The management and definitive treatment of segmental bone defects in the setting of acute trauma, fracture non-union, revision joint arthroplasty, and tumor surgery are challenging clinical problems with no consistently satisfactory solution. Orthopaedic surgeons are developing novel strategies to treat these problems, including three-dimensional (3D) printing combined with growth factors and/or cells. This article reviews the current strategies for management of segmental bone loss in orthopaedic surgery, including graft selection, bone graft substitutes, and operative techniques. Furthermore, we highlight 3D printing as a technology that may serve a major role in the management of segmental defects. The optimization of a 3D-printed scaffold design through printing technique, material selection, and scaffold geometry, as well as biologic additives to enhance bone regeneration and incorporation could change the treatment paradigm for these difficult bone repair problems.
Background and ObjectiveThis study describes the complication profile of modern cryoablation utilizing probes as an adjuvant during open surgical treatment of orthopedic tumors.MethodsA retrospective, single‐surgeon study was performed for patients receiving cryoprobe cryoablation. Demographic information, malignancy‐related and operative details, and clinical courses were collected. Outcomes assessed included rates of complications, recurrence, and correlations between the number of probes or cryoablation cycles performed.ResultsIn this 148‐patient study, 67.6% had metastatic carcinoma to bone, 27.7% had benign bone tumors, and 4.7% had soft tissue tumors. An average of 3.4 ± 1.7 cryoablation probes were utilized and 1.7 ± 0.6 freezing cycles were performed. The overall cohort aggregate complication rate was 16.9%. These complications included postoperative fracture (3.4%), nerve palsy (2.7%), wound complications (7.4%), and infection (3.4%). The number of cycles and probes was significantly correlated with the incidence of aggregate complications in the overall cohort (Pearson = 0.162, p = 0.049) and metastatic bone cohort (Pearson = 0.222, p = 0.027). There were 13 recurrences.ConclusionThis study describes the complication rates involving cryoablation probes used as surgical adjuvants. Greater probe number usage was correlated with increased aggregate complications in patients with metastatic disease to bone; meanwhile, more treatment cycles were associated with increased aggregate complications in the overall cohort.
abdomen noted asymmetric wall thickening with enhancement of the small bowel. The patient underwent laparoscopy-assisted enteroscopy with rendezvous technique allowing direct visualization of a 3 cm proximal ileum mass requiring open segmental resection with primary anastomosis. Pathology suggested malignant GNET or clear cell sarcoma-like tumor of the GI tract. Immunohistochemistry was positive for neural crest markers (S100, SOX10) and Vimentin; negative for CD117, DOG1, HMB45, MART1, MAA, chromogranin, and synaptophysin. Fluorescence in-situ hybridization was positive for EWSR1 (22q12) rearrangement. Given the clear surgical margins, absent regional lymph node spread and lack of standard guidelines for this rare pT1N0M0 tumor, surveillance imaging every three months without adjuvant radiation or systemic chemotherapy was recommended. (Figure ) Discussion: This case highlights the importance of VCE for small bowel assessment after negative bidirectional endoscopy to identify the etiology of IDA per American Gastroenterology Association guidelines. In this case, an ulcerated GNET was the etiology of IDA persisting despite iron supplementation.[3438] Figure 1. A-Luminal view of small bowel tumor on Video Capsule Endoscopy (VCE) B-Close up view of ulceration of small bowel tumor on VCE C-Histopathology slide showing epithelioid cells with eosinophilic cytoplasm, pleomorphic nuclei with prominent nucleoli and vesicular nucleoli. Scattered mitotic figures identified.
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