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Aim There is insufficient evidence to support bony reconstruction of the pubis after a type III internal hemipelvectomy (resection of all or part of the pubis). In this study, we compared surgical complications, postoperative pain, and functional outcome in a series of patients who had undergone a type III internal hemipelvectomy with or without bony reconstruction. Methods In a retrospective cohort study, 32 patients who had undergone a type III hemipelvectomy with or without allograft reconstruction (n = 15 and n = 17, respectively) were reviewed. The mean follow-up was 6.7 years (SD 3.8) for patients in the reconstruction group and 6.1 years (SD 4.0) for patients in the non-reconstruction group. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system and the level of postoperative pain with a visual analogue scale (VAS). Results The mean MSTS score of the patients was significantly better in patients after reconstruction (26 (SD 1.7) vs 22.7 (SD 2.0); p < 0.001). The mean visual analogue scale score for pain was significantly less in the reconstruction group (2.1 (SD 2) vs 4.2 (SD 2.2); p = 0.016). One infection occurred in each group. Bladder herniation occurred in three patients (17.6%) in the non-reconstruction group but none in the reconstruction group. Five patients (29.4%) in the non-reconstruction group and one (7%) in the reconstruction group had a limp. Graft displacement occurred in two patients in the reconstruction group. Conclusion We recommend reconstruction of the bony defect after a type III hemipelvectomy: it gives a better functional result, less postoperative pain, and fewer late surgical complications. Cite this article: Bone Joint J 2021;103-B(6):1155–1159.

Objective The role of vitamin D in the pathogenesis of osteoarthritis (OA) is not well understood. In this study, we aimed to investigate the association of serum vitamin D with the serum cytokine profile in patients with primary knee OA. Design In a cross-sectional study, 116 patients with radiologic diagnosis of grade I to III knee OA were included. The study population included 79 (75.9%) females and 25 (24.1%) males with a mean age of 55.1 ± 9.6 years. The serum concentration of IL-6, IL-8, TNF-α, IL-4, IL-10, IL-13, and vitamin D were assessed using an enzyme-linked immunosorbent assay. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used for the assessment of patient’s reported disability associated with knee OA. Results Serum vitamin D status was deficient, insufficient, and sufficient in 18 (15.5%), 63 (54.3%), 35 (30.2%) patients, respectively. Higher levels of serum IL-6 were observed in patients with vitamin D deficiency ( P = 0.022). The mean serum vitamin D level was not associated with OA grade ( P = 0.88) and WOMAC scores of the patients ( P = 0.67). Serum IL-6 level was significantly associated with both OA grade and WOMAC scores of the patients ( P < 0.001 and P = 0.001, respectively). The vitamin D status was not significantly associated with the serum levels of other evaluated cytokines. Conclusion Vitamin D deficiency in knee OA seems to be associated with a higher release of IL-6. Therefore, vitamin D supplementation could reduce the disease burden by controlling the IL-6 release.

Background:The optimal nonoperative management for subacromial impingement syndrome (SIS) is unclear. This study evaluated the efficacy of subacromial corticosteroid, hyaluronic acid injection and physiotherapy in patients with SIS to determine which treatment is most effective. Methods:SIS patients treated with either physiotherapy or subacromial injection of triamcinolone (40 mg), or subacromial hyaluronic acid injection were included in this retrospective study. The outcome measures were evaluated 3 and 6 mo after the intervention and included pain evaluated by a visual analog scale (VAS) and limb function assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Results:Eighty-eight patients with SIS were included. Treatment was done with corticosteroid injection in 31 patients, hyaluronic acid injection in 30 patients, and physiotherapy in 27 patients. The mean improvement of VAS, DASH, and ASES scores of the corticosteroid group was significantly higher when compared with the physiotherapy group at 3 mo (P = 0.035, P < 0.001, and P < 0.001, respectively) and 6 mo (P = 0.036, P < 0.001, and P < 0.001, respectively), also in comparison with the hyaluronic acid group at 3 mo (P = 0.038, P < 0.001, and P = 0.002, respectively) and 6 mo (P = 0.044, P < 0.001, P < 0.001, respectively). The mean improvement of DASH and ASES scores, but not VAS, was significantly higher in the hyaluronic acid group compared to the physiotherapy group at 3 mo (P = 0.022, P = 0.034, and P = 0.55, respectively) and 6 mo (P = 0.46, P = 0.039, and P = 0.51, respectively). Conclusions:Subacromial corticosteroid injection is more effective than physiotherapy and hyaluronic acid injection in treating SIS symptoms.

CB generally occurs at the epiphyses/apophyses of long bones, and the peak age of involvement is 10 to 25 yr. 12 In this study,

Chondroblastomas are rare benign neoplasms and scarcely present in the acromion. We reported a case of chondroblastoma presented in the right acromion of a 36-year-old male. The patient had pain and restricted abduction. Moreover, the histological analysis of the biopsy sample was consistent with the diagnosis of chondroblastoma. The patient was treated with extended curettage and bone grafting. Besides, the 2-year follow-up of the patient was event-free. This case reveals that the chondroblastoma of acromion can be adequately treated by extended curettage. It also highlights the importance of acromion chondroblastoma in the differential diagnosis of shoulder pain to avoid the undertreatment of the patients.

Infantile fibrosarcoma is a rare soft-tissue neoplasm, which may render a diagnostic challenge leading to misdiagnosis and consequently an inappropriate treatment of patients. This study reports a case of infantile fibrosarcoma that mimicked a hemangioma in an 11-month-old girl. As the lesion signal in the MRI was not consistent with the diagnosis of hemangiomas, we performed a core needle biopsy, which its result was consistent with the diagnosis of infantile fibrosarcoma. The lesion was initially treated with surgical resection. However, the lesion recurred one year after the surgery. The recurrence was managed with debulking surgery. The fifth finger was necrotized during the hospitalization after the relapse surgery. Finally, the necrotic finger was amputated. Also, adjuvant chemotherapy was used to prevent further relapses. The 1-year follow-up of the patient was recurrence-free. These findings highlight the importance of considering infantile fibrosarcoma when an infant presents with a lesion that clinically mimics a vascular lesion.

Background:Associated injuries in tibial shaft fractures are not investigated often, and their impact on patient outcome is not clear. In this study, associated knee injuries in tibial shaft fractures were arthroscopically investigated, and their impact on the outcomes of patients were evaluated. Methods:In a prospective study, 57 patients with closed tibial shaft fractures and without concomitant fibular fractures were included. Motorvehicle accident was the most frequent mechanism of the injury. The fractures were treated with reamed and locked titanium intramedullary tibial nailing. The functional outcome was evaluated using the International Knee Documentation Committee score and compared between the patients with and without an ipsilateral associated injury. Results:The mean age of the patients was 33.2 ± 13.2 years. The mean follow-up duration was 10.2 ± 3.1 mo. In 35 patients (61.4%), at least one associated knee injury was detected. Chondral damage was the most frequent arthroscopic finding (n = 23, 40.4%). The anterior cruciate ligament (ACL) injury was the second most frequent injury (n = 7, 12.3%). No intervention was performed for chondral lesions and ACL tears. Meniscal injuries were detected in three (5.3%) patients only. The mean International Knee Documentation Committee score was 95.9 ± 2.2 in patients with and 96.2 ± 2.1 in patients without an arthroscopic finding (P = 0.38). The severity of comminution was not correlated with the incidence of arthroscopic findings (r = 0.089, P = 0.45). Conclusions:Ipsilateral injuries are frequent in tibial shaft fractures. However, they do not seem to affect the functional outcome of patients, at least in short-term follow-up.