Background:Tru-cut biopsy in suspected bone tumors can be performed even in less specialized centers. Tru-cut biopsy has been proved as safe with more than 90% accuracy. However, its usefulness was not widely studied in general hospitals where Tru-cut biopsy is performed by orthopedic surgeons. This study was conducted to find out the accuracy and adequacy of Tru-cut biopsy performed by an orthopedic surgeon not trained in musculoskeletal oncology, in a general hospital.Materials and Methods:A study was conducted through a prospectively collected database using a uniform protocol. All patients who had a malignant appearing bone lesion with a palpable soft tissue mass were included in the current study. Fifty such consecutive cases underwent Tru-Cut biopsy by orthopedic residents or registrars who were aware of the principles of Tru-cut biopsy and the recommendations of Musculoskeletal Tumor Society. When an open biopsy or a resection of the tumor was subsequently performed, the histological diagnosis was compared for accuracy with the diagnosis of needle biopsy. We evaluated adequacy of sample obtained and accuracy of diagnosis in terms of sensitivity, specificity, positive predictive value, and negative predictive value.Results:Seventy seven cases were initially enrolled. Out of which 18 were excluded and 59 patients were biopsied. Out of which 50 were analysed. Only 4 out of 50 biopsied specimens were inadequate resulting in an adequacy rate of 92%. Among 46 cases, which were analyzed for diagnostic accuracy, 84.78% had true-positive result, 8.69% had true negative, and 6.52% had false-negative report. The sensitivity and specificity of Tru-cut biopsy in our series was 92.85% and 100%, respectively, with positive predictive value of 100% and negative predictive value of 57.14%.Conclusions:Tru-cut biopsy can be recommended as an initial method of tissue diagnosis in musculoskeletal tumors with soft tissue extension.
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Hydrogen peroxide, an over the counter irrigation solution used in infected and dirty wounds, has been reported mainly in the anesthesia literature to have life threatening complications. We report a case of near fatal gas embolism during an orthopedic procedure of irrigating the wound of a 30 year old female with chronic osteomyelitis of the femur using hydrogen peroxide solution.
Introduction: Stress fracture of neck of femur is known to occur in athletes and soldiers. From treatment perspective, this is still an unsolved fracture. The purpose of this study is to critically analyse the functional outcome of surgical treatment of stress fracture of neck of femur in military recruits performed by the same surgical team. Methods: This is a retrospective study of surgically treated femoral neck stress fracture from 1st December 2012 to 1st December 2013. All fractures were fixed with three 6.5 mm cancellous lag screws with washers. For failure of primary fixation or non-union, osteosynthesis with fibular strut graft was performed. Patients were evaluated at six weeks, 12 weeks, six months, 12 months and then yearly for three years. Functional outcome was evaluated by using Harris Hip Score at six months and at final follow-up. The outcome was followed up for six years up to Dec 2019. Results: There were eight males and one female patient. Mean age of patient was 20.7 years (Range, 19-23 years). Average follow-up period was 67.6 months (range 6-81). Lag screw fixation was done in five cases after closed reduction and in four cases after open reduction. Osteosynthesis with fibular graft was done in two cases. In six cases, fracture united at a mean duration of 9.8 months (Range 6-20). In three cases there was non-union of the fracture with added infection in one case. Avascular necrosis of femoral head developed in two cases. Conclusions: Successful surgical treatment of stress fracture of neck of femur requires anatomical reduction and stable interfragmentary compression with lag screws.
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