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Consequences and Prevention of Inadvertent Internal Fixation of Primary Osseous Sarcomas

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Clinical Orthopaedics and Related Research

Abstract

The evaluation and treatment of aggressive bone tumors continue to be diagnostic and therapeutic challenges for orthopaedic surgeons. Despite compelling data regarding the hazards of biopsy, incomplete preoperative evaluation, inappropriate biopsy techniques, and premature surgical interventions continue to compromise optimal treatment of primary bone sarcomas. We retrospectively identified eight patients who had internal fixation of a primary bone sarcoma before referral to an orthopaedic oncology service. Six of the eight patients subsequently underwent amputations and two patients underwent limb salvage for local disease control. Biopsy techniques from referring institutions were highly variable, with only two of seven rendering an accurate diagnosis. The average Musculoskeletal Tumor Society functional score was 10.6 and four of eight patients were disease-free and alive at a minimum followup of 8 months (mean, 26.9 months; range, 8–80 months). Implant violation of primary bone malignancies was associated with frequent high-level amputation for local disease control and low Musculoskeletal Tumor Society functional scores. Common errors in the initial evaluation and treatment included inadequate attention to patient history, incomplete radiographic evaluation, and improper biopsy and surgical techniques, which violated compartmental boundaries.

Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedics & Rehabilitation, University of Miami School of Medicine, PO Box 016960 (D-27), Miami, FL, 33101, USA

    Sheila Conway Adams MD, Benjamin K. Potter MD, Zakariah Mahmood MD, J. David Pitcher MD & H. Thomas Temple MD

Authors
  1. Sheila Conway Adams MD
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  2. Benjamin K. Potter MD
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  3. Zakariah Mahmood MD
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  4. J. David Pitcher MD
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  5. H. Thomas Temple MD
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Correspondence to Sheila Conway Adams MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Adams, S.C., Potter, B.K., Mahmood, Z. et al. Consequences and Prevention of Inadvertent Internal Fixation of Primary Osseous Sarcomas. Clin Orthop Relat Res 467, 519–525 (2009). https://doi.org/10.1007/s11999-008-0546-3

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  • DOI: https://doi.org/10.1007/s11999-008-0546-3

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