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Olga D. Savvidou, Panagiotis Koutsouradis, Ioanna K. Bolia, Angelos Kaspiris, George D. Chloros, and Panayiotis J. Papagelopoulos

  • Soft tissue tumours of the elbow are mostly benign. Malignant tumours in this area, although uncommon, often present unique clinical and histopathological characteristics that are helpful for diagnosis.

  • Management of soft tissue tumours around the elbow may be challenging because of their rarity and the proximity to neurovascular structures. Careful staging, histological diagnosis and treatment are essential to optimize clinical outcome. A missed or delayed diagnosis or an improperly executed biopsy may have devastating consequences for the patient.

  • This article reviews the most common benign and malignant soft tissue tumours of the elbow and discusses the clinicopathological findings, imaging features and current therapeutic concepts.

Cite this article: EFORT Open Rev 2019;4:668-677. DOI: 10.1302/2058-5241.4.190002

Maria A. Smolle, Dimosthenis Andreou, Per-Ulf Tunn, and Andreas Leithner

  • Tumour endoprostheses have facilitated limb-salvage procedures in primary bone and soft tissue sarcomas, and are increasingly being used in symptomatic metastases of the long bones.

  • The objective of the present review was to analyse articles published over the last three years on tumour endoprostheses and to summarize current knowledge on this topic. The NCBI PubMed webpage was used to identify original articles published between January 2015 and April 2018 in journals with an impact factor in the top 25.9% of the respective category (orthopaedics, multidisciplinary sciences).

  • The following search-terms were used: tumour endoprosthesis, advances tumour endoprosthesis, tumour megaprosthesis, prosthetic reconstruction AND tumour. We identified 347 original articles, of which 53 complied with the abovementioned criteria.

  • Articles were categorized into (1) tumour endoprostheses in the shoulder girdle, (2) tumour endoprostheses in the proximal femur, (3) tumour endoprostheses of the knee region, (4) tumour endoprostheses in the pelvis, (5) (expandable) prostheses in children and (6) long-term results of tumour endoprostheses.

  • The topics of interest covered by the selected studies largely matched with the main research questions stated at a consensus meeting, with survival outcome of orthopaedic implants being the most commonly raised research question.

  • As many studies reported on the risk of deep infections, research in the future should also focus on potential preventive methods in endoprosthetic tumour reconstruction.

Cite this article: EFORT Open Rev 2019;4:445-459. DOI: 10.1302/2058-5241.4.180081

Robert Grimer, Michael Parry, and Steven James

  • Inadvertent excision of lumps which turn out to be sarcomas is not uncommon.

  • Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field.

  • Standard treatment is wide re-excision, usually combined with radiotherapy.

  • Residual tumour is found in an average of 50% of reported cases.

  • The presence of residual disease is an adverse prognostic factor.

  • All lumps bigger than a golf ball should have a diagnosis prior to excision.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180060

Catalin Cirstoiu, Bogdan Cretu, Bogdan Serban, Zsombor Panti, and Mihai Nica

  • Modern surgical management of extremity bone sarcomas is governed by limb-sparing surgery combined with adjuvant and neoadjuvant chemotherapy.

  • All the resection and reconstruction techniques have to achieve oncologic excision margins, with survival rates and functional results superior to amputation.

  • The main reconstruction techniques of bone defects resulted after resection are: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; resection arthrodesis; and rotationplasty.

  • Oncologic resection and modular endoprosthetic reconstruction are the generally approved surgical options adopted for the majority of cases in major specialized bone sarcoma centres.

  • Good basic principles, efficient multidisciplinary approach and sustained research in the field can provide a better future for the challenge posed by extremity bone sarcoma treatment.

Cite this article: EFORT Open Rev 2019;4:174-182. DOI: 10.1302/2058-5241.4.180048

Olga D. Savvidou, Panagiotis Koutsouradis, George D. Chloros, Ioannis Papanastasiou, Thomas Sarlikiotis, Aggelos Kaspiris, and Panayiotis J. Papagelopoulos

  • Bone tumours around the elbow are rare. Even nowadays diagnostic dilemmas and delays are common. During recent decades the management and prognosis of patients with elbow bone tumours has improved significantly.

  • Benign tumours can be treated using minimally invasive procedures, whereas malignant ones require a multidisciplinary team approach based on an adjuvant therapeutic regimen of chemotherapy, radiotherapy and limb salvage procedures.

  • This article reviews the most commonly encountered elbow bone tumours and their management.

Cite this article: EFORT Open Rev 2019;4:133-142. DOI: 10.1302/2058-5241.4.180086

Maria Anna Smolle, Dimosthenis Andreou, Per-Ulf Tunn, Joanna Szkandera, Bernadette Liegl-Atzwanger, and Andreas Leithner

  • The relatively low incidence and often atypical clinical presentation of soft-tissue sarcomas (STS) impedes early and adequate diagnosis. Patients may report on recently enlarged soft-tissue swellings, infrequently complain of painful lesions, or even have no symptoms at all.

  • A thorough diagnostic work-up is essential in order to distinguish between benign soft-tissue tumours and STSs. Patient history, clinical features and radiological findings all help in assessing the underlying pathology. ‘Worrying’ features such as recent increase in size, deep location relative to the fascia, a tumour exceeding 4 cm in size, and invasive growth patterns seen on imaging should prompt verification by biopsy.

  • Even though acquisition of biopsy material may be incomplete, one should bear in mind some essential rules. Regardless of the biopsy technique applied, the most direct route to the lump in question should be identified, contamination of adjacent structures should be avoided and a sufficient amount of tissue acquired.

  • Treatment of STS is best planned by a multidisciplinary team, involving experts from various medical specialities. The benchmark therapy consists of en bloc resection of the tumour, covered by a safety margin of healthy tissue. Depending on tumour histology, grade, local extent and anatomical stage, radiotherapy, chemotherapy and isolated hyperthermic limb perfusion may be employed.

  • Due to the complexity of treatment, any soft-tissue swelling suspected of malignancy is best referred directly to a sarcoma centre, where therapeutic management is carefully planned by an experienced multidisciplinary team.

Cite this article: EFORT Open Rev 2017;2:421-431. DOI: 10.1302/2058-5241.2.170005

Miklós Szendrői, Imre Antal, Attila Szendrői, Áron Lazáry, and Péter Pál Varga

  • Oncological management of skeletal metastases has changed dramatically in the last few decades. A significant number of patients survive for many years with their metastases.

  • Surgeons are more active and the technical repertoire is broader, from plates to intramedullary devices to (tumour) endoprostheses.

  • The philosophy of treatment should be different in the case of a trauma-related fracture and a pathological fracture. A proper algorithm for establishing a diagnosis and evaluation of prognostic factors helps in planning the surgical intervention.

  • The aim of palliative surgery is usually to eliminate pain and to allow the patient to regain his/her mobility as well as to improve the quality of life through minimally invasive techniques using life-long durable devices.

  • In a selected group of patients with an oncologically controlled primary tumour site and a solitary bone metastasis with positive prognostic factors, which meet the criteria for radical excision (approximately 10% to 15% of the cases), a promising three to five years of survival may be achieved, especially in cases of metastases from breast and kidney cancer.

  • Spinal metastases require meticulous evaluation because decisions on treatment mostly depend on the tumour type, segmental stability, the patient’s symptoms and general state of health.

  • Advanced radiotherapy combined with minimally invasive surgical techniques (minimally invasive stabilisation and separation surgery) provides durable local control with a low complication rate in a number of patients.

Cite this article: EFORT Open Rev 2017;2:372-381.

James Plant and Stephen Cannon

  • Benign abnormalities of bone are common, especially in children.

  • Malignant bone sarcomas are aggressive and have a poor outcome, particularly if treatment is delayed or initiated in a non-specialist centre.

  • Conversely, specialist tumour centres are overwhelmed with referrals for benign disease, a predictable outcome of an increasingly litigious medical environment. This review aims to arm the general orthopaedic surgeon or general practitioner with information to better discern a benign bone lesion from a malignant one, and explain the process of investigation and onward referral for those in whom malignant disease is suspected.

Cite this article: Plant J, Cannon S. Diagnostic work up and recognition of primary bone tumours: a review. EFORT Open Rev 2016;1:247-253. DOI: 10.1302/2058-5241.1.000035.

Julie J. Willeumier, Yvette M. van der Linden, Michiel A.J. van de Sande, and P.D. Sander Dijkstra

  • Bone metastases of the long bones often lead to pain and pathological fractures. Local treatment consists of radiotherapy or surgery. Treatment strategies are strongly based on the risk of the fracture and expected survival.

  • Diagnostic work-up consists of CT and biopsy for diagnosis of the primary tumour, bone scan or PET-CT for dissemination status, patient history and blood test for evaluation of general health, and biplanar radiograph or CT for evaluation of the involved bone.

  • A bone lesion with an axial cortical involvement of >30 mm has a high risk of fracturing and should be stabilised surgically.

  • Expected survival should be based on primary tumour type, performance score, and presence of visceral and cerebral metastases.

  • Radiotherapy is the primary treatment for symptomatic lesions without risk of fracturing. The role of post-operative radiotherapy remains unclear.

  • Main surgical treatment options consist of plate fixation, intramedullary nails and (endo) prosthesis. The choice of modality depends on the localisation, extent of involved bone, and expected survival. Adjuvant cement should be considered in large lesions for better stabilisation.

Cite this article: Willeumier JJ, van der Linden YM, van de Sande MAJ, Dijkstra PDS. Treatment of pathological fractures of the long bones. EFORT Open Rev 2016;1:136–145. DOI: 10.1302/2058-5241.1.000008.