Background Giant-cell tumor of bone (GCTB) is a locally aggressive primary benign tumor presenting as an expansile osteolytic lesion affecting the epiphysis of long bones. Denosumab halts the osteolysis by giant cells thereby downstaging the tumor, helping in performing less morbid procedures to remove the tumor. Our aim was to report the incidence of local recurrence (LR) in patients operated following neoadjuvant denosumab, to investigate factors associated with LR following extended curettage for GCTB, and to compare the postoperative functional and oncological outcome of patients operated with and without neoadjuvant denosumab. Methods A total of 123 patients with a mean age of 29.6 years undergoing extended curettage for GCTB were retrospectively divided into group 1 receiving neoadjuvant denosumab and group 2 operated without denosumab. The mean follow-up period was 35 months. The perioperative characteristics and outcome were compared between the two groups and the factors for LR of GCTB were analyzed. Results The incidence of LR among patients operated after neoadjuvant denosumab therapy was 42.8% and was significantly high compared to that in patients without denosumab ( p < 0.001). On multivariate logistic regression analysis, use of denosumab as a neoadjuvant was the only factor independently associated with LR following surgery ( p = 0.002). Patients treated with denosumab had a lower LR-free survival rate (log-rank, p = 0.018). Conclusions Denosumab was independently associated with increased LR following surgery for GCTB. Denosumab has to be used cautiously in patients in whom the burden of downstaging the disease outweighs the possible chance of LR.
Case: Two male patients aged 37 years and 39 years, diagnosed with sacral chordoma, underwent robotic-assisted preparatory adhesiolysis from the anterior aspect of the tumor, followed by posterior en-bloc partial sacrectomy. The average total operative time was 360 minutes (anterior docking + anterior console + posterior excision), and mean blood loss was 930 mL. Both patients were mobilized early, had no postoperative complications, and were free of local recurrence at 18 month of follow-up. Conclusions: Robotic-assisted surgery is a novel, valid, safe, and minimally invasive technique which drastically reduces the associated surgical complications of single-staged posterior sacrectomy, resulting in excellent functional and oncological outcome.
Femoral neck fractures in young adults still remains a challenge due to high rates of nonunion and avascular necrosis associated with it. Traditionally fracture neck of femur are treated as emergency operations but in our set up there is usually a delay in treating them. This paper evaluates the effect of timings of surgery on healing of fracture and functional outcome. METHODS: This retrospective study was conducted in Department of Orthopaedics & Traumatology, Bundelkhand Medical College, Sagar from November 2012 to May 2015 during which 34 cases were evaluated and treated with closed reduction and internal fixation. Only physiological young patients between the ages of 15 to 65 years with Garden's grade III & IV were included. Fractures associated with any pathological process or associated with other ipsilateral lower limb fractures were excluded. Patients treated with open reduction were also not included in this study. RESULTS: Out of 34 patients only 3 patient could be operated within 48 hours. The average delay in admission of patient was 4 days and average duration from injury to operation was 8.5 days. Non-union rates overall was 38.2%, for those operated within a week was 35.7% and for those operated after was 40%. If non-union due to mal reduction were excluded the rates were 19.2%, 10% and 25% respectively. CONCLUSION: In the treatment of fracture neck of femur quality of reduction proves to be the single most important variable affecting the outcome if operated within a week appears to be less significant variable if reduction was within acceptable range as non-union rate of only 14.2% was recorded. Thus good results can be achieved even after 48 hours though after a week non-union rates were high which suggests that after a week fibrosis around the fracture and hip and proximal migration of the distal fragment necessitate other open reduction or procedures such as intertrochanteric osteotomy or bone grafting in order to achieve union.
OBJECTIVETo compare the efficacy of corticosteroid injection versus prolotherapy for the treatment of chronic lateral epicondylitis. DESIGNA prospective, randomised-controlled study. PARTICIPANTSThirty-six subjects with clinically determined chronic (of duration three months or longer) lateral epicondylitis were recruited. All subjects noted pain intensity levels disturbing enough to prevent involvement in activities such as kneading dough, wringing clothes, lifting heavy weights and playing racquet sports. METHODSSubjects were randomised to get either corticosteroid injection or prolotherapy for treatment of chronic lateral epicondylitis. Each subject underwent injection at baseline followed by a second injection 3 weeks later. RESULTSAnalysis in both the groups demonstrated statistically significant improvements in VAS and DASH scores within the prolotherapy group having significant changes recorded from baseline to 2 months and baseline to 6 months after initial treatment. The ste roid group also recorded a clinically and statistically significant change for DASH only at both 2 month and 6 month followup. Analysis and comparison of the subjects completing the study gave no significant differences between the prolotherapy and the corticosteroid group for change in VAS or DASH, although at 1 year followup, 2 patients out of 20 patients reported sometimes pain in corticosteroid group while nobody reported pain in prolotherapy group. The study lacked sufficient power to draw conclusions from this finding. Aside from injection-associated pain, no other adverse reactions were documented. CONCLUSIONSBoth corticosteroid and prolotherapy therapy were generally well tolerated and showed to provide benefit of short duration, however, prolotherapy gets preference on long term. Small sample size precludes determining whether one therapy is advantageous to the other. Larger controlled trials appear feasible and justified on the basis of these findings.
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