This prospective study assessed the outcome of percutaneous cannulated screw fixation in 49 of 60 acute scaphoid fractures. The union rate was 100% (mean time for radiological union at 12 weeks). There were no early or mid-term complications and all achieved an excellent functional recovery.

Background Computer-assisted navigation was recently introduced to aid the resection of musculoskeletal tumors. However, it has not always been possible to directly navigate the osteotomy with real-time manipulation of available surgical tools. Registration techniques vary, although most existing systems use some form of surface matching. Questions/purposes We developed and evaluated a workflow model of computer-assisted bone tumor surgery and evaluated (1) the applicability of currently available software to different bones; (2) the accuracy of the navigated excision; and (3) the accuracy of a new registration technique of fluoro-CT matching. Methods Our workflow involved detailed preoperative planning with CT-MRI image fusion, three-dimensional mapping of the tumor, and planning of the resection plane. Using the workflow model, we reviewed 15 navigation procedures in 12 patients, including four with joint-saving resections and three with custom implant reconstructions. Intraoperatively, registration was performed with either paired points and surface matching (Group 1, n = 10) or a new technique of fluoro-CT image matching (Group 2, n = 5). All osteotomies were performed under direct computer navigation. Postoperatively, each case was evaluated for histologic margin and gross measurement of the achieved surgical margin. Results The margins were free from tumor in all resected specimens. In the Group 1 procedures, the correlation between preoperative planned margins and actual achieved margins was 0.631, whereas in Group 2 procedures (fluoro-CT matching), the correlation was 0.985. Conclusions Our findings suggest computer-assisted navigation is accurate and useful for bone tumor surgery. The new registration technique using fluoro-CT matching may allow more accurate resection of margins.

Background Primary malignant tumors located near the acetabulum are usually managed by resection of the tumor with wide margins that include the acetabulum. These resections are deemed P2 resections by the Enneking and Dunham classification. There are various methods to perform the subsequent hip reconstruction. Unfortunately, there is no consensus as to the best management. In general, patients undergoing resection at this level will have substantial levels of pain and disability as measured by the Musculoskeletal Tumor Society (MSTS) scoring system. We believe there is a subset of patients whose tumors in this location can be resected while preserving all or most of the weightbearing acetabulum using navigation and careful surgical planning. Questions/purposes (1) What complications were associated with this resection; (2) what oncological outcomes (histological margins and local recurrence) were achieved; and (3) what is the function achieved by these patients? Methods This was a retrospective study of patients with periacetabular primary malignancy. From 2008 to 2014, we treated 12 patients who had periacetabular primary malignant tumors and in five, we performed resection with the weightbearing portion spared. During this period, our general indications to perform a resection that spared the acetabulum were the tumor with its resection margin not involving the weightbearing portion of the acetabulum. However, we did not perform this procedure in patients who had more cranial lesion involving the weightbearing portion or whose hip stability might be in question after the tumor excision. Three patients were women and the other two were men. Four were chondrosarcomas, whereas the other one was synovial sarcoma. Ages ranged from 46 to 60 years (average, 53 years). Minimum followup was 14 months (median, 37 months; range, 14-88 months); no patients were lost to followup before a 1-year minimum was achieved, and all patients have been seen within the last 9 months. Results There were no intraoperative or early postoperative complications. None of the five patients had a positive margin by histological assessment. No local recurrences were detected. The median functional score by MSTS was 28 out of 30 (range, 27-30). Conclusions The roof of the acetabulum is the weightbearing portion of the acetabulum. It also maintains the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed cons...

We presented a case of diffuse-type tenosynovial giant cell tumour (DTSGCT) of foot masquerading as Langerhans cell histiocytosis. Preliminary diagnosis by needle biopsy was difficult due to the major involvement of bones and the overshadowing effect of the accompanying Langerhans cells. The complete curettage specimen with relevant immunohistochemistry and molecular tests made the final diagnosis of DTSGCT possible. The biomolecular mechanism for the masquerading phenomenon was explained by CSF1 overexpression in the neoplastic cells attracting migration and proliferation of CSF1R-positive Langerhans cells.

MICROSURGERY 18:248-255 1998In clinical microvascular surgery, there are occasions when grafting of blood vessels is necessary to bridge vascular defects. To this end, autologous vein graft has been the most popular technique. However, harvesting an autologous vein entails additional operative field and extra operating time. Furthermore, veins are floppy and often do not have matching calibres with recipient vessels. It is for this latter reason that Godina 1 has attempted to use arterial grafts instead of veins. However, the dissection of small arterial grafts, in his instance the thoracodorsal artery, is equally tedious and time-consuming.It seems that the perfect vascular graft has not been found, and the search for better substitutes has continued for the past few decades. Marrangoni et al.2 introduced the use of freeze-drying to preserve arterial homografts. Moore et al.3 then reported a fair success rate with freeze-dried arterial homografts and alcohol-preserved grafts. Since the late 1970s, there has been a surge of interest in synthetic 4,5 and freeze-dried grafts.6,7 Freeze-drying has been reported to decrease immunogenicity of the vascular grafts, whereby histological studies show very little evidence of cellular immune response. The idea of having a convenient freezedried microvascular graft bank is truly attractive, and has prompted several important experimental studies in the eighties.Chow et al. 8 have achieved a high success rate in freezedried microarterial allografts. However, their use of freezedried placental heterografts and rabbit heterografts was much less promising. The heterografts underwent immune rejection, and resulted in a high incidence of aneurysm formation.It is perhaps fair to say that such experiments have established certain facts about freeze-dried microvascular grafts that made their potential clinical use quite attractive. On the other hand, there are still areas of unsolved problems and controversies that make one hesitate to launch clinical trials at this point in time. FREEZE-DRIED MICROVASCULAR GRAFT Procurement and StorageThe donor vessel is harvested using atraumatic technique after maximal dilatation by local anti-spasmodic agents. After the graft segment is removed, it is immediately flushed with heparin-saline solution to remove any residual blood in the lumen. It is then freeze-dried at −70°C. The freeze-dried vessel is then conveniently stored in sealed vacuum tubes at room temperature (Fig. 1). Before grafting, the graft is rehydrated in normal saline solution for an hour. After rehydration, the graft still has a mild degree of rigidity (as a result of the freeze-drying process), and therefore is quite easy to handle during anastomosis. Biological Changes of Freeze-Dried Grafts in GeneralThe freeze-drying process causes a generalised destruction of the vessel wall, leaving the graft to function merely as a biological conduit. The graft wall is then gradually re-organised and its surface replaced over a period of several months. It is generally believed that neo-e...