Purpose Various methods for the treatment of chondroblastoma of bone have been used including simple curettage, or combined with bone grafting, in addition to the use of adjuvant therapy. However, local recurrence still represents a challenge in the management of this aggressive tumour. This study focuses on evaluating the role of intraregional extended curettage together with the use of adjuvant cryotherapy and autogenous bone grafting in the treatment of benign chondroblastoma of bone aiming to decrease the recurrence rate. Methods All patients with chondroblastoma included in this study underwent intralesional extended curettage, adjuvant cryotherapy using liquid nitrogen, and autogenous iliac crest bone grafting. Follow up for healing of chondroblastoma lesions and detection of any local recurrence was assessed on clinical and radiological bases. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system. Results The mean follow-up period was 49 months. The average time for bone healing was 7.4 months. Our rate of local recurrence is 7.1 %. Two patients (14.3 %) developed physeal growth arrest. One patient had superficial skin sloughing (7.1 %). None of the cases had pathological fracture. The mean Musculoskeletal Tumour Society functional score was 92.7 %. Conclusion Chondroblastoma is an aggressive benign bone tumour with a high rate of recurrence. The use of high-speed burr combined with adjuvant intralesional cryotherapy and iliac crest autogenous bone grafting is a reliable method of treatment with a low rate of recurrence.

Background: Many technical and financial obstacles face surgeons when performing limb-salvage surgeries. Methods: We retrospectively studied 15 patients with osteosarcoma around the knee joint treated with limb salvage procedure in the form of wide resection, recycling the resected segment using liquid nitrogen followed by implantation of a hinged knee prosthesis and re-implantation of the autograft-prosthetic composite to the host bone by osteosynthesis, with mean follow-up duration of 66.53 mo. Results: The average duration until union of the graft was 7.73 mo (range, 4-13 mo). Implant failure occurred in one of 15 patients with resultant screw pull out for whom revision plating was done. Superficial wound infection occurred in one of 15 patients for whom surgical debridement was done. No prosthesis-related complications were detected until the final follow-up. Musculoskeletal Tumor Society (MSTS) scoring was applicable for 13 patients who were alive at the final follow-up period and was 73%. Eleven of 15 patients were disease free at last follow-up (average follow-up 66.5 mo). Conclusions: As far as we know no other research showed population study homogeneity regarding autograft prosthesis composite reconstruction using liquid nitrogen around the knee joint for the same pathology. Use of recycled autograft prosthesis composite is an option that eliminates disadvantages of both stand-alone endoprosthetic replacement and recycled tumor-bearing segment autografts while preserving the advantages of these techniques. The technique provides comparable survival rates to other techniques. It represents an alternative to the use of allograft when culturally unacceptable and saves about 50% of expected cost as compared to megaprosthesis reconstruction.

Background: The distal tibia is an unusual location for giant cell tumor. Less than 4% occurring in bone involve the foot and ankle region; the exact prevalence in the distal tibia is not known. Treatment remains unclear because of the rarity of the lesion in this location, the anatomy of the ankle, and difficulties associated with reconstruction. Methods: We retrospectively reviewed 10 patients who underwent extended curettage for giant cell tumor of the distal tibia, using adjuvant cryotherapy and biological reconstruction with autograft. The age of the patients ranged between 23-50 yr. Nine patients had newly diagnosed giant cell tumor while one patient presented with a recurrent lesion after simple curettage and synthetic bone grafting at another hospital. One patient presented with a nondisplaced pathological fracture of the distal tibia. He was treated initially with a short leg cast until the fracture healed, then surgical intervention was done. No intraarticular extension was present preoperatively in any patient. Results: The average follow-up from primary surgical intervention was 57 mo. At the end of the study, the mean musculoskeletal tumor score (MSTS) was 90. Local recurrence occurred in two patients. The average duration until union of the graft was 6.2 mo (range, 4-10 mo). Conclusions: Giant cell tumor of the distal tibia is a rare benign but aggressive tumor. Extended curettage and liquid nitrogen as adjuvant, followed by biologic reconstruction using autogenous bone graft is a solid line of treatment for lesions without intraarticular extension that provides good results.

Background: Chondrosarcoma is the second most common malignant primary tumor of bone. The prognosis for chondrosarcoma depends mainly on its histologic grading and location. High-grade chondrosarcoma has higher a tendency to recur and metastasize. The standard treatment for chondrosarcoma is wide resection without adjuvant therapy. Numerous reconstructive options are available, varying from endoprostheses, biological reconstruction using allografts or osteoarticular allografts, and recycling of tumor-bearing segment. Methods: We retrospectively reviewed seven patients with high-grade chondrosarcoma who underwent wide resection of the tumor mass and reconstruction using liquid nitrogen treated recycled autograft prosthesis composite. Evaluation was done for local recurrence, metastasis, graft-bone union, osteosynthesis, implant, or graft-related complications. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system. Results: The mean follow-up period was 46 mo (range 24-65 mo). The average duration for graft union was 8.2 mo (range 7-10 mo). No local recurrence was detected in any patient. None of them had any metastatic deposits. One had a superficial wound infection. One had fulminant infection that required hip disarticulation. The mean Musculoskeletal Tumour Society functional score was 67.7% (range 60-78). Conclusions: Recycled autograft prosthesis composite using liquid nitrogen is an oncologically safe and effective reconstructive option for the management of chondrosarcoma around the knee. It maintains knee function and restores the bone stock. It overcomes endoprosthesis-related problems, overcoming the obstacles of allograft in countries where it is not available or not socially or religiously acceptable.

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Background: The proximal humerus represents one of the most common sites for primary malignant bone tumors. Limb salvage procedures have become the standard modality in treatment of these tumors. Several techniques can be used in shoulder reconstruction after wide resection of malignant bone tumors. The purpose of this study was to compare the functional outcome and complications for two important methods of shoulder joint reconstruction: conventional arthrodesis using fibular autogenous graft and clavicula pro humero. Methods: We retrospectively studied 30 patients with malignant tumors of the proximal humerus treated with limb salvage procedures with mean follow-up period of 67.16 mo. In 13 we used the clavicula pro humerus technique for reconstruction, and in 17 we performed conventional shoulder arthrodesis using nonvascularized fibular graft. Results: The mean Musculoskeletal Tumor Score (MSTS) for the conventional shoulder arthrodesis group was 69.6%. For the clavicula-pro-humero group the score was 67.5%. The Oxford Shoulder Score (OSS) for the conventional shoulder arthrodesis group was 34.6, while for the clavicula-pro-humero group it was 36.8. The median time to union was 8 wk for both groups. Conclusions: Both techniques represent reliable methods of shoulder reconstruction after wide resection of malignant tumors with comparable functional outcome and complications rates.