Periosteal Osteosarcoma Arising from the Rib and Scapula: Imaging Features in Two Cases

Periosteal osteosarcoma is an extremely rare chondroblastic osteosarcoma in the flat bone. There were authors reporting of two cases of periosteal osteosarcoma in the highly unusual sites. One of them arose from the rib, in a 17-year-old male, which appeared as a hypodense juxtacortical mass with periosteal reaction on CT. The other one arose from the scapula, in a 17-year-old female, which showed the intermediate signal intensity (SI) on T1-weighted image (WI), heterogeneous high SI on T2WI, and rim-enhancement on contrast-enhanced T1WI with cortical destruction on MRI.     

Reconstruction of isolated mandibular bone defects with non-vascularized corticocancellous bone autograft and graft viability

Objective

The aim of this study is to discuss the use of non-vascularized bone grafts in mandibular reconstruction and their viability.

Methods

In this study, 11 patients with mandibular defect treated by surgery using non-vascularized bone grafts between 2011 and 2012 were reviewed. All patients underwent preoperative and postoperative 3-dimensional computerized tomography scan for surgical planning and evaluation of success after surgery. Grafts were used for defects caused by mandible tumors in 2 patients and firearm injuries in 9 patients. Reconstruction was achieved by using various non-vascularized bones, including iliac crest, fibula and scapula. To improve graft supply, periosteum of the grafts was spared and multiple bores were created on the graft during surgery by drilling. At the postoperative period, Dextran 70 and Bencyclane Hydrogen Fumarate was given in order to enhance micro-circulation. On the postoperative day 5, 15 and 30, Tc-99 m methylenediphosphonate scintigraph, blood-pool single photon emission computed tomography and it's bone phase were performed in order to assess viability of bone grafts greater than 3 cm.

Results

Mean age was 32. 27 ± 13.33 (min = 10–max = 56). Of the 11 patients, 10 (90. 9%) were men and 1 (9. 1%) was woman. Mandibular defects were at right corpus in 3 patients; at right ramus and angulus in 1 patient; at left corpus in 1 patient; at left ramus and angulus in 1 patient; at left ramus, angulus and corpus in 1 patient; left parasymphysis in 1 patient; at bilateral corpus in 1 patient; at symphysis in 1 patient and at whole segment from right corpus to left one in 1 patient. The following grafts were used: iliac crest grafts in 9 cases, scapula graft in 1 case and fibula graft in 1 case. The smallest graft used was 1 × 2 cm in size, while the greatest, single piece graft was 7 cm in size. The greatest multi-piece graft was a fibula graft of 14 cm in length. All grafts with a size of 3 and 7 cm had been supplied at the end of first month. No bone resorption or donor site morbidity was observed in any patient.

Conclusion

Non-vascular bone grafts can be successfully used in isolated bone defects of mandible in case of appropriate graft selection for fitting anatomical region. A single piece iliac crest grafts up to 7 cm can be revascularized in long-term.     

异形钢板的研制及其在肩胛骨骨折的应用

目的：设计一种用于治疗不稳定肩胛骨骨折的新型内固定钢板，并评价其近期疗效。方法：根据肩胛骨解剖特点以及对18例不稳定肩胛骨骨折患者的X线片和CT扫描及其手术观察，设计出适用于肩胛骨骨折内固定治疗的异形钢板。所有患者按Hardegger的骨折分型：肩胛骨体部骨折9例，外科颈骨折3例，解剖颈骨折1例，盂缘骨折3例，肩胛岗骨折2例。均行新型内固定钢板内固定。结果：18例均获随访，随访时间6～18个月，平均12个月。按Rowe评分系统评价术后功能：优14例，良3例，可1例。结论：本钢板设计合理，生物力学性能良好，适用于各型不稳定肩胛骨骨折。     

Cluster analysis using physical performance and self-report measures to identify shoulder injury in overhead female athletes

Objectives

To evaluate the diagnostic validity of the Kerlan-Jobe orthopedic clinic shoulder and elbow score (KJOC) and the Closed kinetic upper extremity stability test (CKCUEST) to assess functional impairments associated with shoulder injury in overhead female athletic populations.

腋后路内固定治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效分析

目的:探讨腋后路治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效。方法:回顾性分析2018年12月至2021年9月采用腋后路治疗的9例肩胛盂下部分骨折患者的资料,男3例,女6例;年龄50～78岁。所有患者骨折为闭合性骨折,依据肩胛盂骨折Ideberg分型:Ⅰa型6例,Ⅱ型3例。分别于术后第6、12周及6、12个月摄肩关节正、侧位X线片,记录所有患者末次随访时的Constant-Murley肩关节评分,上肢功能障碍(disability of the arm,shoulder and hand,DASH)评分,骨折愈合情况以及其他并发症情况。结果:术后9例患者获得随访,时间6～15个月。末次随访时9例均获得骨性愈合,愈合时间3～6个月,末次随访时患者的Constant-Murley评分为55～96分;DASH评分为3.33～33.33分。结论:腋后路内固定治疗IdebergⅠa、Ⅱ型肩胛盂骨折有效解决了前方入路显露肩胛盂下部分骨折困难的问题,可避免肩胛下肌以及关节囊医源性损伤,临床效果满意,值得临床推广使用。     

肩胛骨结构特点与骨折不同内固定手术疗效的分析

目的　探讨肩胛骨骨折采用不同内固定手术治疗的临床效果。 方法 对我们2007年7月至2012年1月手术治疗的36例肩胛骨骨折患者进行总结分析,选择普通钢板的19例,选择锁定钢板的15例,选择拉力螺钉固定的2例。 结果　36例患者均获得随访,平均(17.5±6.5)个月,骨折全部愈合。根据Hardegger 等功能评定标准,本组优24例,良7例,可4例,差1例,功能恢复优良率达86.1%。 结论 肩胛骨骨折诊断明确后根据骨折的分型、解剖学特点,选择合适的内固定达到有效的固定后,进行早期的功能锻炼,肩关节远期的功能恢复一般达优良。     

Functional outcomes of operative fixation of clavicle fractures in patients with floating shoulder girdle injuries

BackgroundDouble disruptions of the superior suspensory shoulder complex, commonly referred to as ‘floating shoulder’ injuries, are ipsilateral midshaft clavicular and scapular neck/body fractures with a loss of bony attachment of the glenoid. The treatment of ‘floating shoulder’ injuries has been debated controversially for many years. The purpose of this study was to demonstrate the clinical and functional outcomes of patients with ‘floating shoulder’ injuries who underwent operative fixation of the clavicle fracture only.ResultsAll injuries were the result of high-energy mechanisms. Fracture union of the clavicle was seen after initial surgical fixation in the majority of patients (12; 92.3 %). Final pain was reported as minimal (11 cases; 1–3 VAS), moderate (1 case; 4–6 VAS), and high (1 case; 7–10 VAS) at last follow-up. Excellent range of motion (180° forward flexion and abduction) was observed in the majority of patients (8; 61.5 %). The Herscovici score was 12.9 (range 10–15) at 3 months. Unplanned surgeries included two clavicular implant removals and one nonunion revision. None of the patients required reconstruction for scapula malunion after nonoperative management. Twelve patients returned to previous work without restrictions.Conclusions‘Floating shoulder’ injuries with only clavicular fixation return to function despite persistent scapular deformity and some residual pain.Level of evidence Level IV.     

不稳定性肩胛骨骨折的手术治疗与入路选择分析

目的探讨不稳定性肩胛骨骨折的手术治疗及手术入路选择。方法2004年7月-2009年7月治疗不稳定性肩胛骨骨折患者25例,其中开放性骨折取原伤口入路,闭合性骨折分别取肩关节前侧、肩胛骨后侧、肩胛骨外侧缘入路,骨折复位后运用重建钢板、螺钉、钢丝等进行固定。结果所有患者均获随访,随访时间3～20个月,平均11个月。术后复查x线片显示复位满意。根据Hardegger功能评定标准,优18例,良6例,可1例,优良率为96％。结论对不稳定性肩胛骨骨折选择合适的手术入路和固定方法,辅以早期功能锻炼,疗效满意。