Chondrosarcoma is the second most frequent malignant bone tumour after osteosarcoma. It most often occurs in the pelvis. Treatment of pelvic chondrosarcoma is a difficult problem for the musculoskeletal oncologist. We report 3 patient with chondrosarcoma in pelvic region that undergoing internal hemipelvectomy. First patient, male 28 y.o. with chondrosarcoma in left iliac wing 11.2cm x 10.8cm x 9.2cm. Second, woman, 47 y.o with chondrosarcoma in right superior and inferior pubic rami 13.7cm x 11.5cm x 14.2cm with soft tissue mass around extended to medial part of proximal thigh. Already done A wide excision of the tumor was performed and we use non-vascularized fibular graft (NVFG) to fill the defect. Last patient, pregnant woman 22 y.o. (16weeks gestational age) with chondrosarcoma in right pubic rami 9.8cm x 11.4cm x 13cm. We already done internal hemipelvectomy without terminating the fetus. The second and third patient confirmed with the histopathology result with chondrosarcoma grade II, and the first patient with chondrosarcoma grade I. After 3month post operatively, all of the patients have no pain, no urinary tract complain. The first patient can ambulatory full weight bearing with no crutches or walker. Second patient ambulatory partial weight bearing with crutches. The last patient ambulatory with wheel chair during the pregnancy. Since chondrosarcomas are unresponsive to chemotherapy or radiotherapy, surgical resection was the only therapeutic solution for these patients. It also reinforce the need of a correct diagnose and collaboration between specialities in the treatment of oncological patients.
Background: Bipolar Hemiarthroplasty and Cephalomedullary Nailing (PFNA) are operative procedures for the management of proximal femoral fractures. Both of these surgical techniques have their respective advantages and disadvantages. This study aims to determine the differences in biological and functional outcomes. C-Reactive Protein (CRP) used to measure inflammation due to tissue damage and Harris Hip Score (HHS) used to measure functional output. This study hoped to facilitate the selection of appropriate techniques for the treatment of proximal femoral fractures.Methods: Prospective cohort study conducted among patient with proximal femoral fractures who underwent Bipolar Hemiarthroplasty and PFNA surgery. CRP levels were examined before surgery and 12 hours postoperatively. The HHS assessment was performed at weeks 4, 6, and 8 postoperatively.Results: In general, the preoperative CRP levels of the groups undergoing Bipolar Hemiarthroplasty and PFNA were not significantly different (32.4±16.7 and 33.7±17.1; p> 0.05), whereas postoperatively, Bipolar Hemiarthroplasty shown significantly higher CRP (76.5±27.3 and 42.6±17.6; p <0.0001). Similar results were also shown from the ∆CRP analysis (45.1±22.1 and 8.9±3.2; p<0.0001). The mean HHS score was higher in the Bipolar Hemiarthroplasty group than in PFNA group at each measurement. At the 4th week, the mean HHS score did not show a significant difference (52.3±4.2 vs 52.2±5.4; p>0.05). The 6th week evaluation showed Bipolar Hemiarthroplasty had a mean HHS of 76.5±4.6 while PFNA 61.4±5.4 (p <0.0001). At week 8, HHS in Bipolar Hemiarthroplasty was consistently higher than PFNA (89.43±4.5 and 74.95±4.9; p <0.0001). The Bipolar Hemiarthroplasty group was hospitalized 56% longer (6.1±1.3 and 3.9±1.3 days; p<0.0001) and the Bipolar Hemiarthroplasty had an average bleeding volume of 4.5 times more (407.4±122.8 and 90±13 ml; p <0.0001).Conclusion: Bipolar Hemiarthroplasty and PFNA procedures have significantly different functional and biological outcomes. The postoperative HHS score in Bipolar Hemiarthroplasty is better but with a higher delta CRP. Latar Belakang: Hemiarthroplasti bipolar dan Cephalomedullary Nailing (PFNA) merupakan prosedur operatif penatalaksanaan fraktur proksimal femur. Kedua prosedur tersebut menggunakan pendekatan yang berbeda utamanya pada upaya preservasi bagian proksimal femur. Kedua teknik bedah ini memiliki keuntungan dan kerugian masing-masing. Penelitian ini bertujuan untuk mengetahui perbedaan luaran biologis dan fungsional kedua teknik tersebut. C-Reactive Protein (CRP) digunakan sebagai parameter terkait inflamasi akibat kerusakan jaringan dan Harris Hip Score (HHS) digunakan mengukur luaran fungsional. Studi ini diharapkan dapat mempermudah pemilihan teknik yang tepat untuk penanganan fraktur proksimal femur.Metode: Penelitian ini adalah penelitian kohort prospektif pada pasien dengan fraktur proksimal femur yang menjalani operasi Hemiartroplasti Bipolar dan PFNA. Kadar CRP diperiksa sebelum operasi dan 12 jam paska operasi. Penilaian HHS dilakukan pada minggu ke-4, 6, dan 8 paska operasi.Hasil: Secara umum kadar CRP preoperasi kelompok yang menjalani Hemiarthroplasti Bipolar dan PFNA tidak berbeda signifikan (32,4±16,7 dan 33,7±17,1; p>0,05), sedangkan pada paska operasi kadar CRP Hemiarthroplasti Bipolar secara signifikan lebih tinggi (76,5±27,3 dan 42,6±17,6; p<0,0001). Hasil yang sama juga ditunjukan dari analisis ∆CRP (45,1±22,1 dan 8,9±3,2; p < 0,0001). Rerata skor HHS lebih tinggi pada kelompok Hemiarthroplasti Bipolar daripada PFNA pada setiap kali pengukuran. Pada minggu ke-4 nilai rerata HHS tidak menunjukan perbedaan yang signifikan (52,3±4,2 vs 52,2±5,4, p>0,05). Evaluasi minggu ke-6 menunjukan Hemiarthroplasti Bipolar memiliki rerata HHS 76,5±4,6 sementara PFNA 61,4±5,4 (p<0,0001). Pada minggu ke-8, HHS pada Hemiarthroplasti Bipolar konsisten lebih tinggi daripada PFNA (89,43±4,5 dan 74,95±4,9; p<0,0001). Kelompok Hemiarthroplasti Bipolar menjalani rawat inap 56% lebih lama (6,1±1,3 dan 3,9±1,3 hari; p < 0,0001) serta Hemiarthroplasti Bipolar memiliki rerata volume perdarahan 4,5 kali lebih banyak (407,4±122,8 dan 90±13 ml; p < 0,0001).Kesimpulan: Prosedur Hemiarthroplasti Bipolar dan PFNA memiliki luaran fungsional dan biologis yang berbeda secara signifikan. Skor HHS pada Hemiarthroplasti Bipolar lebih baik tetapi selisih CRP yang lebih tinggi.
Osteosarcoma is the most common bone tumor. These tumors are usually asymptomatic and show clinical symptoms as a result of trauma and pressure from the surrounding muscles, joints, nerves, and blood vessels. Treatment from this tumor varies from patient to patient. In this case report, we describe 3 cases of osteochondroma around knee. The cases were boys 17 years old, 15 years old, and 38 years old patient. The diagnose was confirmed by imaging such as plain radiography and histology. All three patients were treated with arthroscopic marginal excision of knee. Key words: arthroscopic marginal excision, osteochondroma, knee.
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