Introduction:GCT is a locally aggressive tumor involving the epi-metaphyseal region characterized by proliferation of mono-nuclear stromal cells. Commonly used modalities are curettage, wide resection, resection arthrodesis, modular prosthesis and rarely amputation.Aim:Descriptive analysis and clinical profile of patients with GCT coming to our hospital.Methodology:Patients with GCT from 2008 to 2018 with average of 5-6 patients/year. confirmed GCT. Inclusion criteria- GCT with minimum 1 year follow up. 50 patients fulfilled the case definition and included. Radiological staging was standard campanacci grading and functional assessment was revised Enneking’s musculoskeletal tumour society scoring expressed as percentage for upper and lower limb separately.Data analysis with SPSS software. Follow up at regular intervals.Techniques included curettage, extended curettage, bone grafting, Bone cement, knee arthrodesis and resection arthroplasty.Results: MSTS score included Endoprosthetic replacement-100, curettage with cement – 96, curettage with bone grafting- 90.13, curettage bone grafting-85.5, extended curettage -91.1, resection arthrodesis & fibula graft-61, resection arthroplasty -86.76, resection and fibula graft-82, curettage -90 resection arthroplasty – 100. Complications included recurrence- 4, infection-2, palmar subluxation – 2 and non-union -2. No donor site morbidity in fibula harvested cases. Conclusion:GCT most commonly occurs in 3rd decade with female preponderance. Pain most frequent presentation. Most common location is around knee with Campanacci 2 being most common radiological stage. Resection is recommended grade 3 tumours for expendable bones but functional outcome is inferior to other invasive procedures. Recurrence usually occurs within first 2 years of index surgery as seen in our study.

Background: Treatment of GCT of bone around knee presents a challenge of, complete removal of tumor as well as maintaining function of knee joint. Native joint preservation by intralesional curettage gives better long term functional result as compare to marginal resection and endoprosthesis insertion. Intralesional curettage leads to a defect which is very large in campanacci grade III GCT. There are various options available to fill the defect like bone cement, bone auto graft, bone allograft and bone substitute. Most biological and sustainable outcome will be obtained from bone auto graft. Harvesting large amount of auto graft causes donor site morbidity . In this study we worked on a hypothesis that using auto graft then filling up the whole defect is not necessary.Methods: 20 patients of campanacci grade III GCT around knee,operated between 2015-2017, were reviewed retrospectively. Patients were operated by intralesional extended curettage and bone grafting and knee spanning tubular external fixator applied in all the cases. All the patients were regularly followed upto minimum two years. Outcome was measured by 30 point system developed by MSTS and radiographs were also evaluated.Result: Average MSTS score at last follow up was 27.6 ( 16-30). Average range of motion of knee was 0-116°( 0-80° to 0 to 130°).Evaluation of radiographs according to system of International Society of Limb Salvage showed excellent result in 12 patients(60%), good result in 6 patients(30%) and poor result in 2 case(10%). Both functional score as well as radiological score, showed good outcome supporting our hypothesis.

Case 1:13 year old girl presented with pain in the left leg for 15 days duration. Radiologically, well circumscribed Lytic lesion at epi-metaphyseal junction with physeal infiltration. MRI investigation involving the proximal tibia with posterior cortical breach. Biopsy confirmed GCT. Definitive procedure was done with extended curettage and allograft fibula strut with iliac crest bone graft from the father. Bone cement deferred due to absence of posterior cortex. knee spanning external fixator was applied. Patient received zoledronic acid pre-operatively and two doses post-operatively at 3 wks interval. External fixator removed at 8 weeks. At 18 months follow up, patient is pain free, FWB, knee ROM of 0-140 deg. Radiologically, posterior cortex of proximal tibia is completely formed with incorporation of the fibula graft.
Case 2:13 year old girl presented with pain and swelling over the medial malleolus for 1 month. MRI ankle GCT(Campanacci grade 2). Biopsy confirmed GCT. Extended curettage and filling of the defect with bone cement. Patient followed up regularly. follow up 1 year.Patient good ankle ROM and FWB. 18 mon she developed soft tissue recurrence with extension of lesion with lysis around the cement. She underwent soft tissue clearance with intra-op zoledronic acid, removal of cement and soft tissue flap cover with LRS fixator.case3: 8 year old child presented with pain and swelling over the left wrist for 5 month.Radiologically it showed expansile lytic lesion in the distal ulna.Intra-operative the entire distal ulna with the TFCC was removed with 1.5 cm of tumour free margin

Osteoid osteoma account for 10%of all benign bone tumours Seen in age of 10 and 30 years . with a male: female ratio of 3:1.tibia and lumbar vertebra involved .Majority of the patients experience pain at involved site worse at night and relieved by non-steroidal anti-inflammatory drugs .prostaglandin E2 and prostacyclin found directly in the nidus tissue and it explains pain.The central lytic area called the nidus around which the sclerotic bone is laid.Radiofrequency ablation has an role in treatment of osteoid osteoma at accessible sites Other modalities en block excision.Complete removal of the sclerotic bone and nidus should be done Case report A 20-year-old male presented with pain in left hip for 6  months. pain occurred at night, 6/10 on VAS. CT scan showed osteoid osteoma at superior border of femoral neck Of diameter 0.5 cm. Procedure A cannula with inner stylet is introduced.CT images are obtained to verify position.inner stylet is removed. Bone penetration is done through cannula Once within nidus ablation is done with RF generator. The lesion heated to 90°C for a time of 5 min.one year after patient didn’t complain of pain or difficulty in walking Discussion osteoid osteoma is composed of woven bone and osteoid .mainly located in appendicular skeleton.microscopic finding shows nidus of interlacing network of bone trabeculae with different level of mineralization along with vascular connective It has osteoblasts rim with numerous osteoclasts like giant cells.
conclusion RFA is good method of treatment for Osteoid osteoma that are present in accessible area

Soft tissue hemangiomas are common and benign neoplasms, constituting about 7% of all soft tissue tumors. In addition, they are the most common soft tissue neoplasm in children. However they are uncommon in the hand. Histologically, they can be divided into five categories: capillaries, cavernous, arteriovenous, venous and mixed variations. Cavernous hemangiomas have larger dimensions, are deeper, and often intramuscular. This subtype is rare in the hand, constituting a challenging differential diagnosis when there is no skin involvement.
We present a clinical case of a 15-year-old male patient, referred for dorsal swelling of the first ray of the right hand. He presented without sensory or motor deficits, without pain on palpation and without limitation of metacarpophalangeal mobility. An ultrasound was performed, which was inconclusive, and an MRI was subsequently requested, which showed a subcutaneous lesion with 32x23x12mm, lobulated, not capturing contrast, with possible hemorrhagic content inside. Macroscopically after surgical excision the lesionado was a solid, vascularized and well-defined mass, with 30 mm of larger diameter. The histological study revealed a cavitary nodule, with a thin wall and hemorrhagic material, compatible with cavernous hemangioma.
Hemangiomas can develop anywhere on the hand, the most common locations being tenar and hypotenar eminences and deep volar spaces. Since skin involvement is not common, diagnosis and excision are challanging. The imaging study recommended in this type of lesions is MRI. The recommended treatment for cavernous hemangiomas is excision or embolization and sclerotherapy, especially when their size and location pose a high hemorrhagic risk.

Introduction: Osteochondroma is the group of benign bone tumours, which are composed of spongy bone covered by a cartilaginous cap. Patients with distal ulnar osteochondromas frequently cause forearm deformities with relative ulnar shortening, wrist joint deviation, and varus bowing. Surgical ulnar lengthening is necessary to restore the carpal balance.
Case report: We report the case of multiple exostosis in 13 year old male with distal ulna osteochondroma with long standing and progressive ulnar shortening and radial bowing treated with limb reconstruction system. Our case is type 1 Masada managed with excision of distal ulna osteochondroma and gradual ulnar lengthening without osteotomy of radius.
Conclusion: Progressive ulna deformity can lead to increasing pain, joint instability, limited motion, and functional decline. For type 1 Masada Ulnar lengthening is necessary, but overcorrection is inadvisable due to possible ulnocarpal impaction syndrome. As significant remodeling effects on the radius were observed, simultaneous radial correction can be delayed.
Keywords- Distal ulna osteochondroma, Limb reconstruction system, Type 1 Masada

Introduction: Extra-medullary plasmacytoma is rare and it involves 1-2% of the solitary plasmacytoma.we are reporting a case of solitary plasmacytoma of the distal femur which was complicated with pathological fracture.the importance of this article is to consider solitary myeloma as a differential diagnosis of lytic lesion
Case report: 47 year old male presented with isolated pain and swelling in thigh for 6 month. No constitutional symptoms. On local examination bony tenderness was present. No warmth, skin was normal. Radiological examination revealed a lytic lesion in the distal femur with cortical breach. Radiologically differential diagnosis was giant cell tumour, bone cyst or aneurysmal bone cyst. MRI imaging revealed 5.4*5.2*10.0 cm with cortical breach andsoft tissue infiltration. lesion curetted out. Histopathological examination showed bony trabeculae(inter-trabecular spaces) with sheets of plasma cells.focal woven bone seen. Post operatively non-weight bearing. Further investigations were done. Bone marrow aspiration and bone marrow biopsy showed 6%plasma cells. Bence jones proteins negative. Serum immunoglobulins were normal. Radiotheraphy-30 grey in 10 fractions for two weeks duration. pathological fracture through the lytic lesion. Following procedures were done, cement spacer application, LCP, spacer removal and fibulagraft. At 3 yr follow up no recurrence and complete incorporation.Conclusion:Solitary bone plasmacytoma are rare and they are of diagnostic challenge because the present with solitary lytic lesion of the bone. In our report we also highlight the complication of pathological fracture which is common because of the bone destruction of the myeloma cells.Knowledge and prevention of these complications can reduce significant morbidity and multiple procedures.

Introduction:
The surgical treatment of soft tissue sarcomas of the retroperitoneum present great challenges because of their large size and deep location in an anatomically complex area containing a number of vital structures.

Methods:
A 66 year old male patient presented with a 110x100x45mm heterogenous tumor located in the transversus abdominis and internal oblique muscles. Extending cranially to the 11th rib and caudally over the pelvic crest.
After preoperative radiation wide surgical excision of the tumor was performed followed by reconstruction of the lateral abdominal wall.
A lumbotomy approach with an extension over the iliac crest was performed and due to the extensive growth of the tumor an extension to retroperitoneum and peritoneum cranially and intermuscular through iliacus and psoas muscle caudally had to be undertaken. We proceeded with full resection of retroperitoneal fat, abdominal wall muscles, part of the iliac crest and parts of 11th and 12th ribs.
After resection the diaphragm was plicated on the thoracic wall and a reconstruction of the abdominal wall was completed.
Because of a subcutaneous soft tissue defect, the wound could not be closed primarily.
The defect has been fully covered with a harvested anterolateral thigh flap and vastus lateralis.
The postoperative course was uneventful and at 6 months follow-up there was no recurrence of the tumor and no postoperative abdominal wall hernia.

Conclusion:
Through this case report we highlight the importance of the complex management and interdisciplinary approach required for successful therapy.

Multiple myeloma (MM) spinal fractures are mostly compression fractures occurring in vertebrae weakened by malignant osteolysis. Radiotherapy and vertebral augmentation are the main tools used to treat stable fractures. However, they are insufficient for unstable fractures and important kyphotic deformities. Fixation with cement-augmented screws followed by corporeal reconstruction may overcome these limitations. Our aim is to report a case of simultaneous transpedicular fixation, tumoral excision and hyperkyphosis correction in a MM patient with pathologic fracture adjacent to butterfly vertebra. A 73-year-old woman suffered a fall resulting in T10 compression fracture with pathologic features. Diagnosis of T9 butterfly vertebra was also made. Regional kyphotic angle: 38º. No neurologic deficits, but severe pain. The lesion extended to the posterior elements and showed hypointense signal on T1 and hyperintense on T2. Following medical work-up, diagnosis of stage I MM was made. Spinal instability neoplastic score (SINS): 16. Through a posterior approach, the patient underwent augmented pedicle screw fixation (T6-T7-T8-T11-T12-L1), T10 corpectomy, PEEK cage reconstruction and hyperkyphosis correction. Bisegmental kyphotic angle was corrected to 18º. Post-operative was uneventful. At four months, the patient presents with no pain/limitation. Besides an increased SINS, our case was more challenging due a butterfly vertebra occurring superiorly resulting in hyperkyphosis. Since MM was diagnosed early, increased survival is expected. A percutaneous approach, although safer in terms of infection, would not allow simultaneous tumoral excision and corporeal reconstruction. Since the patient was immunologically fit, an open posterior approach was carried out, with no infectious or mechanical complications to date.

Introduction: Malignant tumors of the scapula are rare. With advances in neoadjuvant therapy, total joint arthroplasty, and 3-D printing, limb-salvage surgery is a viable option. After total scapulectomy, two techniques of scapular reconstruction are reported in the literature these are endoprosthetic reconstruction and suspension arthroplasty. Loss of shoulder volume after suspension arthroplasty leaves the soft-tissue envelope loose without tension. The working length of the deltoid muscle is shortened by the medial displacement of the humerus. Advantages of endoprosthetic reconstruction are the higher MSTS functional scores, range of motion, and cosmesis when compared to other methods. Case Presentation: We present a case of a 49-year-old male who was evaluated for a left periscapular mass due to 2 months of worsening shoulder pain. MRI identified a periscapular mass that did not extend through the scapular body and showed no shoulder joint involvement. Biopsy resulted in undifferentiated pleomorphic sarcoma. The patient underwent chemotherapy showing a decrease of 56.7% by volume of the tumor. Given the anatomic considerations, the patient underwent a glenoid sparing total scapulectomy with 3-D printed endoprosthetic reconstruction. At nine months follow up the patient showed improved forward flexion range of 0-90°, horizontal abduction range of 0-80°, with an anatomical preserved deltoid curvature. Imaging demonstrated no evidence of reoccurrence. Conclusion: This report shows that with proper multi-disciplinary pre-surgical planning an endoprosthetic reconstruction after total scapulectomy results in superior functional outcomes and is best in cases with adequate soft-tissue coverages, preservation of the deltoid-axillary nerve complex, all while achieving negative oncologic margins.

Background: Melanoma is a rare cause of bone metastases with rates <5%. The tumor prosthesis is an option if there is functional disability and uncontrolled pain. We present a surgery technique of cotyloid and femoral resection-reconstruction with a cotyloid ring and femoral tumor prosthesis.
case presentation: 62-year-old male, history of superficial melanoma excision of the abdomen 11 years ago, revisions without recurrence. Onset of pain in the right thigh gradually evolving 6 months with inability to ambulation. PET / CT: hypermetabolic focus in the intertrochanteric region with extension to the femoral neck and right iliac bone and spine. CT: lytic lesions of the right proximal femoral epiphysis-iliac bone, compatible with metastases. Bone biopsy-L4 revealed a Melanoma metastasis. Moore incision was performed, external rotators were disinserted for exposing acetabulum and proximal femur. The upper 10 cm of the femur were removed. Acetabulum was drilled and a hole was created in the ceiling to access iliac metastasis. A cemented iliac stem was inserted through the roof of the acetabulum bypassing the metastatic lesion to support the iliac region. Acetabular ring and double mobility cup completed the cotyloid reconstruction. A cemented tumor femoral stem was implanted to correct the deficit of proximal femur. Results: Clinical follow up at 6 months shows a good evolution, the patient was pain free with independent ambulation. Discussion: Cotyloid and femoral reconstruction with a cotyloid ring and femoral tumor prosthesis may be an option to consider in these patients because of pain relief and acceptable functional results.

Introduction: Following debridement, patients with periprosthetic joint infection (PJI) require two-stage reimplantation of an endoprosthesis (EPR). Instability related to the residual bone defect presents a challenge in management. Methods: Retrospectively reviewed patients treated for revision total joint or endoprosthetic infection at the hip from 2003-2018. Stage 1, following explant of prosthesis, patients are managed with intramedullary antibiotic spacers. Antimicrobial therapy included six weeks of intravenous and six weeks of oral antibiotics. Prior to reimplantation of an endoprosthesis, antibiotics are held for six weeks, open biopsy and histopathology is repeated. Stage 2, once inflammatory markers (CRP and ESR) are at baseline and negative tissue cultures are observed, EPR was performed. Results: Ten patients with a mean age of 52±19 years were treated for PJI at the proximal femur and hip. 50% of the patients were initially treated due to tumor presence, the remaining patients underwent arthroplasty. Staphylococcus epidermidis growth was observed in 40% of cases, Methicillin-resistant Staphylococcus aureus in 30%, and polymicrobial growth observed in 10%. Patients required a mean 1.6±1.3 procedures to treat infection prior to reimplantation. Mean defect size after Stage 1 was 21.8±12.2 cm. PJI eradication was achieved in 90% of patients, with one patient receiving suppressive Bactrim. Mean MSTS score was 16. Conclusion: Residual bone defects at the hip following explant can be managed by using an intramedullary antibiotic spacer, maintaining stability, and resulting in high rates of limb salvage with conversion to an endoprosthesis.