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Bone mineral density (BMD) is central to osteoporosis diagnosis but incompletely reflects bone microarchitecture, a key determinant of fracture risk. Fractal analysis of radiographs has been proposed as a low-cost way to characterize trabecular structure, but its relationship with densitometric measures remains uncertain. This study investigated the association between femoral neck fractal dimension (FD) derived from pelvic radiographs and DXA-derived BMD and T-scores in postmenopausal women. This retrospective, cross-sectional study included postmenopausal women who underwent anteroposterior pelvis radiography and DXA within the same year. FD was computed from a standardized femoral neck region of interest using the box-counting method. DXA outcomes were BMD and T-scores at the lumbar spine, femoral neck, and total hip. Associations were evaluated using Spearman correlation and univariable linear regression. A total of 152 women were included; mean femoral neck FD was 1.297 ± 0.083. FD showed no meaningful correlation with DXA-derived measurements (Spearman ρ range, -0.004 to 0.122; all p > 0.05; largest at total hip T-score, ρ=0.122, p=0.134). In univariable regression, FD was not associated with any densitometric endpoint (all p > 0.05), with negligible model fit (R² range, 0.000-0.010). Radiograph-derived femoral neck FD was not associated with DXA BMD or T-scores and provided essentially no explanatory or predictive value for densitometric outcomes. These findings argue against its use as a surrogate for DXA and support the need for standardized methods with prospective outcome validation.
The rising prevalence of metastatic bone disease (MBD), driven by improved oncological survival, places increasing demands on accurate staging. Standard computed tomography of the chest, abdomen, and pelvis (CT-CAP) often may fail to identify orthopaedically relevant lesions, which may contribute to pathological fractures and poorer outcomes. A retrospective single-centre review was conducted of 135 patients who underwent surgery for non- spinal MBD between 2005 and 2024. Preoperative staging imaging was re-evaluated to assess lesion visibility, anatomical distribution, and detection rates across modalities. Lesions were analysed with respect to fracture occurrence, Mirels scores, and postoperative survival. Interobserver agreement for Mirels scoring was calculated. Survival was analysed using Kaplan-Meier methods and a multivariate Cox proportional hazards model. Lesions not identified on staging imaging were associated with significantly higher rates of pathological fracture (p = 0.01) and shorter postoperative survival (median 6 vs. 25 months, p = 0.03). CT-CAP detected fewer orthopaedically relevant lesions than alternative imaging modalities in this retrospective real-world cohort (p < 0.01). Seven clinically relevant lesions were visible only on CT scout images but lay outside the diagnostic field of view; four subsequently fractured. Detection varied by anatomical region, with proximal femoral lesions identified most frequently. In this retrospective cohort, reliance on CT-CAP alone was associated with missed clinically significant MBD lesions, particularly outside the standard field of view. Routine review of full-body scout images may improve detection and potentially reduce preventable fractures. Integration of automated analysis techniques could further strengthen diagnostic accuracy.
Although there have been improvements in surgical fixation techniques, the process of fracture healing continues to pose challenges, especially for patients with additional health issues. Low-intensity pulsed ultrasound (LIPUS) has been proposed as a non-invasive method to facilitate faster bone recovery; however, its effectiveness in clinical settings remains unclear. This study aimed to assess the impact of LIPUS on the healing of lower limb fractures. A double-blinded, prospective, randomised controlled trial was conducted in two hospitals in Gauteng, South Africa. The study was approved by the University of the Witwatersrand (M150236). Ninety-four individuals aged 18 years and older with lower limb fractures were consecutively recruited and randomly assigned to either the LIPUS or control group. The intervention group underwent 20-minute LIPUS sessions every alternate day for a duration of 20 days during their hospitalisation, followed by follow-up after discharge. Callus formation, cortical bridging, fracture gap, and overall radiographic healing were evaluated at 6, 12, and 18 weeks. An intention-to- treat analysis was performed to accommodate missing radiographs and loss to follow-up. No statistically significant differences were found between the intervention and control groups concerning callus formation, cortical bridging, fracture gap, or overall healing at any assessment time. A high rate of loss to follow-up and unavailability of radiographs diminished the analysis's power. LIPUS did not show a notable improvement in fracture healing when compared to standard care. Its clinical use may need to be reevaluated, especially in low- and middle-income countries, where cost-effectiveness is a crucial factor.
We have not identified any research in the literature that explores the severity of knee osteoarthritis in relation to the type of hip fracture. In our study, we examined the severity of knee osteoarthritis in patients with hip fractures affecting the intertrochanteric (Group 1) and femoral neck region (Group 2). In our study, patients over 50 years of age were analyzed and Kellgren-Lawrence classification was applied to bilateral knee radiographs. The correlation between the severity of knee osteoarthritis and the classification of hip fractures was analyzed, and subgroups were compared. The stages of knee osteoarthritis in Group 1 and Group 2; the stage of knee osteoarthritis on the hip fracture side and the healthy side were compared both between groups and within groups. 109 patients were evaluated in Group 1 and 74 patients in Group 2. The knee osteoarthritis grade of Group 1 patients was significantly more severe on both the fractured side (3.44 ± 0.81) and the healthy side (3.17 ± 0.91) in comparison to the fractured side (2.89 ± 1.00) (p<0.01) and the healthy side (2.88 ± 0.82) (p=0.032) of Group 2 patients. In Group 1, the severity of knee osteoarthritis on the fractured side was statistically substantially greater than on the healthy side (p<0.01). In Group 2, the comparison of knee osteoarthritis severity between the fractured and healthy sides revealed no statistically significant difference (p=0.849). Severe knee osteoarthritis was associated with a higher proportion of intertrochanteric hip fractures. Also, the hip on the same side as the knee with more advanced osteoarthritis is more likely to fracture.
While the relationship between radial head fractures (RHF) and coronoid process fractures (CPF) is biomechanically established, the exact frequency of CPF in RHF patients without focus on elbow dislocations is underexplored. To better estimate the likelihood of CPF, the analysis of typical fracture constellations is useful. The aim of this study was therefore to analyze the correlation between RHF severity and the presence and type of CPF. This retrospective study analyzed 356 RHF patients, evaluating the prevalence and correlation of CPF using CT and intraoperative data. Only cases with confirmed presence or absence of CPF based on CT imaging or surgical reports were included. CPF were classified according to O'Driscoll (OD) and correlated with the severity of the RHF according to Mason (MA). Descriptive statistics and correlation using Spearman correlation were performed. CPF was observed in 42.1 % of RHF patients. 51.3 % of CPF were OD Type 1, 26% Type 2 and 10.7% Type 3. The correlation between RHF severity and CPF presence was statistically significant but weak (Spearman r = 0.19). In this study cohort, a high proportion of additional CPF were found in the presence of RHF. Although the correlation was weak, increasing RHF severity was associated with a higher likelihood of CPF. These findings emphasize that in cases of RHF, the CP should be critically examined and CT imaging should be considered in unclear cases.
Gustilo-Anderson type III fractures, characterized by extensive soft-tissue damage, require urgent debridement and external fixation to minimize infection risk. Despite these measures, deep infections and osteomyelitis may still develop, sometimes leading to amputation. The Masquelet and Ilizarov techniques have emerged as effective approaches for reconstructing infected bone defects by promoting bone regeneration and soft-tissue healing. A 57-year-old male sustained a Gustilo-Anderson type IIIB open tibial-fibular fracture with severe soft-tissue injury in a traffic accident. Initial treatment included emergency debridement, external fixation, and vacuum sealing drainage (VSD). However, he developed a progressive infection with extensive soft-tissue necrosis and osteomyelitis. A modified Masquelet-Ilizarov technique was employed, involving necrotic bone resection, antibiotic cement spacer implantation, and subsequent bone transport using an Ilizarov frame. At final follow-up, satisfactory bone union and functional limb recovery were achieved.The combined Masquelet-Ilizarov technique offers a viable limb-salvage strategy for infected Gustilo-Anderson type IIIB tibial fractures with bone loss, yielding acceptable clinical and functional outcomes.
Calcaneal fractures present challenges due to the complex anatomy and difficulty in achieving precise screw placement. Traditional methods often rely on empirical screw insertion, leading to complications like joint penetration or nerve damage. We selected 66 adult calcaneus specimens and conducted analyses using micro-CT scanning and anatomical measurement techniques, dividing the calcaneus into the anterior, middle, posterior, and ST regions. The calcaneus was divided into anterior, middle, posterior, and ST regions. Linear regression was used to analyze the relationship between anatomical parameters and the lengths of screws for the posterior facet (PF) and articulatio calcaneocuboidea (AC). The derived models for AC/PF screw length based on CT data are: G1 = -1.96 + 0.71F1 + 0.48F8 + 0.39F9 (AC screw) and G2 = 3.95 + 0.28F1 + 0.59F8 + 0.31F9 (PF screw), with similar results for anatomical data. Predicted screw lengths were validated through Micro-CT imaging, confirming accurate insertion without perforating the medial calcaneal cortex. In conclusion, linear regression models based on Micro-CT and anatomical data can accurately predict AC/PF screw lengths, improving surgical precision and outcomes. Meanwhile, we'll keep collecting more data to validate and improve the models. Additionally, we'll explore new methods like machine learning to enhance prediction accuracy in the future. Study design: Experimental cadaveric study with anatomical and Micro-CT-based measurements.
Periprosthetic joint infection (PJI) is a major complication after oncologic reconstruction with mega-implants. The optimal duration and regimen of antibiotic prophylaxis remain debated, with wide variability in clinical practice. This study aimed to report infection rates and associated risk factors in patients undergoing oncologic mega-implant reconstruction using a standard 24-hour cefazolin-based prophylaxis, similar to conventional arthroplasty. We retrospectively reviewed 107 oncologic mega-implants implanted between 2015 and 2023 at a tertiary referral centre. All patients received a 24-hour cefazolin-based prophylaxis. PJI was defined according to the 2011 Musculoskeletal Infection Society criteria. Patient-, surgical-, tumour-, and peri-hospital- related variables were collected. Infection-free implant survival was assessed using Kaplan-Meier analysis, and univariate analyses identified factors associated with infection. Deep infection occurred in 22 of 107 mega-implants (20.6%), mostly within the first two postoperative years. Infection rates varied by anatomical site, with pelvic reconstructions showing the highest incidence (38.7%), compared with lower-limb (15.2%) and upper-limb (10.0%) reconstructions. Pelvic location (p=0.003), postoperative wound dehiscence (Henderson type 1B; p<0.001), and tumour extension into surrounding soft tissues (p=0.03) were significantly associated with infection. Operating time and hospital stay were longer in infected cases but strongly collinear with pelvic reconstruction. In this cohort, infection rates observed after oncologic mega-implant reconstruction in patients treated with a 24-hour cefazolin-based prophylaxis fell within the range reported in the existing literature. Pelvic reconstructions and compromised soft tissues were associated with higher infection risk, suggesting that a uniform prophylactic strategy may not be appropriate for all anatomical locations, particularly the pelvis.
Artificial intelligence (AI) is an exciting development makes life easier and solves many problems in daily life. The Birmingham Orthopaedic Oncology Meeting (BOOM) met in January 2024 with 309 participants from 53 countries to discuss the optimal consensus for chondrosarcomas on 21 questions. The aim of this study was to investigate how reliable the expert statements from the BOOM were compared to ChatGPT-4 and DeepseekR1. 21 questions and consensus statements in the section on chondrosarcomas in the BOOM were extracted. The answers were classified according to the level of evidence and consensus status, taking into account the consensus strength category determined in the meeting. Each statement were written separately for the ChatGPT-4 and DeepseekR1. Consensus questions and answers were written for the AI modules and they were asked to interpret these expressions as ''strongly disagree, disagree, undecided, agree or strongly agree''. BOOM participants reached a strong consensus on 19 questions. The number of people who accepted the proposition for 1 question was 52% and no consensus was reached. ChatGPT-4 and DeepseekR1 responded ''disagree'' for a same question. The level of evidence for that question was ''low to moderate'' and a strong consensus was reached. A significant relationship was found between the responses of ChatGPT-4 and DeepseekR1. ChatGPT-4 and Deepseek expressed more positive opinions in the answers with high levels of evidence, while BOOM participants were able to make stronger consensus decisions by combining their clinical observations with literature knowledge, regardless of level of evidence.
To obtain more information about the characteristics and stiffness of soft tissue tumors using shear wave elastography (SWE) and magnetic resonance imaging (MRI). This study involved 83 patients diagnosed with a soft tissue mass who underwent surgical excision. These patients were evaluated with MRI and then ultrasonographically and SWE values were measured. The values obtained were compared with the pathology results of the patients following surgical excision. Correlations between SWE and tumour size, grade, and content components were investigated.A total of 52 benign and 31 malignant soft tissue tumors were diagnosed pathologically. The SWE values measured were significantly higher in the malignant and high grade tumors (pswe=11.2) compared with the benign tumors (pswe=3.07) (p<0.001). A significant correlation was determined between the SWE values and the fibrotic component in the content of the excised tumour (Spearman correlation: r=0.571; p<0.001). High SWE values were obtained, close to malignant values in desmoid tumors and those with a dense fibrotic component, despite being benign. The study results showed that high SWE values were associated with the mass content and malignancy in certain tumors. Positive correlations were observed between SWE values and tumor size, grade, and fibrotic component density. When SWE is combined with MRI and ultrasonography, the awareness of benign lesions is increased and may reduce the need for biopsy in benign lesions.
Postoperative delirium (POD) is a common and serious complication in elderly hip fracture patients, including those undergoing surgery for femoral neck fractures and intertrochanteric fractures, and is associated with poor clinical outcomes. Early identification of at-risk individuals remains challenging with conventional methods. To develop and validate machine learning models for predicting POD using preoperative variables, and to identify key risk factors, we conducted a retrospective study of 400 patients aged ≥65 years undergoing hip fracture surgery. Five machine learning algorithms were developed and validated using 70-30 split with 10-fold cross-validation. Results demonstrated that POD incidence was 20.0% (80/400). Significant predictors included age (OR=1.06, 95%CI:1.02-1.10), cognitive impairment (OR=2.85, 95%CI:1.70-4.78), hypoalbuminemia (OR=2.32, 95%CI:1.45-3.71), and preoperative waiting time (OR=1.18, 95%CI:1.06-1.32). The Random Forest model demonstrated superior performance (AUC=0.89, accuracy=0.83), outperforming other algorithms (XGBoost AUC=0.87, SVM AUC=0.84, Logistic Regression AUC=0.82, Decision Tree AUC=0.79). Variable importance analysis consistently identified cognitive impairment, hypoalbuminemia, and age as the most prominent predictors across all models. In conclusion, machine learning models, particularly Random Forest, effectively predict POD risk using routine preoperative data. Within our study cohort, machine learning models, particularly Random Forest, showed potential for predicting POD risk using routine preoperative data upon internal validation. The consistent identification of key predictors enables targeted prevention strategies for high- risk elderly hip fracture patients. The broader applicability of the model requires confirmation through external validation in future studies. The consistent identification of key predictors enables targeted prevention strategies for high-risk elderly hip fracture patients.
This study aimed to evaluate the feasibility of proximal femoral nailing (PFN) in the lateral decubitus position using a standardized, limb-based approach without a traction table and to report early postoperative (24-72 hours) radiographic and technical outcomes, focusing on lag screw position and tip- apex distance (TAD). This single-center retrospective study included 52 adult patients (>18 years) who underwent PFN in the lateral decubitus position according to a standardized algorithm between January 2021 and December 2024. Demographic characteristics, fracture classification, operative parameters, early postoperative (24-72 hours) radiographic measurements (TAD and Cleveland-Bosworth quadrant position), and postoperative complications recorded during available follow-up were collected. Evans and Boyd-Griffin classifications were used for fracture typing. Statistical analyses evaluated the association between fracture stability and operative duration; analyses involving cut-out were interpreted descriptively due to the low event count. The mean age was 70.5 ± 13.4 years, and 59.6% of patients were male. According to the Evans classification, 69.2% of fractures were stable, 23.1% were unstable, and 7.7% were reverse oblique. The mean operative preparation time was 10.4 ± 1.8 minutes, and the mean operative duration was 43.6 ± 7.9 minutes; operative duration was longer in unstable fractures (p < 0.001). According to the Cleveland-Bosworth system, 73.1% of lag screws were positioned central- central, and no screws were placed in the superior-posterior quadrant. The mean TAD was 17.7 mm, and 96.2% of patients had TAD < 25 mm. Cut-out occurred in two patients (3.8%) and was observed among patients with higher TAD values; this observation was considered exploratory. We present a novel standardized, limb-based lateral decubitus PFN algorithm without a traction table. The approach yielded reproducible early postoperative radiographic parameters (24-72 hours), including acceptable TAD values and favorable Cleveland-Bosworth screw placement.
This study aimed to elucidate the function of CTHRC1 and its linkage to the Wnt/β-catenin signaling pathway in the pathogenesis of osteoarthritis (OA), and to preliminarily explore whether a similar molecular interplay exists in rheumatoid arthritis (RA). We employed an integrated strategy combining bioinformatics, in vitro, and in vivo approaches. Bioinformatic screening of GEO-derived RNA-seq data identified CTHRC1 as a key differentially expressed gene in osteoarthritis. Its functional role was subsequently investigated in OA chondrocyte models, where we measured proliferation (via CCK-8 and EdU assays) and apoptosis (by Western blot analysis of Bax, Bcl-2, and Cleaved Caspase-3), along with key proteins in the Wnt/β-catenin pathway. Furthermore, to assess its relevance to inflammatory arthritis in vivo, we utilized a collagen-induced arthritis (CIA) rat model, evaluating clinical arthritis indices, inflammatory cytokine levels, and joint histopathology by HE staining. We found that CTHRC1 expression was significantly upregulated in OA tissues. Functional enrichment analysis indicated its close association with the Wnt/β-catenin signaling pathway. In vitro experiments confirmed increased CTHRC1 expression in IL-1β-induced OA chondrocytes, while knockdown of CTHRC1 effectively promoted cell proliferation and inhibited apoptosis. Mechanistic studies revealed that the protective effects of CTHRC1 knockdown were reversed by the Wnt/β-catenin pathway agonist BML-284, confirming that CTHRC1 mediates chondrocyte degeneration through activation of this pathway. Furthermore, intra- articular knockdown of CTHRC1 in a CIA rat model significantly alleviated joint swelling, reduced levels of inflammatory factors (IL-1β, IL-6, and TNF-α), and effectively mitigated synovial inflammation and collagen deposition. This study identifies CTHRC1 as an upregulated gene in OA and validates its role in promoting chondrocyte dysfunction. CTHRC1 knockdown reverses these effects by attenuating Wnt/β-catenin signaling, a mechanism confirmed by pharmacological rescue. Preliminary in vivo evidence further suggests a similar pathogenic role in RA. Collectively, CTHRC1 emerges as a potential therapeutic target in arthritis through modulation of the Wnt/β-catenin axis.
Robotic-assisted Total Knee Arthroplasty (RA-TKA) is increasingly adopted to improve component position, limb alignment and soft tissue balance, potentially enhancing functional outcomes and patient satisfaction. However, long-term clinical benefits over conventional procedures remain unproven and emersion in daily practice remains limited. This study aims to investigate the adaptation rationale, workflow modifications and expectations of Flemish knee surgeons who adopted RA-TKA in their arthroplasty practice. A 28-item Web survey was sent on January 21st, 2025 to 64 Flemish knee surgeons, all members of the Belgian Knee Society. 51 surgeons completed the survey, representing a response rate of 80.0%. The questionnaire addressed demographics, RA-TKA usage, alignment and balancing strategies, and opinions on cost-effectiveness and future trends. Data were analyzed descriptively. Flemish surgeons adopted RA-TKA primarily to enhance operative assessment, component positioning and balance. Only 45% of surgeons expected improved clinical outcomes. Surgical techniques shifted significantly, with 73.0% altering alignment techniques, predominantly from mechanical to (inverse) kinematic alignment (59.0%). The type of constraint changed in 76.0% of surgeons, most commonly toward medial-stabilized (25.0%) and cruciate-retaining (22.0%) inserts. 98.0% support the continued inclusion of manual TKA training for residents. While 69.0% of surgeons considered RA-TKA too expensive, 76.0% expected to achieve cost savings due to reduced revisions. RA-TKA is increasingly integrated into clinical practice by Flemish knee surgeons, influencing alignment philosophy and implant constraint. Despite the high satisfaction rate among RA-TKA users, cost remains a major concern. Furthermore, less than half of the surgeons expected to achieve improved clinical outcomes with the use of RA-TKA.
This study aimed to validate potential clinical and radiological features for distinguishing enchondromas from atypical cartilaginous tumours (ACT) and to analyse the association between maximum tumour diameter and local recurrence of enchondromas. It is important to note that this research serves as a validation cohort rather than proposing a new diagnostic framework. This retrospective study reviewed the clinical data of 50 patients pathologically diagnosed with enchondroma or ACT and treated in our center between 1 January 2015 and 1 June 2024. Imaging characteristics, recurrence outcomes and other variables were compared among patients, and chi-square tests were used to assess the influence of maximum tumour diameter and other relevant factors on the recurrence rate. This study has been approved by the ethics committee of our institution. Patients with a maximum tumor diameter ≥ 5 cm exhibited a higher recurrence risk (recurrence 8 % vs. non-recurrence 0 %, P = 0.01, P < 0.05). This difference is statistically significant and may aid in distinguishing enchondroma from ACT. Moreover, all recurrent cases exhibited cortical bone destruction, which further validates the importance of this imaging feature as a key differentiating point. The primary treatment consisted of curettage combined with bone grafting, yielding an overall favorable prognosis. A maximum tumor diameter of ≥5 cm and cortical bone destruction can be considered important predictive factors for local recurrence, and they may also assist in differentiating between atypical cartilaginous tumors (ACTs) and enchondromas. Based on our findings, we are more inclined to consider lesions ≥5 cm as ACTs, particularly when accompanied by cortical destruction, as these features suggest a more aggressive biological behavior. Therefore, we recommend performing extended curettage combined with intraoperative electrocautery or other effective local adjuvant techniques in such cases to achieve adequate tumor control and reduce the risk of recurrence.
To evaluate the efficacy of a staged protocol using an antibiotic-impregnated cement-coated intramedullary nail (ACCIN) for achieving infection eradication and bone consolidation in the treatment of septic shaft non-union of long bones. A retrospective cohort study was conducted on 18 patients treated for septic nonunion of the humerus, femur, or tibia at a single tertiary referral center between January 2018 and January 2024. All patients were managed with a standardized staged protocol involving radical debridement and first-stage stabilization with a custom-made ACCIN, followed by definitive fixation and bone grafting after infection control after an additional spacer Masquelet augmentation and later bone grafting. Data on demographics, injury characteristics, microbiology, and treatment outcomes were collected. The primary outcomes were infection eradication and radiographic union. The cohort consisted of 14 males (78%) and 4 females (22%) with a mean age of 43 years. The tibia was the most common location (50%). Staphylococcus aureus was the most frequently isolated pathogen (44.4%). Following the staged protocol, both infection eradication and bone union were successfully achieved in 16 of the 18 patients, for an overall success rate of 88%. The mean time to consolidation was 7 months. Unfavorable outcomes were significantly associated with advanced age. Long-term functional complications were significantly associated with advanced age, tobacco use, and failure to control the infection after the first stage. The use of an antibiotic-impregnated cement nail as part of a staged protocol is a highly effective and reliable strategy for managing septic shaft non-union. This technique successfully addresses the dual challenges of infection and instability, leading to high rates of limb salvage and bone union. Patient-specific factors, particularly age and smoking, remain important predictors of the final outcome.
Platelet-rich plasma (PRP) is commonly used to support skeletal muscle healing, although its efficacy remains variable and concerns persist regarding profibrotic effects. Platelet-derived extracellular vesicles (pEVs) may modulate inflammation, and this study aimed to compare the histological effects of two PRP systems and a pEV-rich plasma preparation in a rabbit muscle injury model. A standardized partial muscle injury (5 × 5 mm) was created in the biceps femoris of 28 female New Zealand White rabbits. Animals were allocated to four groups: control, Arthrex ACP®, T-LAB PRP®, and platelet-derived extracellular vesicle-rich plasma (Exomine®). Treatments were administered locally on postoperative days 0, 4, and 7. Half of the animals were euthanized at week 3 and the remainder at week 6. Histological evaluation focused on inflammatory infiltration, fibrotic scar formation, and indicators of muscle regeneration. At week 3, overall group comparisons showed significant differences in acute inflammatory parameters, with the pEV-rich plasma group exhibiting lower neutrophil infiltration and fewer multinucleated giant cells. At week 6, significant differences were observed in chronic inflammation and remodeling, with reduced lymphocyte-macrophage infiltration and fibrosis in the pEV-rich plasma group. Both PRP groups showed histological findings comparable to control. In this preclinical rabbit model, a platelet-derived extracellular vesicle-rich plasma preparation was associated with more favorable histological features related to inflammation resolution and fibrosis than conventional PRP. These findings are limited to histopathological outcomes and require confirmation with functional studies.
Synovial sarcoma is an aggressive and rare malignant soft tissue neoplasm, typically affecting young adults and predominantly arising near major joints. Primary cranial involvement is extremely uncommon. In rare circumstances, patients may develop multiple soft tissue tumors either synchronously or metachronously, raising a challenging differential diagnosis between metastatic disease and a second primary malignancy. We report the case of a woman diagnosed with a primary high-grade cranial synovial sarcoma, treated with wide surgical resection followed by adjuvant radiotherapy, who remained disease-free for two years. She later presented with multifocal skeletal lesions. Biopsies taken from two distinct bone lesions demonstrated diffuse STAT6 positivity and the absence of SS18 rearrangement by molecular analysis. These features, confirmed by independent pathological reviews and a multidisciplinary tumor board, were consistent with a multifocal solitary fibrous tumor rather than metastatic disease. This rare case highlights the diagnostic complexity of multifocal skeletal lesions developing after primary cranial synovial sarcoma and emphasizes the importance of thorough pathological, molecular, and multidisciplinary evaluation.
This retrospective study aimed to evaluate patients with similar clinical and radiological features of diaphyseal intramedullary osteoid osteoma, an enigmatic location subtype. Sixteen patients (11 males and 5 females) with an average age of 12.3 years at the time of presentation were reviewed. The lesion was located in the tibia unilaterally in 10 patients, bilaterally in three, and in the femur unilaterally in three. Diagnosis was established based on the typical clinical presentation of OO and the identification of nidus on computed tomography (CT) scan and magnetic resonance imaging (MRI), and confirmed by histopathological examination of tissues obtained during surgery. All patients underwent en bloc excision of the intramedullary abnormal bone, including the nidus, through a small cortical window. The typical pain of OO was the main complaint in all patients and was completely relieved by the second day after surgery. Out of the 16 histopathologically confirmed lesions, 15 showed a visible nidus on CT scan and MRI. After a mean follow-up period of 40.1 months (range 26 - 73 months), most patients were enthused about surgery and resumed their daily activities without pain or any limitation of movement. Only one patient experienced a traumatic tibial fracture at the operative site 3 months after surgery and healed spontaneously after 6 weeks of immobilization. Diaphyseal intramedullary osteoid osteoma should be considered when the typical clinical picture is present, regardless of whether the nidus is detected radiologically.