the seat itself, in a way that improves the distribution of contact pressure and reduces sitting fatigue, with the pneumatic system. The transformed seats provide better sitting comfort and safety than the conventional automobile seat, by providing a seat shape suitable for the body shape of all users. It was verified that the SSA seats, proposed in this paper, have a uniform and improved pressure distribution, compared to the conventional seat, in various sitting postures; the contact area between the seat and user is enlarged, and the pressure concentrated on the ischial bone is lowered. In addition, it was proven (through user evaluation) that quantitative evaluation verification was the same as qualitative evaluation results.

A Case of Undifferentiated Carcinoma in a 2-Month Postpartum Reproductive Tract with a Rapid and Fulminant Course

Advanced carcinoma of the lower female reproductive tract is rare during pregnancy and the postpartum period. We here present a case of a 32-year-old Japanese woman, whose entire lower reproductive tract had been invaded by carcinomas as of 2 months after childbirth. She had been infertile, and pregnancy had been established by repeated embryo transfer. The gynecological cancer screening, which included Pap smear tests, was negative during the periods she underwent infertility treatment or during the first trimester. At 26 gestational weeks, the patient noticed uterine contractions concomitant with genital bleeding. Labor progressed slowly and steadily; thus, the pregnancy was ended by cesarean section at 29 weeks. At 2 months after childbirth, the patient experienced increased left abdominal pain and underwent a pelvic examination, revealing multiple pelvic masses and diffuse vaginal tumors causing stenosis. Vaginal tumors were biopsied, and histochemical analysis showed undifferentiated carcinoma with possible adenocarcinoma. Imaging modalities including CT, MRI, and PET-CT suggest that the carcinoma had invaded the entire reproductive tract, especially the uterine body, metastasized into the lungs and the ischial bones, and disseminated onto the peritoneum. She received multiple rounds of chemotherapy but died 6 months after childbirth. Taking into consideration the clinical feature and immunohistochemical profiles of the cancer cells, the endometrium is the most likely origin.

Treatment of Unstable Injury of Pelvic Bones in Pregnant (Case Report)

Summary. There is no doubt in the relevance of the problem of treatment of patients with unstable fractures of pelvic bones, since these injuries involve a threat to the patient's life in the early period and often lead to disability in the future. This article presents a rare case of treatment of a patient with an unstable pelvis injury, while being 16 weeks pregnant. Patient A., born 1993, was admitted after a road accident injury. The examinations included: X-ray, CT, ultrasound, and gynecologist consultation. The patient was diagnosed with closed bilateral fracture of the pubic and ischial bones with displacement; rupture of the left sacroiliac joint with the boundary fracture of the sacrum (61-С1.3 by the Tile-AO-ASIF classification). The patient was 16 weeks pregnant. The surgery – open reduction and extramedullary metalosteosynthesis – was performed at the 9th day after the injury. The patient was discharged to outpatient treatment at the 12th day after the surgery. She started walking on crutches 3 weeks after the surgery; no additional support was needed since 1.5 months after the surgery. The patient gave birth at 39 weeks by surgical intervention (caesarean section). The baby's condition was assessed as 8 according to the Apgar scale. At the control examination 10 months after the surgery, musculoskeletal function of the patient was fully restored.

Successful endoscopic diagnosis of angiosarcoma of the small intestine: A case report.

A 51‐year‐old man had hematochezia, anemia, and an intraabdominal mass. Gastroscopy and colonoscopy showed no significant lesions with intraluminal bleeding, while radiological examinations showed bulky swelling of the lymph nodes around the abdominal aorta and a tumor in the left ischial bone. Small intestine endoscopy detected a dark purpuric protruding tumor of the jejunum and its biopsy specimen brought a definitive diagnosis of primary jejunal epithelioid angiosarcoma from positive staining of AE1/AE3, CD31, and erythroblast transformation specific related gene in immunohistochemical studies. The patient underwent surgical resection with adjuvant chemotherapy but died of progression of metastases 7 months after the diagnosis. Epithelioid angiosarcoma of the gastrointestinal tract is an extremely rare malignancy with poor prognosis and it is challenging to distinguish from undifferentiated carcinoma or melanoma. Immunohistochemistry is necessary for a definitive diagnosis. Sufficient biopsy specimen may aid a prompt diagnosis of this disease of the small intestine, which may present as obscure gastrointestinal bleeding.

Evaluation of different grafting materials for alveolar cleft repair in the context of orthodontic tooth movement in rats

To minimize the postoperative risks posed by grafting autologous transplants for cleft repair, efforts are being made to improve grafting materials for use as potential alternatives. The aim of this study was to compare the bone graft quality of different bone substitutes including the gold standard autografts during the healing processes after cleft repair in the context of orthodontic treatment. In 21 Wistar rats, a complete, continuity-interrupting cleft was created. After 4 weeks, cleft repair was performed using autografts from the hips’ ischial tuberosity, human xenografts, or synthetic bone substitutes [beta-tricalcium phosphate (β-TCP)/hydroxyapatite (HA)]. After another 4 weeks, the first molar movement was initiated in the reconstructed jaw for 8 weeks. The bone remodeling was analyzed in vivo using micro-computed tomography (bone mineral density and bone volume fraction) and histology (new bone formation). All the grafting materials were statistically different in bone morphology, which changed during the treatment period. The β-TCP/HA substitute demonstrated less resorption compared to the autologous and xenogeneic/human bone, and the autografts led to a stronger reaction in the surrounding bone. Histologically, the highest level of new bone formation was found in the human xenografts, and the lowest was found in the β-TCP/HA substitute. The differences between the two bone groups and the synthetic materials were statistically significant. Autografts were confirmed to be the gold standard in cleft repair with regard to graft integration. However, parts of the human xenograft seemed comparable to the autografts. Thus, this substitute could perhaps be used as an alternative after additional tissue-engineered modification.

Two-Dash Line: A New Approach for Prenatal Ultrasound Measurement of Iliac and Ischial Bones to Estimate Gestational Age.

There has been a dearth of an accurate and reliable method for the measurement of fetal pelvic bones. In this study, we describe a novel, easy-to-use method for ischial and iliac bone measurement in fetal ultrasound scanning. This prospective cross-sectional study was performed on 1179 pregnant women at 12 to 40 weeks of an uneventful gestation. Pelvic biometric indices, including the length of the ilium and ischium, were measured by a novel and easy method. Then data were analyzed by regression models to develop a formula for gestational age (GA) estimation based on pelvic bones. The approximate ossification time of the ischium was determined to range between the 13th and 20th gestational weeks. We calculated 3 formulas using linear regression models: formula 1, GA (days)=92.563 + (11.604 × ischial length); formula 2, GA (days)=57.006 + (7.819 × iliac length); and formula 3, GA (days)=65.809 + (5.610 × iliac length) + (3.431 × ischial length). The 2-dash line method can contribute to efficient and precise ultrasound measurement of the ilium and ischium in pelvic biometry of the fetus.

Bone Disease Associated With Hereditary Diffuse Leukoencephalopathy With Spheroids

This 14-year-old adolescent male with a diagnosis of metaphyseal dysplasia presented for evaluation of left hemibody dysfunction. His facial features were coarsened. Examination showed a mild left hemiparesis. Magnetic resonance imaging showed relatively symmetric areas of restricted diffusion involving the posterior frontal/frontoparietal deep white matter. Restricted diffusion extended along the corticospinal tracts to the level of the ventral cerebral peduncles (Figs 1 and 2). There was initial suspicion of an inflammatory or metabolic etiology for these changes. Magnetic resonance imaging of the spine showed fish-shaped vertebrae and a narrow spinal canal at C1 (Fig 3). A skeletal survey had shown an unusual sclerosing skeletal dysplasia, with undertubulation and flaring of the metaphyses of most of the tubular long bones. There was expansion of the clavicles, pubic, and ischial bones and mild expansion of the ribs. Cortical thickening was noted in the distal aspect of the phalanges of both hands and feet. FIGURE 2The lesions (arrows) demonstrate robust hyperintensity on diffusion-weighted images. Corresponding apparent diffusion coefficient images demonstrate signal loss consistent with restricted diffusion. The color version of this figure is available in the online edition. View Large Image Figure Viewer Download Hi-res image FIGURE 3Sagittal T2-weighted images show diffuse fish-shaped vertebral bodies. These result from disk remodeling of weakened endplates (arrows). The color version of this figure is available in the online edition. View Large Image Figure Viewer Download Hi-res image

Inferior extended fixation utilizing porous titanium augments improves primary anti-rotational stability of the acetabular component

BackgroundThe primary anti-rotational stability is critical to preventing cup tilting failure following revision total hip arthroplasty, but is frequently compromised by severe ischial bone loss. A novel technique of “inferior extended fixation” was introduced by securing a porous metal augment into the deficient ischium. This study evaluated the effect of this technique on primary anti-rotational stability in revision total hip arthroplasty. MethodsComposite hemipelvis specimens, acetabular components and “lotus” augments were used to simulate total hip arthroplasty surgeries. Three different cementless operative settings of cup implantation were simulated: (1) native ischium without defects; (2) ischium with a defect not reconstructed; (3) ischial defect reconstructed with inferior extended fixation using a lotus augment. Lever-out testing was used to examine primary anti-rotational stability, which was measured as interface stiffness and yield moment. FindingsCompared with the native ischium setting, the mean interface stiffness decreased by 53.1% in the ischial defect setting (p < 0.001). In the inferior extended fixation setting, the mean value was 110% greater than that in the ischial defect setting (p = 0.014), and comparable to that in the native ischium setting (p = 1). Similar results were observed for the yield moment (declined by 63.1%, p < 0.001; 200% higher, p < 0.001; and p = 0.395; respectively). InterpretationIn revision total hip arthroplasty with severe ischial defects, inferior extended fixation with a lotus porous titanium augment restores anti-rotational stability of the acetabular component to the level of that with a native ischium, which provides the mechanical environment for bone ingrowth and prevents cup tilting failure.

A rare presentation of carcinosarcoma of the bone in a young female; response with gemcitabine and docetaxel

BackgroundSarcomatoid carcinoma, or carcinosarcoma, is a neoplasm that contains both sarcomatous and carcinomatous elements. It is an extremely rare cancer most often arising from visceral organs. Here we report the seventh documented de novo case of carcinosarcoma of the bone, in a young female who showed initial clinical improvement with gemcitabine and docetaxel.Case presentationA 36-year-old Caucasian female presented with diffuse musculoskeletal pain that had progressed from her shoulder to her back, arm, and knee over 6 months. Imaging revealed diffuse sclerotic lesions of bilateral humeral heads, iliac and ischial bones, and thoracic and lumbar spine. Histopathologic examination of biopsies from the T9 vertebra and left femur showed mainly sarcomatous spindle cells with focal osteoid production. Immunostaining showed the cells to be OSCAR cytokeratin, patchy positive for pankeratin, and negative for CK7, GATA3, S100, SOX10, CD99, EMA, AE1/AE3, and HMW keratin indicative of an epithelial origin. After thorough clinical correlation, sarcomatoid carcinoma of a visceral organ was excluded and the diagnosis of primary sarcomatoid carcinoma of the bone was ultimately favored. She received chemotherapy with gemcitabine and docetaxel, and showed improvement at 6 months but ultimately passed 1 year post diagnosis.ConclusionsPrimary carcinosarcoma of the bone is an extremely rare malignancy. Early diagnosis is crucial as localized disease may be curable with resection. As shown in this case, combination chemotherapy with gemcitabine and docetaxel is a potential option in patients with unresectable or metastatic disease.

Retrospective Audit of Various Surgical Modalities Adopted for Giant Cell Tumor in a Rural Tertiary Cancer Center.

Giant cell tumor of bone (GCTB) is a rare tumor with a spectrum of clinical behavior. Standard treatment modalities include surgical curettage to wide resection, and varying oncological and functional results have been reported. The aim of this study was to evaluate the functional outcome and recurrence rates of patients who underwent surgery for giant cell tumor in a rural tertiary cancer center from June 2009 to December 2016. A retrospective review of 12 patients (7 males and 5 females) with GCT of the extremity bones treated in the institution between the period of June 2009 and December 2016 was performed to study the oncological and functional outcomes. All patients were evaluated by clinical examination, plain X-ray of local parts, X-ray of the chest, and MRI of local parts. A biopsy was taken in all cases to confirm the diagnosis. All patients underwent surgical treatment including curettage combined with cryosurgery and bone cement or wide resection and reconstruction. Selection of the surgical technique was based on the site and size of the lesion, soft tissue involvement (intra- or extra-compartmental), and if recurrent or not. The patients were followed up to April 2018. The mean age of the patients was 31.3years. The tumor sites were distal femur in 3 cases, proximal tibia in 6, ischial bone in 1, distal radius in 1, and 1 in the metacarpal bone. Campanacci radiographic grading was grade1 in 3 cases, grade 2 in 2 cases, and grade 3 in 7 cases. Out of 12 patients, local recurrence was noted in 2 patients (16.7%). Functional evaluation was performed according to the Musculoskeletal Tumor Society Scoring (MSTS) system. Mean MSTS score was 25. To preserve the good function of the extremities and avoid local recurrence, we consider that curettage with adjunctive therapy such as polymethylmethacrylate (PMMA) and liquid nitrogen should be employed for the treatment of benign GCT of bone. Wide excision should be considered for large tumors where achieving oncological results with functional preservation would be difficult with curettage procedure.

Differing MRI appearances of symptomatic proximal hamstring tendinopathy with ageing: a comparison of appearances in patients below and above 45 years

To compare magnetic resonance imaging (MRI) appearances of symptomatic proximal hamstring tendinopathy (PHT) in younger (<45 years) and older (>45 years) patients. MRI of patients with symptomatic PHT were reviewed and compared to asymptomatic age- and sex-matched controls. Appearances recorded were as: type 0, normal tendon; type I, intra-substance signal abnormality; type II, ischial bone and soft-tissue oedema with/without type I findings; type III, curvilinear fluid signal tearing with/without type II findings; type IV, bony avulsion. Disease pattern was compared between age groups using Fisher's exact test. Thirty-one symptomatic patients (18 male, 13 female; mean age 42 years) were identified. Imaging findings of 16 patients >45 years, 15 patients <45 were as follows: type 0 n=8, type I n=7, type II n=6, type III n=10, type IV n=0. Those >45 years tended to have type III tendinopathy, no examples of type III disease were found in patients <45 years (p<0.001). No significant difference in disease pattern was seen between males and females (p=0.39). Seven of 31 controls >45 years had type III findings and four controls <45 years had type I findings. MRI appearances of symptomatic PHT differ with age. Differences may reflect mechanism, whereby overuse-related micro-tearing of healthy tendons occurs in young patients versus degenerative tendinopathy in older patients. Abnormal tendon appearances in patients >45 years may or may not be symptomatic. In contrast, abnormalities identified in younger patients are generally symptomatic. These described differences are important in the primary diagnosis and may impact upon patient response to therapy.