Ultra-High Molecular Weight Polyethylene Tape Applied for Distal Humeral Condyle Fracture around Total Elbow Arthroplasty in Patients with Rheumatoid Arthritis: Report of Two Cases

Managing fractures of distal humerus in patients with rheumatoid arthritis (RA) is technically challenging. Total elbow arthroplasty (TEA) is one of the treatment options for these fractures. While elbow motion is largely regained by TEA, comminuted condyle fragments are often ignored. Although numerous approaches for repair of condylar fragments around TEA are described, any universal fixation strategy for these fractures has not been established. This report describes, for the first time, application of an ultra-high molecular weight polyethylene (UHMWPE) tape for the treatment of distal humerus fracture in 2 patients with rheumatic elbow arthropathy. The post-operative clinical courses were good. Radiographs showed bony union of the condylar fragments without loosening in two cases. Because of its flat configuration, softness, and flexibility, UHMWPE tape is a promising material for stabilizing fracture of the distal humerus associated with TEA.

Dedifferentiated chondrosarcoma of the middle finger arising from a solitary enchondroma:A case report

BACKGROUND Dedifferentiated chondrosarcoma(DDCS)accounts for 10%of all chondrosarcomas and has the poorest outcome,with a 5-year survival rate of 7%-25%.DDCS commonly occurs in the femur and pelvis,whereas DDCS of the finger is extremely rare.Furthermore,the histological findings of preexisting solitary enchondroma samples are important and valuable for diagnosing malignant transformations.CASE SUMMARY We report our experience with DDCS in the proximal phalanx of the left middle finger of an 87-year-old woman.She had undergone surgery for enchondroma,with curettage and artificial bone grafting,11 years ago,in the same location.Several years after the primary surgery,the left middle finger gradually started to enlarge,and the growth speed increased in the past year.Plain radiographs showed an expansive osteolytic lesion with calcifications and residual grafting material.Owing to the suspicion of malignancy,we performed ray amputation.Histological findings revealed an abrupt transition between the low-grade chondrosarcoma and dedifferentiated sarcoma components.The dedifferentiated components showed the features of a high-grade undifferentiated pleomorphic sarcoma.The patient was diagnosed with DDCS arising from a preexisting enchondroma.She had no local recurrence or distant metastasis and died of pneumonia 6 years and 10 months after the second surgery.CONCLUSION The histological findings of a precursor lesion showed a typical enchondroma,suggesting that DDCS can arise from enchondroma.

Long-term survival in a patient with Hutchinson-Gilford progeria syndrome and osteosarcoma:A case report

BACKGROUND Hutchinson-Gilford progeria syndrome(HGPS)is an extremely rare disease characterized by the rapid appearance of aging with an onset in childhood.Serious cardiovascular complications can be life-threatening events for affected patients and the cause of early death.Herein we report a HGPS patient with osteosarcoma hat was successfully managed and is alive 13 years after the diagnosis.This is the first report describing the detailed surgical procedure and long-term follow-up of osteosarcoma in a patient with HGPS.CASE SUMMARY The patient was diagnosed with HGPS at 5 years of age with typical features and was referred to our department with a suspected bone tumor of the left proximal tibia at the age of 18.Open biopsy of the tibial bone tumor revealed a conventional fibroblastic osteosarcoma.We have developed and performed a freezing technique using liquid nitrogen for tumor reconstruction.This technique overcame the small size of the tibia for megaprosthesis and avoided amputation and limb salvage was achieved 13 years post-operatively.Although the patient had a number of surgical site complications,such as wound dehiscence,and superficial and deep infections due to vulnerable skin in HGPS,no recurrence or metastases were detected for 13 years,and she walks assisted by crutches.Her general health was good at the latest follow-up at 31 years of age.CONCLUSION A HGPS patient with osteosarcoma was successfully managed and she was alive 13 years after the diagnosis.

Reconstruction Using a Free Vascularized Fibular Graft after Frozen Autograft Reconstruction for Osteosarcoma of the Distal Tibia: A Case Report

Recently we have been performing biological reconstruction for malignant bone tumors of the extremities using frozen autografts. Here we present a case treated with free vascularized fibular graft (FVFG) after this method. A 23-year-old man developed osteosarcoma in his left distal tibia. There was nonunion after frozen autograft reconstruction, which we treated with FVFG. Twenty-four months later, bridging between the host bone and the frozen autograft was achieved. Our department has achieved bone union in almost all cases, but we sometimes encounter cases of nonunion after this method because of delayed blood supply. In these instances, reconstruction using FVFG may represent an attractive choice for salvage treatment.

Glycogen synthase kinase 3b biology in bone and soft tissue sarcomas

Bone and soft tissue sarcomas are malignant neoplasms probably originating from musculoskeletal and mesenchymal progenitor cells.More than 80 different histopathological subtypes are encountered in orthopedics.The standard of care for sarcoma patients involves a multidisciplinary combination of surgery,anthracycline-based multiagent chemotherapy and radiation.Unfortunately,these are associated with adverse events and occasionally disappointing outcomes.Various genomic-,biologically-,and immunologically-based therapies are still under evaluation in early-phase clinical trials.However,there are strong barriers to the development and clinical translation of new therapeutic modalities.This is due to the rarity of these diseases,the broad spectrum of tumor subtypes with genetic and biological heterogeneity,and the wide variability in clinical manifestation,response to treatment and prognosis.A potential approach toward overcoming this barrier is to identify therapeutic targets that cover multiple sarcoma types.Glycogen synthase kinase 3b(GSK3b)has emerged as a common therapeutic target in more than 25 different cancer types.Here we review the evidence for tumor-promoting roles of GSK3b in the major types of bone and soft tissue sarcomas including osteosarcoma,rhabdomyosarcoma,synovial sarcoma,and fibrosarcoma.In this review,we describe the therapeutic effects of inhibiting GSK3b in these sarcoma types,while also protecting healthy cells and tissues from detrimental effects associated with conventional therapies,such as doxorubicin-induced cardiotoxicity.Consequently,we highlight GSK3b as a potential therapeutic target spanning multiple sarcoma types.