-
Karim Z Masrouha,
Khaled M Musallam,
Alexis Bou Samra,
Ayman Tawil,
Rachid Haidar,
Zaher Chakhachiro, Said Saghieh,
Abeer Abdallah,
Raya Saab,
Samar Muwakkit,
Miguel R Abboud,
Nabil J Khoury
[show abstract]
[hide abstract]
ABSTRACT: The aim of this work was to determine the role of MRI in interpreting abnormal signals within bones and soft tissues adjacent to tumor bulk of osteosarcoma and Ewing's sarcoma in a pediatric population by correlating MR findings with histopathology.
Thirty patients met the inclusion criteria, which included (1) osteosarcoma or Ewing's sarcoma, (2) MR studies no more than 2 months prior to surgery, (3) presence of abnormal MR signal surrounding the tumor bulk, (4) pathological material from resected tumor. The patients received standard neoadjuvant chemotherapy. Using grid maps on gross pathology specimens, the abnormal MR areas around the tumor were matched with the corresponding grid sections. Histopathology slides of these sections were then analyzed to determine the nature of the regions of interest. The MR/pathological correlation was evaluated using Mann-Whitney U test and Fisher's exact test.
Twenty-seven patients had osteosarcoma and three patients had Ewing's sarcoma. Of the studied areas, 17.4% were positive for tumor (viable or necrotic). There was no statistically significant correlation between areas positive for tumor and age, gender, signal extent and intensity on MRI, or tissue type. There was, however, a statistically significant correlation between presence of tumor and the appearance of abnormal soft tissue signals. A feathery appearance correlated with tumor-negative areas whereas a bulky appearance correlated with tumor-positive regions.
MR imaging is helpful in identifying the nature of abnormal signal areas surrounding bone sarcomas that are more likely to be tumor-free, particularly when the signal in the soft tissues surrounding the tumor is feathery and edema-like in appearance.
Skeletal Radiology 03/2012; 41(11):1453-61. · 1.54 Impact Factor
-
Current Orthopaedic Practice 04/2011; 22(3):272–275.
-
[show abstract]
[hide abstract]
ABSTRACT: Frontal plane malalignment of the lower extremity results in abnormal load distribution across the knee joint. Consequences of this increased stress may lead to compartmental osteoarthritis. High tibial osteotomy is well established for early osteoarthritis of the knee joint in middle-aged patients. We hypothesize that earlier realignment of the varus knee can be performed without undue risks and debilitation toward the young active patient and with good results in short-term follow-up. Open-wedge high tibia osteotomy using the Puddu plate was performed on eleven patients (19 knees) under 25 years of age for constitutional high tibia vara. The mechanical femorotibial angle (FTA) and Knee Society Knee Score (KSKS) were compared pre-operatively and 24 months post-operatively. The average FTA improved from +8.8 degrees (+5 - +16) to -0.1 (-2 - +5). The average KSKS improved from 74 (50-100) to 93 (60-100) and the function score improved from 84 (50-100) to 95 (60-100). Special concerns in this age group include unsightly cosmesis, and kneeling pain and discomfort. Open-wedge high tibia osteotomy provides a satisfactory solution for constitutional high tibia vara with minor morbidity on behalf of the patient in the short-term follow-up period.
Knee Surgery Sports Traumatology Arthroscopy 01/2011; 19(1):89-93. · 2.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Correction of a relapsed clubfoot deformity by distraction with an external fixator is a recognized alternative to open surgery. Most published series report a good outcome but none are prospective observational studies using the scoring system of the International Clubfoot Study Group (ICFSG). We present a series of 9 relapsed club feet treated with closed gradual distraction using this scoring method.
Strategies in Trauma and Limb Reconstruction 12/2010; 5(3):127-35.
-
[show abstract]
[hide abstract]
ABSTRACT: Results of the use of the non-invasive expandable endoprosthetic device Repiphysis in limb salvage surgery for skeletally immature children with bone cancer have been promising.
In this report, we analyze the outcomes and complications associated with using 17 Repiphysis prosthesis from January 2002 to March 2009 in 17 skeletally immature children with bone sarcoma around the knee.
The average follow-up was 61.7 months. All patients who underwent active expansion experienced successful lengthening with a total of 38 lengthening sessions and an average of 8.6 mm gained per session. The Musculoskeletal Tumor Society functional scores averaged 90% at the most recent follow-up. The average survival time of the device from implementation to revision or last follow-up was 2 years and 8 months. There were 12 complications in 12 patients, including 6 mechanical problems, 2 tibial fractures and 3 infections. For the 17 insertions, 7 revision operations were performed, 3 of which were done using a new Repiphysis device.
Despite the high rate of complications, the goal of achieving equal leg length at skeletal maturity with fewer surgeries per patient has been relatively achieved with the use of this device.
Pediatric Blood & Cancer 09/2010; 55(3):457-63. · 1.89 Impact Factor
-
Current Orthopaedic Practice 08/2010; 21(5):E39-E41.
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the local recurrence rate (LRR) of bone sarcoma along the core-needle biopsy (CNB) tract in patients who underwent limb Salvage Surgery (LSS) following a diagnostic CNB performed irrespective of the planned surgical incision site and for which surgery did not involve any biopsy tract removal.
A retrospective review of 10 pediatric patients diagnosed with bone sarcoma using a computed tomography-guided core-needle biopsy, with evaluation of medical records, pathological specimens and radiological films from the date of diagnosis until the most recent follow-up.
None of the patients experienced local recurrence during their follow up, despite the lack of biopsy site resection. CT scans of the involved extremities were negative for any suspicious lesions in all patients up until the most recent follow-up.
Our study and review of the literature suggest that the incidence of tumor seeding the CNB tract in bone sarcoma patients is apparently low, and possibly negligible. CNB should be performed through the most direct approach to the tumor, and LSS can be performed safely through the standard approaches without excision of the biopsy tract.
The Iowa orthopaedic journal 01/2010; 30:80-3.
-
[show abstract]
[hide abstract]
ABSTRACT: We investigated the role of zoledronic acid on the regenerate and native bone after consolidation and removal of the external fixator in a rabbit model of distraction osteogenesis using 28 New Zealand white rabbits. The rabbits were randomly distributed into two groups. The first group received three doses of zoledronic acid (ZA) 0.1 mg/kg subcutaneously at weekly intervals while the second group received injections of sterile saline. Distraction started on day 7 at a rate of 0.8 mm/day for 12 days. At week 3 the average lengthening, regenerate density, and regenerate continuity were comparable between the two groups. At week 11 the regenerate in the treated group had a significant increase in Bone Mineral Density (BMD) and Bone Mineral Content (BMC) compared to the placebo group. On axial compression, the regenerate showed an increase in the peak load and a higher modulus of elasticity in the treated group. At 6 months, radiographs demonstrated signs of osteopenia of the proximal metaphysis in the control group, and failure of new bone formation around the pin sites in the treated group. BMC and BMD value differences between the two groups were not statistically significant. Histologically, there was persistence of more bone trabeculae in the medullary canal of the regenerate with the persistence of the pin-holes in the treated group. Mechanically, the regenerates in the treated group remain stronger in resisting the axial compression. The proximal fragment in the treated group exhibited a statistically significant decrease in the peak load, toughness and efail %. In conclusion, bisphosphonate-treated rabbits have a stronger regenerate during distraction, and directly after removal of the fixator. They do not develop disuse osteopenia in their lengthened tibia. This treatment may shorten the time in the external fixator and prevent fragility fractures in the treated extremity. However, its long-term safety has not yet been established.
Bone 10/2009; 46(2):363-8. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This article mainly reviews hypercoagulability--and specifically inherited thrombophilia--in different types of surgery including kidney transplantation, simultaneous kidney and pancreas transplantation, orthopedic surgery, vascular surgery, cardiac surgery and other categories of surgical procedures, with a major focus on its associated complications and the need to screen or not. A search was conducted using Medline and cross-referencing for articles related to thrombophilia, screening for it, and its association with surgical complications post-op. Thrombosis associated predisposing entities like factor V Leiden, Prothrombin and Methylene tetrahydrofolate reductase gene mutations, in addition to Protein C and S deficiencies, are discussed. In addition, common and relatively uncommon complications of thrombophilia in the above mentioned surgeries will be covered in length, as well as the necessity to screen for thrombophilia prior to the surgical step. This topic is gaining more and more importance for both surgeons and internists (especially Hematologists) and we, herein, present a general review of the published literature as an update on the subject.
Molecular Biology Reports 06/2008; 36(5):1041-51. · 2.93 Impact Factor
-
Journal of Hand Surgery (European Volume) 05/2008; 33(2):218-9. · 1.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The treatment of open segmental tibia fracture associated with bone loss is very demanding. Despite the fact that the principles
of the distraction osteogenesis are being followed commonly in these fractures, there is not a single technique that fits
all situations. In this article, we report a case where the initial fractures were stabilized with a monolateral bridging
external fixator with no evidence of callus formation 6weeks later. The proximal fracture was used as “an osteotomy” for
bone transport after a latent period of 6weeks of compression. The successful outcome in this patient, confirms that distraction
of a delayed union even when it is mobile, can lead to bone formation and healing of the delayed union.
Le traitement d’une fracture ouverte du tibia avec perte de substance osseuse est très difficile. Malgré le fait que les principes
de l’ostéogenèse par distraction sont communément suivis dans ces fractures, il n’existe pas une technique univoque qui conviendrait
à tous les cas. Dans cet article, nous rapportons un cas dans lequel la fracture avait été initialement stabilisée avec pontage
par un fixateur externe monolatéral, sans apparition de cal au bout de six semaines. La fracture proximale a alors été utilisée
comme «ostéotomie» pour le transfert osseux après une période de latence pour mise en compression.de six semaines. Le succès
obtenu chez ce patient confirme le fait que la mise en distraction d’un retard de consolidation, même s’il persiste de la
mobilité, peut conduire à l’ostéogenèse et à la guérison du retard de consolidation.
European Journal of Orthopaedic Surgery & Traumatology 03/2008; 18(3):237-242. · 0.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The efficacy of microsurgical free-tissue transfer for the treatment of chronic nonhealing infected diabetic foot ulcers was evaluated in a retrospective study. Between January 1992-December 1997, 10 patients underwent surgery at the American University of Beirut. Muscular free flaps were used to salvage 8 feet, and fasciocutaneous free flaps were used in 2 feet. The flap survival rate was 90%, a result that is equivalent to other series of microvascular tissue transfer in nondiabetic patients; the postoperative morbidity rate was comparable to that of nondiabetic patients. Infection control was achieved in 87.5% of patients. Seven of the 9 surviving patients had bipedal gait and were ambulatory, with full weight-bearing on their flaps at the end of the 2-year follow-up period. Microvascular free-tissue transfer can be used successfully for the salvage of infected diabetic foot ulcers.
Microsurgery 02/2003; 23(3):257-61. · 1.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Osteoblastoma is an uncommon neoplasm of the bone accounting for only 0.5-2% of all primary bone tumors. It constitutes 9% of all primary bone tumors arising in the sacrum. The symptoms have a wide spectrum of variety and the diagnosis is often delayed. We report a case of sacral osteoblastoma in a 20-year-old man who presented with classical symptoms of postero-lateral herniation of L5-S1 vertebral disc. The clinical and radiographic findings are discussed as well as the surgical treatment.
International surgery 90(5):289-92. · 0.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Pes cavus is a multiplanar deformity that involves the 3 foot-joint complexes. Description of the deformity is not well standardized and the surgical management does not have a comprehensive algorithm to follow. Treatment should be tailored to the patient's requirements, foot condition, and the potential for future progression of the deformity. This study describes a heterogeneous group of patients treated surgically and followed for 5 to 28 years. The benefits and risks are discussed, together with pitfalls encountered.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 47(6):527-32.
-
[show abstract]
[hide abstract]
ABSTRACT: Burn injuries involving the joints around the lower extremity often lead to debilitating postburn contractures that frequently compromise extremity functions. Treatment of such injuries, especially involving the ankle and foot area, is very challenging. Conservative management has limited efficiency in correcting the deformities, whereas open surgical treatment is often coupled with high complication rates because of poor soft-tissue coverage and poor vascularity around the burnt areas. The use of the Ilizarov fixator has the advantage of tackling these deformities without the need for extensive open surgical procedures, which will minimize complications and recurrences. The authors present a series of three patients, two adults and one pediatric patient, who were treated successfully with minimally invasive surgery and soft-tissue distraction with the Ilizarov apparatus.
Journal of burn care & research: official publication of the American Burn Association 32(1):160-5. · 1.37 Impact Factor
