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ABSTRACT: BACKGROUND: Desmoplastic fibroma (DF) is an extremely rare locally aggressive bone tumor with an incidence of 0.11% of all primary bone tumors. The typical clinical presentation is pain and swelling above the affected area. The most common sites of involvement are the mandible and the metaphysis of long bones. Histologically and biologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue. CASE PRESENTATION AND LITERATURE REVIEW: A case of a 27-year old man with DF in the ilium, including the clinical, radiological and histological findings over a 4-year period is presented here. CT scans performed in 3-year intervals prior to surgical intervention were compared with respect to tumor extension and cortical breakthrough. The patient was treated with curettage and grafting based on anatomical considerations. Follow-up CT scans over 18-months are also documented here. Additionally, a review and analysis of 271 cases including the presented case with particular emphasis on imaging patterns in MRI and CT as well as treatment modalities and outcomes are presented. CONCLUSION: In patients with desmoplastic fibroma, CT is the preferred imaging technique for both the diagnosis of intraosseus tumor extension and assessment of cortical involvement, whereas MRI is favored for the assessment of extraosseus tumor growth and preoperative planning. While tumor resection remains the preferred treatment for DF, curettage and grafting prove to be an acceptable alternative treatment modality with close follow-up when resection is not possible. Curettage and grafting have been shown to provide good clinical results and are associated with long recurrence free intervals.
The Open Orthopaedics Journal 01/2013; 8:40-6.
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ABSTRACT: To compare sensitivity of bone scintigraphy using 99mTechnetium-labelled methylene diphosphonate (Tc-99m MDP) and magnetic resonance imaging (MRI) in the detection of inflammatory bone lesions in patients with chronic non-bacterial osteomyelitis (CNO).
Tc-99m MDP bone scintigraphy and MRI were performed in 32 CNO patients at the time of diagnosis and compared regarding their sensitivity in detecting inflammatory lesions in symptomatic regions of the body.
Inflammatory lesions could be detected in 40 out of the 54 (74.1%) symptomatic regions by bone scintigraphy and in 53 (98.1%) of these regions by MRI (p<0.001). Sensitivity of MRI compared to bone scintigraphy was superior in detecting lesions in the long bones of the thigh and the lower legs (100% vs. 78.4%, respectively, p<0.05).
Bone scintigraphy does not seem to display the whole extent of the inflammatory process in CNO. Therefore, depending on clinical relevance, MRI rather than planar bone scintigraphy should be considered for the detection of CNO lesions at diagnosis.
Clinical and experimental rheumatology 07/2012; 30(4):578-82. · 2.15 Impact Factor
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ABSTRACT: Chronic non-bacterial osteomyelitis (CNO) is an inflammatory, non-infectious disorder of the skeletal system with unknown
etiology. Besides bone-inflammation, patients may present with inflammatory involvement of other tissues. Chronic recurrent
multifocal osteomyelitis (CRMO) is the most severe form of CNO. We describe the occurrence of Crohn’s disease (CD) in four
patients, previously diagnosed with CRMO. Mutations in CARD15, encoding the NOD2 protein, have recently been found in patients with CD. Based on the occurence of CNO and CD in these four
and several reported patients, we hypothesized that CD and CRMO might share a common autoinflammatory process. Thus, we searched
for CD associated CARD15 gene variants R702W, G908R and 1007fs in 29 CNO patients, 4 of them additionally diagnosed with CD. In the latter one out
of the four showed compound heterozygosity for the gene variants R702W and 1007fs. The allele frequency in the 25 patients
diagnosed with CNO but not CD was not different from that already reported in healthy people (R702W 4.0%, G908R 2.0%, 1007fs
2.0%). The occurrence of non-bacterial bone inflammation and granulomatous intestinal inflammation seems to represent an extended
phenotype of CD, which partly might be explained by potential disease causing mutations in CARD15. However, CNO without intestinal inflammation is not associated with common CARD15 gene variants. Therefore, other variants of genes coding for proteins involved in innate immunity and inflammation might
predispose for the occurrence of CNO.
KeywordsChronic non-bacterial osteomyelitis-Chronic recurrent multifocal osteomyelitis-Crohn’s disease-NOD2-
CARD15
Rheumatology International 04/2012; 30(5):617-621. · 1.88 Impact Factor
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ABSTRACT: Bone defects resulting from tumour resection or curettage are most commonly reconstructed with autologous bone graft which is associated with limited availability and donor site morbidity. Recent research has focussed on synthetic biomaterials as bone graft substitutes. The aim of this study was to assess the safety and efficiency of a bone substitute as an alternative for autologous bone in the treatment of benign bone tumours and tumour-like lesions.
In the present study, a biphasic ceramic (60% HA and 40% β-TCP) combined with a fibrin sealant was used to reconstruct defects in 51 patients after curettage of benign bone tumours or tumour-like lesions. Patient age ranged from eight to 68 years (mean 29.7), defect size from 2 cm(3) to 35 cm(3) (mean 12.1), and time of follow-up from one to 56 months (mean 22.7).
Radiologic analysis showed complete bony defect consolidation in 50 of 51 patients after up to 56 months. No postoperative fractures were observed. Revision surgery had to be performed in one case. Histological analysis showed new bone formation and good biocompatibility and osseointegration of the implanted material.
In summary, the biphasic ceramic in combination with fibrin sealant was proven an effective alternative to autologous bone grafts eliminating the risk of donor site morbidity for the patient.
International Orthopaedics 05/2011; 36(1):139-48. · 2.03 Impact Factor
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ABSTRACT: Chronic nonbacterial osteomyelitis (CNO) is an inflammatory disorder of unknown etiology. In children and adolescents CNO predominantly affects the metaphyses of the long bones, but lesions can occur at any site of the skeleton. Prospectively followed cohorts using a standardized protocol in diagnosis and treatment have rarely been reported.
Thirty-seven children diagnosed with CNO were treated with naproxen continuously for the first 6 months. If assessment at that time revealed progressive disease or no further improvement, sulfasalazine and short-term corticosteroids were added. The aims of our short-term follow-up study were to describe treatment response in detail and to identify potential risk factors for an unfavorable outcome.
Naproxen treatment was highly effective in general, inducing a symptom-free status in 43% of our patients after 6 months. However, four nonsteroidal anti-inflammatory drug (NSAID) partial-responders were additionally treated with sulfasalazine and short-term corticosteroids. The total number of clinical detectable lesions was significantly reduced. Mean disease activity estimated by the patient/physician and the physical aspect of health-related quality of life including functional ability (global assessment/childhood health assessment questionnaire and childhood health assessment questionnaire) and pain improved significantly. Forty-one percent of our patients showed radiological relapses, but 67% of them were clinically silent.
Most children show a favorable clinical course in the first year of anti-inflammatory treatment with NSAIDs. Relapses and new radiological lesions can occur at any time and at any site in the skeleton but may not be clinically symptomatic. Whole-body magnetic resonance imaging proved to be very sensitive for initial and follow-up diagnostics.
Arthritis research & therapy 04/2010; 12(2):R74. · 4.27 Impact Factor
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ABSTRACT: Osteoid osteoma and osteoblastoma are benign bone tumors that occur most often in adolescents and predominantly in males. Typical clinical symptoms, such as reduced range of motion of adjacent joints, nocturnal bone pain and relief of pain using non-steroidal anti-inflammatory drug therapy especially in osteoid osteoma may lead to the correct diagnosis. However, these symptoms are not always apparent and specific. In radiographic examinations, the initial changes are often uncharacteristic causing further delay in diagnosis. Magnetic resonance imaging is increasingly used for screening, but early findings in the course of disease might not lead to the definite diagnosis. Both entities (especially osteoid osteoma) occur frequently in the area of the hip. To demonstrate pitfalls in the diagnostic pathway of hip pain caused by benign bone tumors, we present two cases with osteoid osteoma and one with osteoblastoma.
Rheumatology International 06/2009; 30(3):395-400. · 1.88 Impact Factor
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ABSTRACT: In children with cerebral palsy, planovalgus deformity of the foot is common. The aim of this study was to evaluate the outcome of calcaneal lengthening for the treatment of planovalgus foot deformity in children with cerebral palsy.
We reviewed 19 children (28 feet) treated between 1996 and 2004 in our institution. There were 14 ambulating (19 feet) and 5 nonambulating children (9 feet). The average age of the children at time of surgery was 8.6 years. Followup averaged 4.3 years.
We found satisfactory results in 75% of the feet clinically and in 79% radiologically according to Mosca's criteria. We saw no overcorrection but a relapse of the deformity in seven cases. There were six unsatisfactory radiological results, two (out of 19) in the ambulating and four (out of nine) in the nonambulating group. Ambulating children had a significantly better clinical and radiological outcome than nonambulating children (p = 0.042). A significant correlation was found between Ankle-hindfoot Score and clinical result according to Mosca's criteria (p = 0.001).
In ambulatory children with cerebral palsy calcaneal lengthening is an effective procedure for the correction of mild to moderate planovalgus foot deformities. In nonambulatory children with severe plano-valgus deformities of the foot, calcaneal lengthening cannot be recommended because of the high relapse rate in these patients.
The Foot and Ankle Online Journal 06/2009; 30(5):398-404. · 1.22 Impact Factor
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ABSTRACT: Multilevel laminectomy in children has a significant rate of postoperative spinal deformity. To decrease the incidence of this complication, the use of osteoplastic laminotomy is advocated to minimise the risk of spinal deformity by preserving the normal architecture of the spine. In this retrospective study, a 10-year series of a paediatric population undergoing multilevel osteoplastic laminotomy is reviewed to determine the incidence, especially in contrast to laminectomies, and to identify factors that affect the occurrence of spinal column deformity. Seventy patients (mean age 4.2 years) underwent multilevel osteoplastic laminotomy for congenital anomalies or removal of spinal tumours. All patients had a clinical and radiographic examination preoperatively, 12 months postoperatively and at follow-up. Mean follow-up was 5.3 years (range 3-12.6 years). Nineteen patients (27%) had a new or progressive spinal deformity. There was an increased incidence in patients who had surgery for spinal tumours (P<0.05), surgery of the cervical spine (<0.01), and who had more than five levels of the spine included (P<0.05). A review of the literature on children with multilevel laminectomy (n=330), the incidence of spinal deformity found a significantly higher (46%) compared to our study group. This study demonstrates that osteoplastic laminotomy was found to be very effective in decreasing the incidence of spinal deformities after spinal-canal surgery for spinal-cord tumours or congenital anomalies in children and adolescents. The choice of an anatomical reconstructive surgical technique such as osteoplastic laminotomy seems to be essential to minimise secondary problems due to the surgical technique itself. Nevertheless, growing patients should be followed up for several years after the initial operation for early detection and consequent management of any possible deformity of the spinal column.
International Orthopaedics 06/2008; 32(3):355-9. · 2.03 Impact Factor
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ABSTRACT: Soft tissue tumours of the foot are rare and often present a difficult clinical and diagnostic situation. We report of a 15-year-old male with a painless swelling at the lateral margin of the left foot. After X-ray and MRI an excisional biopsy was performed. Histology revealed true muscle hypertrophy without myopathic or degenerative changes, consistent with the diagnosis of congenital hypertrophy of the abductor digiti minimi muscle. At a follow-up of one and a half year there was no recurrence and the patient was satisfied with the shape and the appearance of the foot.
Foot and Ankle Surgery 02/2008; 14(1):43-6.
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ABSTRACT: Treatment of slipped capital femoral epiphysis is still controversial with regard to the implants used for stabilization and the need for prophylactic treatment of the contralateral, unaffected, side. The objective of this study was to ascertain whether prophylactic transfixation of the epiphysis with Kirschner wires in patients with unstable slipped capital femoral epiphysis resulted in significant disturbance of the growth plate and impairment of further growth of the femoral neck and head. Between 1990 and 1999, 29 patients with unstable slipped capital femoral epiphysis were simultaneously treated with internal fixation of the epiphysis and metaphysis with 3-4 Kirschner wires on the affected and the not (yet) affected side. After a mean follow-up of 3.5 years, we evaluated the hip joints radiologically, analysing different roentgenological parameters (CCD angle, femoral head diameter, length of the femoral neck and sphericity of the femoral head). CCD angle, femoral head diameter and length of the femoral neck showed statistically significant (P<0.001, Student's t-test) differences between the affected and unaffected, but prophylactically pinned, sides. Asphericity of the femoral head was found in six cases only on the affected side, whereas all hips, which were operated prophylactically, showed spherical femoral heads at follow-up (P<0.02, Pearson's chi test). These results indicate that the slip itself may cause impairment of the femoral growth plate in patients with unstable slipped capital femoral epiphysis and not stabilization with Kirschner wires. Compared with other series from the literature using different implants (screws, nails), prophylactic transfixation of the epiphysis and metaphysis with Kirschner wires is less compromising to the growth plate on the not (yet) affected side.
Journal of Pediatric Orthopaedics B 10/2006; 15(5):328-34. · 0.47 Impact Factor
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ABSTRACT: We report a case of a sternal osteoid osteoma in a 39-year-old man. This localization is very rare and to our knowledge not described in literature.
Archives of Orthopaedic and Trauma Surgery 02/2006; 126(1):53-6. · 1.37 Impact Factor
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ABSTRACT: Degenerative lumbar instabilities are one of the major reasons for low back pain, especially in elderly people. There is still controversy in the literature about the clinical outcome of instrumented monosegmental fusions compared to noninstrumented posterolateral fusions.
In this study we described the postoperative outcome of 33 patients who underwent posterolateral monosegmental spinal fusion:instrumented (17 patients)or noninstrumented (16 patients).All patients received the same instrumentation system. Medical history (considering daily activities,sports,social contacts and quality of life),clinical examination and radiological analysis served as evaluation parameters. Data were collected by a questionnaire based on the Oswestry Disability Score for low back pain.
86.6%of all subjects showed an improvement of postoperative health status. Although patients with fusion without internal fixation needed a reduced dose of postoperative analgesics compared to the monosegmental non-instrumented group,there were no statistical differences in patient-reported,clinical and radiographical outcome between the two groups.
The results do not indicate a benefit in outcome from added instrumentation in elective lumbar fusions. This should be considered in each single case when a spinal fusion in the treatment of degenerative lumbar instability is indicated.
Medical science monitor: international medical journal of experimental and clinical research 08/2003; 9(7):CR324-7. · 1.70 Impact Factor
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ABSTRACT: Zusammenfassung Operationsziel Vollstndige Korrektur der Fehlstellung im subtalaren Gelenkkomplex mit einzeitiger Wiederherstellung einer mglichst normalen Form und Funktion des Fzes. Indikationen Idiopathischer Talus verticalus congenitus sowie sekundrer Talus verticalis bei zu erwartendem funktionellen Gewinn. Voraussetzung: Redressionsbehandlung in Etappen mit Gipsverbandfixation. Kontraindikationen Schwere Allgemeinerkrankung. Nicht zu erwartender funktioneller Gewinn bei sekundrem Talus verticalis. Operationstechnik Peritalare Arthrolyse ber den sogenannten Cincinnati-Zugang mit Adaptation der an der Deformit,t beteiligten Sehnen sowie Reposition des subtalaren Gelenkkomplexes. Neben der Verstrkung des Pfannenbandes wird die Reposition des Talonariskulargelenkes durch Umlenkung der Sehne des Musculus tibialis anterior unter das Talonavikulargelenk gesichert. Ergebnisse Operativ behandelt wurden 14 angeborene Plattfe. Der durchschnittliche Nachuntersuchungszeitraum betrug 3,5 Jahre (1,5 bis sechs Jahre). Die Resultate zeigten alle ein befriedigendes Ergebnis, bewertet nach dem Score von Walker et al. Bis auf geringe, funktionell wenig bedeutsame Bewegungseinschrnkungen traten keine Komplikationen auf. Summary Objectives Complete correction of a congenital vertical talus at the subtalar joint complex in one sitting. The goal is a restoration of normal shape and function of the foot. Indications Idiopathic congenital vertical talus as well as secondary vertical talus if a gain can be expected. Prerequisite: preceding surgery gradual redressment with plaster of Paris for mobilization of joints and stretching of soft tissues. Contraindications Poor general health. Infants with a secondary vertical talus in whom a functional gain cannot be expected. Surgical Technique Peritalar arthrolysis using the Cincinnati approach. Reduction of malposition of subtalar joint complex and adjustment of tendons involved in the deformity. Reinforcement of the calcaneonavicular ligament and a rerouting of the tibialis anterior under the ralonavicular joint to further stabilize the reduction. Results Report of 14 congenital flat feet. Average duration of follow-up 3.5 years (1.5 to 6 years). Using the score of Walker et al. all patients had a satisfactory result. Except for a small, functionally unimportant reduction in the range of motion, no other complications were observed.
Operative Orthopädie und Traumatologie 05/2000; 12(2):154-170. · 0.46 Impact Factor
