Background: Osteosarcoma is the most common primary bone malignancy that frequently occurs in children and adolescents. Etiology is still unknown. Studies about epidemiology and survival of osteosarcoma and subtypes on a wide range of patients are rare. Materials and Methods: Epidemiology was investigated on 6844 patients with osteosarcoma from the National Cancer Institute’s population-based Surveillance, Epidemiology, and End Results (SEER) Program between January 1975 and December 2016 by age, race, sex, marital status, histological subtype, stage, and anatomic site. Kaplan-Meier test was used for survival analysis. Results: Osteosarcoma most commonly occurred in the 0-25 years age group (54.7%). More in males than females and 76% of the patients were whites. The ratio of singles was higher than married ones. Osteosarcoma as a first cancer represented 88% of all reported osteosarcoma cases, 85.5% of the graded cases were high-grade cancer. The most common histological subtype after osteosarcoma NOS (not otherwise specified) was chondroblastic osteosarcoma. The most common anatomic localization was long bones of lower extremity. The survival rate of parosteal and periosteal osteosarcoma was found to be highest, while osteosarcoma with Paget disease had lowest survival. Conclusion: This study which is the largest and most comprehensive study in terms of the number of patients, identified important differences of incidence and survival on various age groups, sex, marital statuses, histological subtypes, cancer stages and anatomical sites. The systematic analysis may provide useful information for guiding clinical work.
Key Words: Osteosarcoma, Subtype, Epidemiology, Survival, SEER Program

Introduction : Treatment of musculoskeletal (MSK) tumors involving the extremities has many options including limb salvaging treatments or amputation. Many scoring tools were developed to measure functional outcomes. Toronto Extremity Salvage Score system (TESS) is a patient filled questionnaire measuring functional status for patients with MSK tumors who underwent limb-sparing procedure. The Purpose of this study is to translate the TESS into Arabic (TESS-AR), and to examine its reliability and validity. Methods : Our study was conducted at multiple centers in Riyadh ,Saudi Arabia. Arabic speaking adults diagnosed with MSK tumors involving the extremities were included. TESS-AR was created following the clear, user-friendly guidelines for translation .Reliability was measured using Test-Retest method. Validity was measured using construct validity. Results :108 participants filled the TESS-AR , 56% were had lower limb tumors. Participants Reported that TESS-AR was clear, they understood all the questions and answers. Test-retest reliability showed excellent reliability with interclass correlation coefficient of 0.965 for both lower and upper extremities TESS-AR. Cronbach’s Alpha of lower extremity TESS-AR was 0.972, where the Cronbach’s Alpha of upper extremity TESS-AR was 0.969 indicating strong internal consistency . Construct Validity between TESS-AR and SF-36 showed strong and moderated correlation between most of the components, with Pearson correlation coefficient >0.40 . similar results found between TESS-AR and EORTC QLQ C30. Conclusion :The TESS-AR is a comprehensible, valid and reliable score to assess the functional outcomes in patient with extremity tumors. We believe that TESS-AR can be used by clinicians, researchers, and patients.

Introduction: The advent of the human genome project has offered new insights into the aetiology of rare tumours along with the potential for the development of new diagnostic and therapeutic techniques. Chondrosarcoma is one of the most common primary tumours of the spine, accounting for approximately 20-27% of primary bone malignancies. Various authors in the literature have suggested that extra-skeletal chondrosarcoma of the spine may have a different aetiology to other locations. Although the genomics of chondrosarcoma in general has been studied, to the knowledge of the authors, there is no comprehensive review of the genetic/genomic landscape of chondrosarcoma of the spine to date. We hypothesize that the genomic landscape of spinal chondrosarcoma is different to non-axial chondrosarcoma. Methods: To systematically review the literature with a focus on identifying prognostic indicators, biomarkers and potential targets for future gene therapy for this malignancy. Results: After exclusion of unrelated studies, 15 studies were identified in a systematic literature search. These articles were extensively reviewed to identify potential bio-markers in one comprehensive review to the readership. Conclusion: Our review has delivered insight into the potential diagnostic, prognostic and therapeutic interventions that could potentially modify management for spinal chondrosarcoma and improve patient outcomes.

Benign bone tumors and tumor-like conditions are very common in proximal femur. The main indications for surgical treatment are lesions with impending fractures or established pathological fractures, or with aggressive or recurrent lesions. Different surgical methods have been described by various researchers. Methods and Materials:We present our experience of non-vascularized fibular strut graft insertion in benign lytic lesion affecting the proximal femur. Our study group consisted of 32 patients with different lytic lesion of proximal femur (20 males, 12 females) between the age group of 14 to 43 years. Following biopsy confirmation and thorough curettage of the lesion, taking care not to leave any pathological tissue behind, full circumference autogenous fibular strut grafts are harvested. Fibular struts are inserted into the lesions after reaming where ever required. Internal fixation was done using various intra- or extramedullary implants as per necessity. Most of the patients were relieved from pain by 10-14 weeks, grafts showed signs of incorporation by 4 -6 months duration; good bony union and satisfactory function were achieved by 9 months to 15 months. In our series all but one pathological fracture resulted in good bony healing, radiological signs of union was seen by 10-16 weeks, fibular grafts incorporated well with the parent bone, patients were relieved of pain and achieved satisfactory function. Conclusion:Cortical fibular strut-grafting following thorough curettage of the lesion, with or without any internal fixation appears to be a very good procedure for management of benign lytic lesion of proximal femur.

Endoprosthetic replacement of the proximal femur is a common reconstruction method for both primary and metastatic disease. The role of acetabular reconstruction remains contentious with regards to dislocation and revision rates, and to our knowledge, there remains no long term follow up data to support this. We therefore asked whether dislocation and revision rates differed between those patients receiving acetabular reconstruction or hemiarthroplasty PFR reconstructive options at long term follow-up. We retrospectively reviewed and matched 122 consecutive patients at our tertiary referral centre with a minimum 5-year follow up. Kaplan-Meier survivorship curves for dislocation and revision were calculated and causes of failure categorised according to the ISOLS classification. There was a total of 10 dislocations: 7 in the acetabular reconstruction group and 3 in the hemiarthoplasty group (p=0.74). There was a total of 13 revisions, 10 of within the acetabular group, and revision -free survival between the groups was not significant at p= 0.13. A comparison of failure types 2, 3 and 5 showed no statistical significance. In conclusion, there showed no statistical difference in dislocations or revisions, however there was a notable difference in revisions between the groups.

Background: Wide-margin resection is mandatory for malignant bone and soft tissue tumors. However, this increases the complexity of resections, especially when vessels are involved. Patients in this high-risk clinical setting could be surgically treated in orthopaedic-vascular multidisciplinary approach.
Objectives: This study was carried out in this health-care organization to evaluate patient safety in term of oncologic outcomes and reduction of complication rate.
Materials and Methods: We retrospectively reviewed 74 patients (37 males, mean age 46 years, range 9-88) who underwent surgical excision for bone/soft tissue malignant tumors closely attached to vascular structures, from October 2015 to February 2019. Vascular surgery consisted of isolation of at least one vessel (64 patients), bypass reconstruction (9 patients), and end-to-end anastomosis (1 patient). Mean follow-up was 27 months (range, 24-44 months). Patients’ demographics, tumor characteristics, adjuvant treatments, type of orthopaedic and vascular procedures, oncologic, functional outcomes and complications were recorded.
Results: Overall survival was 85% at last follow-up. Eleven patients experienced at least one major complication (hematoma and deep venous thrombosis the more frequent), 22 experienced one minor complication. Major complications were higher in pelvic resections compared to limb salvage procedures (p=0.0212) at univariate analysis, whereas the most important multivariate predictor for major complications was radiotherapy (p= 0.0136).
Conclusions: A multidisciplinary ortho-vascular approach for resection of malignant bone and soft tissue tumors tightly attached to important vascular structures should be considered a good clinical practice for patient safety. This correlates with reduction in complication rate and improvement of oncologic outcome of the patients