The use of a fibular strut graft has been shown to provide biologic reconstruction that successfully addresses these issues in the pediatric population. This study aims to evaluate the results of benign and tumor like lesions treated by non-vascularized autologous fibular strut graft and supplementary fixation.

Methods:study was conducted between January 2002 and December 2017 . The study included all patients under 13 years of age with benign and tumor-like lesions of bone undergoing surgical procedures requiring bone grafts. The surgical procedures performed were simple excision, curettage, and stabilization, and marginal resection with reconstruction with autologous fibula bone grafting +/- cancellous bone grafting. Further stabilization was achieved with intramedullary or compression plate and screw fixation. Clinical and radiological follow-up was done until skeletal maturity.

Results:480 cases of benign and tumor-like lesions of bone operated in the study period, with an average age of 7.8 years. The most common lesion operated was aneurysmal bone cysts (38.54%),followed by fibrous dysplasia (28.75%), and non-ossified fibromas (9.37%). All patients could walk with partial weight-bearing four weeks postoperative,and full weight-bearing was permitted after a mean of 8 weeks. Graft union was attained in 468(97.5%) patients at a mean of 2 months while 12(2.5%) required repeated surgery.

Conclusions:This study showed that primary bone tumors were mainly benign, settled predominantly in the lower extremities mostly in the femur with a male preponderance.We conclude that non vascularized autologous fibular strut graft with internal fixation is a safe and effective method of treatment for benign cystic lesions in children.

Introduction: The reconstruction of large bony defect caused by tumour resection can be managed by different technique which includes variety of bone graft, Masquelet technique, mega-prosthesis etc. Literature lacks studies discussing outcomes of Masquelet technique in tumour cases especially pertaining to infected tumour cases in adults. Methods: We reviewed a total of 154 patients of benign & malignant tumour managed by us between 2013 and 2019. Patients belonging to all the age group with infected tumour/diaphysial tumour/periarticular tumour, where single stage surgery or mega-prosthesis is not a viable option and were treated with Masquelet technique for reconstructing a bone defect of at least 10 cm were included in our study. We evaluated the outcomes of 8 patients for four parameters i.e. bony union, healing index, number of re-do surgeries required and limb length discrepancy. Results: Mean age of our study group was 19.7 years and mean follow-up of 3.36 years. Mean bone loss after tumour resection was 13.1 cm. Average time required to achieve bony union was 23.25 months with mean healing index of 1.67 months/cm. All but one patient achieved bony union. Mean limb length discrepancy seen was 1.44cm. Infected cases showed low healing index with higher percentage of re-do surgeries. Conclusion: Induced membrane technique reliable alternative method of reconstruction to megaprosthesis in all age group. However, obtaining union can be a difficult preposition in infected tumour cases and multiple surgeries may be required to get the desired result even after 2 stages.

Objectives: For skeletal reconstruction in surgery for bone tumors, pasteurization of bone has been used with favorable results over other methods of recycling.
Methods: Twenty patients with osteosarcoma (ten patients) and chondrosarcoma (ten patients) of the proximal humerus were reconstructed by pasteurized osteo-articular autologous bone graft. They were 14 females and six males, between 7 and 30 years of age who were followed up for at least 3 years. The ISOLS graft radiographic evaluation method was used . Results: Sixteen patients (80%) had complete incorporation of the graft and four patients (20%) had partial incorporation. Viability of the grafts was evaluated by bone scintigraphy. Of 20 patients evaluated, uptake was detected in 14 patients from approximately 6 months postoperatively . The functional results were assessed by the system of the Musculoskeletal Tumor Society, and the mean functional rating was 86%.
Fifteen patients have been disease free (six osteosarcoma and nine chondrosarcoma), one osteosarcoma patient alive with disease and four have died of disease (three osteosarcoma and one chondrosarcoma).
Resorption of the graft was seen in three osteosacroma patients under the age of ten (15%), no fracture or infection were seen. Local recurrence was detected in single chondrosarcoma patient.
Conclusions: These results indicate that pasteurization of bone may be a useful option for reconstruction after resection of sarcoma of the proximal humerus. In skeletally immature patients resorption of the graft is noticed. Advantages of pasteurization include convenience of use, avoidance of intraspecies infection and allogenic reactions, and satisfactory bone remodeling.

Introduction: Osteosarcomas or Ewing's sarcomas represent 90% of malignant bone tumors in children. In Biologic intercalary reconstruction, 4 techniques are described: vascularized fibula (VF), allograft and vascularized fibula (AVF), allograft alone (A) or induced membrane (IM). Methods: 93 patients (mean age 12.3) operated between 1986 and 2017 of a malignant diaphyseal femur or tibia tumor were included in French or European-chemotherapy protocols. Healing Index (HI), functional score and complications were investigated. Results: There were 53 osteosarcomas, 28 Ewing, and 12 other tumors, in 63 femurs and 30 tibias. Length of resection ranged from 18 to 88% of the bone length (mean 51%). 32 patients had a VF, 13 had an AVF, 20 had an A and 28 were treated with IM. Demographic data were comparable. Mean follow-up was 12 yo (5-25). Per primam consolidation was obtained in 57% of patients. Nine patients (9,5%) required amputation, seven due to local recurrence, one to infection and one to mechanical failure. HI were comparable but the average number of interventions per patient was 1.7 for AVF, 3.3 for VF, 3.3 for A and 2.9 for IM. Four allograft resorptions were reported. In vascularized fibula, 10 patients had donor site complications (15%). Discussion: In femoral resections larger than 50% of bone length, AVFs provides good results. In tibias, VF and IM are comparable. However, MI leads to fewer reoperations and avoids donor site complications. In MI non-unions, usually at proximal junction, fibula graft remained an option.

Introduction: The pathogenesis of cystic fluid storage in solitary bone cysts remains unclear. We aimed to compare the results of the biochemical analysis of cystic fluid with clinical information. We propose a hypothesis for its pathogenesis. Methods: Twenty-seven male and eight female patients were included; the median age at diagnosis was 11 years (range: 5–23). The mean follow-up period was 60 months (range: 14–146). Clinical information including sex, age, affected site, radiological findings of phase (active or latent), surgical procedure, outcome, and biochemical analysis of serum and cystic fluid were examined. Results: The 5-year healing rate was 64.0%. Biochemical analysis revealed that total protein and albumin levels in the cystic fluid were significantly lower than those in the serum. Bone turnover markers such as alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BAP), and TRACP 5b (tartrate-resistant acid phosphatase 5b) were remarkably elevated in the cystic fluid compared to those in the serum. R values were 0.127, 0.076, and 0.095 for ALP, BAP, and TRACP 5b, respectively. Areas under the receiver operating characteristic curves, calculated to assess the association of the values of ALP, BAP, and TRACP 5b in the cystic fluid with postoperative recurrence, were 0.57, 0.51, and 0.70, respectively. Conclusions: No clear correlation of bone turnover markers between the serum and cystic fluid was observed. The high TRACP 5b level in the cystic fluid was associated with postoperative recurrence. The balance between osteoblastic and osteoclastic activities may be important for determining the destiny of solitary bone cysts.

Introduction: Synovial sarcoma (SS) is an aggressive soft tissue malignancy of mesenchymal origin. We reexamined potential predisposing factors predictive of metastatic disease at initial diagnosis of SS using Big Data Analysis. Methods: The U.S. Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify all patients diagnosed with SS from 2000 to 2018 and classify each patient at initial diagnosis as either metastatic or limited to localized disease. Patient-based and tumor characteristics were analyzed using both a univariate and multivariate logistic regression model. Initial diagnosis of SS presenting with metastatic disease was analyzed with regards to age greater than 50 years, tumor in the pelvic area and relative tumor size. Results: 2,162 cases of histologically confirmed SS were identified; 382 (17.7%) initially presented with metastatic disease. Based on an unadjusted logistic regression analysis, patients had the highest odds of metastatic disease at initial diagnosis if their age was greater than 50 years (odds ratio [OR] = 2.77; 95% confidence interval [CI], 2.00 to 3.80), tumor was located in the pelvic area (OR = 3.28; 95% CI, 2.13 to 5.06), and tumor size was greater than 10 cm (OR = 8.98; 95% CI, 5.87 to 13.74). These factors remained significant when combined in a multivariate model controlling for age, sex, race, tumor location, histology, size and socioeconomic factors. Conclusion: SS patients with age greater than 50 years, tumor in the pelvic area, and tumor size greater than 10 cm are more likely to have metastatic disease at initial diagnosis.

Introduction: The relationship between indeterminate pulmonary nodules (IPNs ) and metastasis is difficult to determinate. We expect to explore a predictive model that can help indicate the nature of IPNs and predicte the probability of metachronous metastasis in osteosarcoma patients.
Methods: We conducted a retrospectively study including 184 osteosarcoma patients from January 2016 to January 2021. Hematological markers and clinical features were collected and analyzed.
Results: We constructed a osteosarcoma immune prognostic index (OIPI) according to lung immune prognostic index (LIPI). OIPI had can better predict metastasis than other hematological markers and clinical features. OIPI divided 184 patients into 4 groups. OIPI have a stable predictive effect in both the no-nodule group and the IPNs group and was related to metastatic site time, respectively. Besides, patients with IPNs in high OIPI groups were more likely to develop metastasis than that in low one. Furthermore, the combination of OIPI with IPNs can more accurately identify patients with metastasis. Finally, we constructed an OIPI-based nomogram to predict 3-year and 5-year metastasis rates.
Conclusion: This study firstly assist chest CT in diagnosing the nature of IPNs based on hematological markers. Our findings suggested that OIPI was superior to other hematological markers, and OIPI can be an auxiliary tool to determine the malignant transformation tendency of IPNs. The combination of OIPI with IPNs can further improve the metastatic predictive ability in osteosarcoma patients.