Extraskeletal osteosarcomas (EOSs) are rare tumors that arise in various soft-tissue sites (e.g., gastrointestinal tract, subcutaneous tissue, spleen, liver, skin, kidney, urinary bladder, muscle, thyroid gland, eye, and mammary glands). Soft-tissue osteosarcomas (STOs) occur in older dogs with no sex predilection; beagles and rottweilers are at higher risk. Mammary gland osteosarcomas (MGOs) occur in older females; mixed-breed dogs, German shepherd dogs, and miniature poodles are at higher risk. The median survival time for cases with STO was 26 days, and the major cause of death was local recurrence (92%). The median survival time for cases with MGO was 90 days, and the major cause of death was pulmonary metastasis (62.5%).

Introducere: Deşi leziunile la nivelul umărului sunt frecvente, cele ale claviculei mediane sunt prea puţin explorate. O clasificare aplicată este mai puţin utilizată ca management standard. Metode: O analiză retrospectivă a leziunilor claviculare medii (MCI) pe parcursul unui stagiu de tratament de 5 ani într-un Centru de Traumatologie de nivel 1. Am analizat, printre altele, leziunile concomitente, strategiile de terapie şi clasificarea conform standardelor AO. Rezultate: 19 (2,5%) din 759 de leziuni claviculare au fost mediale (11 fracturi de tip A, 6 B şi 2 C), dintre care 27,8% au fost deplasate şi drept urmare tratate chirurgical. Osteosinteza cu placă fixă a fost utilizată în fracturi instabile şi reconstrucţia ligamentelor în articulaţia sternoclaviculară (SCJ) în cazul întreruperii acestora. 84,2% dintre pacienţi au prezentat leziuni concomitente relevante. Numeroase fracturi de mediane au fost codificate greşit ca fracturi mediale, ceea ce a limitat populaţia de studiu Concluzii: MCI a rezultat din mecanisme de vătămare cu impact puternic, adesea cu dislocare semnificativă şi leziuni concomitente. În ceea ce priveşte complexitatea leziunilor mediale, tratamentul ar trebui efectuat în spitale specializate. Fracturile instabile şi leziunile ligamentelor SCJ trebuie luate în considerare pentru tratamentul chirurgical. Fracturile mediane ar trebui să se

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RezumatDate generale: Leziunile cu volet costal (FCI) sunt asociate cu o rată ridicată de morbiditate şi mortalitate. Având în vedere că asocierea unei fracturi de claviculă concomitente cu FCI agravează chiar rezultatul, întrebarea care se pune este cum pot fi aceste leziuni costoclaviculare (CCI) gestionate chirurgical. Metode: 11 pacienţi cu CCI au fost trataţi chirurgical prin osteosinteză a claviculei şi a coastelor subiacente prin placă blocată, prin abordări chirurgicale limitate, sub anestezie generală. Pacienţii au fost urmăriţi la 2, 6, 12, 26 şi 52 de săptămâni. Rezultate: Toţi pacienţii au prezentat o deformare severă a peretelui toracic din cauza fracturilor puternic deplasate ale coastelor şi claviculei. Ei sufereau de durere şi de restrângerea mişcărilor respiratorii. Peretele toracic a putut fi restabilit la forma normală în toate cazurile, cu vindecare lipsită de complicaţii a oaselor şi confort sporit al pacientului. Fracturile claviculei şi celei de-a doua coaste au fost gestionate printr-o abordare inovatoare clavipectorală, iar celelalte prin abordări standard ale peretelui anterolateral şi posterolateral. Doi pacienţi s-au plâns de amorţeală în zona intervenţiei laterale şi de durere periscapulară peristentă. Concluzii: Stabilizarea chirurgicală ar putea reprezenta terapia adecvată în CCI cu fracturi dislocate, deoarece acestea ar putea cauza deformări severe şi pierderea funcţiei peretelui toracic şi a umărului.

Objective A minimally invasive treatment of osteoporotic and nonosteoporotic thoracic and lumbar spine fractures is cement augmentation (kyphoplasty). Little is known about the impact on adjacent intervertebral discs. A quantitative magnetic resonance imaging (MRI) approach in addition to morphological MRI is desirable to evaluate changes in the intervertebral disc. Our study aims to evaluate the feasibility of T2 mapping for the detection of subtle changes in the intervertebral discs in spines after kyphoplasty. Design Intervertebral discs were assessed by quantitative MRI (3.0 T) using T2 relaxation time mapping. Region of interest (ROI; 6 per disc) analyses were performed. The ROIs at the anterior and posterior edges were interpreted as annulus fibrosus (AF). The 2 very inner zones were regarded as nucleus pulposus (NP) and the regions in between as intermediate transition zone. We compared T2 relaxation time values of intervertebral discs adjacent to the vertebrae after kyphoplasty with those nonadjacent to vertebrae after kyphoplasty, especially in the NP. Results The analysis of the ROIs showed that the intervertebral discs of the adjacent vertebral segments are associated with reduced T2 values compared to those that are nonadjacent to the affected vertebrae. Conclusion This study is to our knowledge the first investigation of intervertebral discs after kyphoplasty by quantitative MRI. Quantitative T2 mapping shows increased degeneration in adjacent intervertebral discs following kyphoplasty. Besides its contribution to a broader knowledge of postoperative changes after kyphoplasty, our findings may help to improve differentiation between healthy and degenerated intervertebral discs using these techniques.

A total of 21,741 patients met the inclusion criteria including 10,474 (48.2 %) suffering from either RF or FC. The mean age was 49.8 ± 19.9 years in the RF group and 54.1 ± 18.2 years in the FC group. Approximately 25 % were female in both groups, 98.1 % were blunt force injuries and the median ISS was 28.0 ± 11.2 in RF and 35.1 ± 14.2 in FC. Shock, insertion of a chest tube, (multi) organ failure and fatality rates were significantly higher in the FC group as were concomitant thoracic injuries, such as pneumothorax and hemothorax. Sternal fractures without rib fractures were less common (3.8 %) than concomitant in the RF (10.1 %) and FC (14 %) groups, as were concomitant fractures of the clavicle and the scapula. Out of all patients 32.6 % showed fractures of the thoracolumbar spine, 26.5 % without rib fractures, 36.6-38.6 % with rib fractures or monolateral FC and 48.6 % concomitant to bilateral FC. Thoracotomy was carried out only in isolated cases in RF and in 10.2 % of the FC group. Operative stabilization of the thoracic cage was carried out in 3.9-9.1 % of patients in the RF group and in 17.9-23.9 % in the FC group.

A total of 16.5 % of sternal fractures were localized at the manubrium, mostly caused by seat belt. Fractures without significant dislocation seemed to be stable and healed well under conservative treatment. Dislocation in this region leads to unstable shoulder girdle. Anterior plating provides sufficient stabilisation and allowed consolidation.

RezumatDate generale: Leziunile de volet costal (FCI) sunt unele dintre cele mai grave leziuni toracice. Mai mult decât atât, o fractură de stern suplimentară (SF) chiar agravează rezultatele, cum ar fi durata ventilaţiei mecanice, prin urmare o fixare chirurgicală a fracturilor poate fi luată în considerare în anumite cazuri pentru a grăbi deconectarea ventilatorului. Această lucrare urmăreşte să sublinieze managementul diferitelor tipuri de SF în FCI. Metode: Toate cazurile tratate chirurgical (2012)(2013)(2014)(2015)(2016) Original ArticleCuvinte cheie: volet costal, fractură de stern, fractură sternală, fractură costală, osteosinteză cu placă blocată, Matrix Rib Abstract Background: Flail Chest Injuries (FCI) are one of the most severe thoracic injuries. Moreover, an additional sternal fracture (SF) even worsens the outcome, such as the duration of mechanical ventilation, therefore an surgical fixation of the fractures could be considered in certain cases to improve the weaning from the ventilator. This paper aims to emphasize on the management of different types of SF in FCI. Methods: All surgically treated cases (2012)(2013)(2014)(2015)(2016) that showed the combination of FCI and SF have been evaluated for their clinical details, the morphology of the fractures and the technical aspects of the surgical procedure in a retrospective investigation.Results: All of the SF (n=15) had been fixed by locked plate osteosynthesis through a median approach in a supine position. Three main regions of the sternum showed the need for different fixation strategies: the upper manubrium, central and lower corpus sterni. Concomitant rib fractures were addressed either through the same approach or through additional limited incisions. Conclusions: Combinations of SF and FCI are high risc injuries with high demand on surgical skills. They can be properly fixed with a locking plate osteosynthesis through a combination of limited incisions employing different types of plates depending on the type of SF.