Background Long-term survival for all patients with osteosarcoma using current aggressive adjuvant chemotherapy and surgical resection is between 60% and 70%. In patients who present with nonmetastatic, high-grade extremity osteosarcoma of bone, limb salvage surgery is favored, when appropriate, over amputation to preserve the limb, because limb salvage may lead to a superior quality of life compared with amputation.

Background Avascular necrosis (AVN) of the femoral head is a potential complication in patients with slipped capital femoral epiphysis (SCFE), radiographically occurring in 3-60%. This may lead to early hip fusion or hip arthroplasty. Free vascularized fibular grafting (FVFG) may provide a reasonable means to preserve the femoral head. Questions/Purposes We asked: (1) What percentage of patients with AVN after SCFE treated with FVFG underwent subsequent THA or hip fusion and what was the lifespan of the FVFG? (2) Did the graft survival rate of FVFG for AVN after SCFE coincide with historically reported rates of FVFG for idiopathic AVN? And (3) did hip function improve after FVFG? Methods We retrospectively reviewed 52 patients who underwent FVFG for SCFE. We calculated the longevity of the graft and factors associated with graft survival. Harris hip scores (HHS) were recorded pre-and postoperatively. Minimum followup was 1 month (median, 19 months; range, 1-136 months).

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Osteosarcoma (OS) patients exhibit poor overall survival, partly due to copy number variations (CNVs) resulting in dysregulated gene expression and therapeutic resistance. To identify actionable prognostic signatures of poor overall survival, we employed a systems biology approach using public databases to integrate CNVs, gene expression, and survival outcomes in pediatric, adolescent, and young adult OS patients. Chromosome 8 was a hotspot for poor prognostic signatures. The MYC-RAD21 copy number gain (8q24) correlated with increased gene expression and poor overall survival in 90% of the patients (n = 85). MYC and RAD21 play a role in replication-stress, which is a therapeutically actionable network. We prioritized replication-stress regulators, bromodomain and extra-terminal proteins (BETs), and CHK1, in order to test the hypothesis that the inhibition of BET + CHK1 in MYC-RAD21+ pediatric OS models would be efficacious and safe. We demonstrate that MYC-RAD21+ pediatric OS cell lines were sensitive to the inhibition of BET (BETi) and CHK1 (CHK1i) at clinically achievable concentrations. While the potentiation of CHK1i-mediated effects by BETi was BET-BRD4-dependent, MYC expression was BET-BRD4-independent. In MYC-RAD21+ pediatric OS xenografts, BETi + CHK1i significantly decreased tumor growth, increased survival, and was well tolerated. Therefore, targeting replication stress is a promising strategy to pursue as a therapeutic option for this devastating disease.

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The authors report an osteoblastoma-like variant of osteosarcoma of the right ischial tuberosity in a 14-year-old boy. Radiographs initially showed a bone-forming lesion of the right ischial tuberosity. The patient underwent biopsy with curettage and bone grafting, with final pathology revealing osteoblastoma. Two years after the initial procedure, he presented with exuberant bone formation about the operative site concerning for recurrence. He underwent a second biopsy that showed transformation into a high-grade osteoblastoma-like osteosarcoma. Results from staging studies were negative for distant metastatic disease. The patient was treated with standard 3-drug chemotherapy along with wide resection of the right ischium with periacetabular reconstruction and total hip arthroplasty. [ Orthopedics. 2019; 42(3):e343–e345.]

All hip surgeons have had the experience of completing a primary total hip arthroplasty (THA) only to discover a proximal femoral fracture just prior to reducing the hip. We can comfort our patients and ourselves that the outcome of a THA with a proximal femoral fracture is excellent with proper treatment and uncemented stem fixation. The purpose of this study was to examine risk fractures, treatment options, and outcomes in THA with proximal femoral fractures. Fracture Risk Factors As the number of uncemented THAs has increased,1,2 there is no question the incidence of uncemented stem fractures has increased as as well.3 The risks for fracture during THA have been well studied. In their study, Schwartz et al4 found women were at higher risk for proximal femoral fracture with the AML stem (DePuy, Warsaw, Ind). Changes in instrumentation and implantation have helped reduce the risk of fracture. Berend et al5 noted higher fracture rates in hips undergoing THA for a diagnosis other than osteoarthritis.