BackgroundIn the Ponseti treatment of idiopathic clubfoot, children are generally provided with a standard foot abduction orthosis (FAO). A significant proportion of these patients experience irresolvable problems with the FAO leading to therapeutic non-compliance and eventual relapse. Accordingly, these patients were equipped with a unilateral lower leg orthosis (LLO) developed in our institution. The goal of this retrospective study was to determine compliance with and the efficacy of the LLO as an alternative treatment measure. The minimum follow-up was 5 years.ResultsA total of 45 patients (75 ft) were retrospectively registered and included in the study. Compliance with the bracing protocol was 91% with the LLO and 46% with the FAO. The most common problems with the FAO were sleep disturbance (50%) and cutaneous problems (45%). Nine percent of patients experienced sleep disturbance, and no cutaneous problems occurred with the LLO. Thirteen percent of patients being treated with an FAO until the age of four (23 patients; 40 ft) underwent surgery because of relapse, defined by rigid recurrence of any of the components of a clubfoot. Fourteen percent of patients being treated with an LLO (22 patients; 35 ft), mostly following initial treatment with an FAO, experienced recurrence.ConclusionChanging from FAO to LLO at any point during treatment did not result in an increased rate of surgery and caused few problems.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2160-1) contains supplementary material, which is available to authorized users.
Purpose Desmoid tumours of the extremity have a high recurrence rate. The purpose of this study was to analyse the outcome after resection of these tumours with special emphasis on recurrent disease and adjuvant therapeutic strategies. Methods In this retrospective study we evaluated prognostic factors for recurrence-free survival after surgical treatment of desmoid tumours of the extremity in 27 patients with an average age of 41 years treated from 1997 to 2009. Adjuvant radiotherapy (50-60 Gy) was given in five cases with primary and in nine patients with recurrent disease. The average follow-up was 64 months. Results The five-year recurrence-free survival in patients with primary disease was 33 %. Patients with negative resection margins tended to have a better outcome than patients with positive resection margins, but the difference between both groups was not significant (56 vs 14 %, p=0.145). In patients with positive margins, adjuvant radiotherapy did not significantly improve recurrence-free survival (40 vs 14 %, p=0.523). Patients with local recurrence had a five-year further recurrencefree survival of 47 %. In those patients further recurrence-free survival was significantly better after adjuvant radiation (89 vs 25 %, p=0.015). Two thirds of all patients suffered moderate or severe complications due to the treatment regimen. Conclusions Compared to desmoids of the trunk or the head and neck region, desmoids affecting the limbs show by far the worst outcome in terms of relapse or treatment-related morbidity. The importance of negative resection margins is still not clear. Particularly in recurrent desmoids adjuvant radiotherapy appears to reduce the further recurrence rate. Therefore, a general use of radiation should be considered for this high-risk group.
Among human neoplasms, primary malignant bone tumors are fairly rare. They present an incidence rate of roughly 10 cases per 1 million inhabitants per year. During childhood (<15 years), the percentage of malignant bone tumors amounts to 6% of all infantile malignancies. Only leukemia and lymphoma show a higher incidence in adolescence. Of all primary malignant bone tumors, 60% affect patients younger than 45 years and the peak incidence of all bone tumors occurs between 15 and 19 years. The most common primary malignant bone tumors are osteosarcoma (35%), chondrosarcoma (25%), and Ewing's sarcoma (16%). Less frequently (≤ 5%) occurring tumors are chordoma, malignant fibrous histiocytoma of bone, and fibrosarcoma of bone. Vascular primary malignant tumors of bone and adamantinoma are very rare. Staging of the lesion is essential for systemic therapeutic decision-making and includes complete imaging and histo-pathological confirmation of the suspected entity. In most cases, this is established by open- or image-guided biopsy. Based on this information, an interdisciplinary tumor board will determine the individual therapeutic approach. Endoprosthetic or biological reconstruction following wide tumor resection is the most common surgical therapy for primary malignant bone tumors. There is vital importance in a thorough postoperative follow-up and continous after-care by a competent tumor center which is permanentely in charge of therapy.
Background/Aim: Ewing sarcoma is a highly malignant tumour predominantly found in children. The radiological signs of this malignancy can be mistaken for acute osteomyelitis. These entities require profoundly different treatments and result in completely different prognoses. The purpose of this study was to develop an artificial intelligence algorithm, which can determine imaging features in a common radiograph to distinguish osteomyelitis from Ewing sarcoma. Materials and Methods: A total of 182 radiographs from our Sarcoma Centre (118 healthy, 44 Ewing, 20 osteomyelitis) from 58 different paediatric (≤18 years) patients were collected. All localisations were taken into consideration. Cases of acute, acute on chronic osteomyelitis and intraosseous Ewing sarcoma were included. Chronic osteomyelitis, extra-skeletal Ewing sarcoma, malignant small cell tumour and soft tissue-based primitive neuroectodermal tumours were excluded. The algorithm development was split into two phases and two different classifiers were built and combined with a Transfer Learning approach to cope with the very limited amount of data. In phase 1, pathological findings were differentiated from healthy findings. In phase 2, osteomyelitis was distinguished from Ewing sarcoma. Data augmentation and median frequency balancing were implemented. A data split of 70%, 15%, 15% for training, validation and hold-out testing was applied, respectively. Results: The algorithm achieved an accuracy of 94.4% on validation and 90.6% on test data in phase 1. In phase 2, an accuracy of 90.3% on validation and 86.7% on test data was achieved. Grad-CAM results revealed regions, which were significant for the algorithms decision making. Conclusion: Our AI algorithm can become a valuable support for any physician involved in treating musculoskeletal lesions to support the diagnostic process of detection and differentiation of osteomyelitis from Ewing sarcoma. Through a Transfer Learning approach, the algorithm was able to cope with very limited data. However, a systematic and structured data acquisition is necessary to further develop the algorithm and increase results to clinical relevance.
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