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International Journal of Rheumatic... Oct 2023
Topics: Humans; Exostoses, Multiple Hereditary; Chondrosarcoma; Bone Neoplasms
PubMed: 37313676
DOI: 10.1111/1756-185X.14769 -
Orthopaedics & Traumatology, Surgery &... Sep 2023In patients who have hereditary multiple osteochondroma (HMO), progressive deformity of the forearm skeleton may lead to radial head dislocation. The latter is...
INTRODUCTION
In patients who have hereditary multiple osteochondroma (HMO), progressive deformity of the forearm skeleton may lead to radial head dislocation. The latter is permanent, painful and causes weakness.
HYPOTHESIS
There is a relationship between the amount of ulnar deformity and the presence of radial head dislocation in patients with HMO.
MATERIALS AND METHODS
This was a cross-sectional radiographic study comprising an analysis of anterior-posterior (AP) and lateral x-rays of 110 forearms in children having a mean age of 8 years and 4 months who were followed for HMO between 1961 and 2014. Four factors reflecting on the ulnar deformity in the coronal plane were investigated on the AP view and three factors in the sagittal plane were investigated on the lateral view to identify any relationship between ulnar deformity and radial head dislocation. The forearms were separated into two groups: with radial head dislocation (26 cases) and without radial head dislocation (84 cases).
RESULTS
Ulnar bowing, intramedullary angle of ulnar bowing, tangent ulnar angle and overall ulnar angle were significantly higher in the group of children who had a radial head dislocation (0.05 vs 0.03, p<.001; 161 vs 167, p<001; 156 vs 162, p<001; 50 vs 30, p<.001) in univariate and multivariate analyses.
DISCUSSION
Ulnar deformity, evaluated using the method described here, is more often associated with radial head dislocation than other previously published radiological parameters. This provides new insight on this phenomenon and may help to determine which factors are associated with radial head dislocation and how to prevent it.
CONCLUSION
Ulnar bowing in the context of HMO, especially when evaluated on AP radiographs, is significantly associated with radial head dislocation.
LEVEL OF EVIDENCE
III; case-control study.
Topics: Child; Humans; Radius; Exostoses, Multiple Hereditary; Case-Control Studies; Cross-Sectional Studies; Retrospective Studies; Ulna; Joint Dislocations
PubMed: 36905956
DOI: 10.1016/j.otsr.2023.103591 -
Orthopaedics & Traumatology, Surgery &... Sep 2023Radial head dislocation in patients with multiple hereditary exostosis (MHE) can lead to functional deficit. We investigated whether the location of the exostosis and...
INTRODUCTION
Radial head dislocation in patients with multiple hereditary exostosis (MHE) can lead to functional deficit. We investigated whether the location of the exostosis and certain radiological criteria predict risk of radial head dislocation/subluxation.
HYPOTHESIS
We hypothesized that the radiological criteria differentiate between patients who need closer follow-up of the forearm and others for whom multiple radiographs are superfluous.
PATIENTS AND METHODS
We retrospectively reviewed the demographics of patients with MHE in our hospital, and radiographic measurements were made on forearm radiographs: radial length, ulnar length, ulnar variance, radial articular angle, and radial bowing.
RESULTS
Forty-nine forearms were analyzed in 30 patients. Mean age was 9.5 years at first evaluation and 11.8 years at last evaluation. Radial head dislocation or subluxation was found in 6 forearms (12%). Risk factors comprised isolated exostosis in the distal portion of the ulna or exostosis in the distal part of both the ulna and radius, radial or ulnar shortening>4.6cm, radial bowing>8.1%, radial articular angle>35°, and≥3 exostoses in the forearm.
DISCUSSION
In patients with MHE with risk factors for radial head dislocation, close follow- up with regular radiography is indicated and early surgery should be performed before the radial head dislocates.
LEVEL OF EVIDENCE
IV; retrospective study.
Topics: Humans; Child; Forearm; Retrospective Studies; Ulna; Radius; Joint Dislocations; Exostoses, Multiple Hereditary; Osteochondroma; Bone Neoplasms
PubMed: 36270444
DOI: 10.1016/j.otsr.2022.103445 -
International Journal of Surgical... Aug 2023A subset of clear cell chondrosarcomas may contain focal areas of low-grade conventional chondrosarcoma; however, it is rare to find foci resembling clear cell... (Review)
Review
A subset of clear cell chondrosarcomas may contain focal areas of low-grade conventional chondrosarcoma; however, it is rare to find foci resembling clear cell chondrosarcoma admixed with areas otherwise typical conventional chondrosarcoma. We report two patients with conventional chondrosarcoma with clear cell features occurring in the rib, one in the setting of multiple hereditary exostoses (MHE) and the other without MHE. Both patients were found to have a destructive rib mass with a soft tissue component and underwent en bloc resection. Histologic examination revealed predominantly grade 2 conventional chondrosarcomas; however, multiple foci containing large cells with pale eosinophilic to clear cytoplasm, distinct cell borders, centrally located nuclei, and conspicuous nucleoli, resembling clear cell chondrosarcoma were identified throughout the specimen. The significance of clear cell features in an otherwise typical conventional chondrosarcoma, to our knowledge, is unknown and deserves recognition. Finally, these tumors highlight the need for careful histologic examination and proper classification as unexpected findings may impact management.
Topics: Humans; Chondrosarcoma, Clear Cell; Chondrosarcoma; Cell Nucleus; Bone Neoplasms; Ribs
PubMed: 35899291
DOI: 10.1177/10668969221113488