Abdul-Kader Martini

Osteosarcoma of the Hand and Forearm: Experience of the Cooperative Osteosarcoma Study Group

BackgroundOsteosarcoma is extremely rare in the hand and forearm. Therefore, only limited data are available for planning treatment or predicting the outcome and prognosis of osteosarcoma in the peripheral upper extremity.MethodsEpidemiological, clinical, and histopathologic data were analyzed in 39 patients with osteosarcoma of the forearm or hand who were enrolled in studies of the Cooperative German-Austrian-Swiss Osteosarcoma Study Group from 1977 to December 2000. In patients with high-grade osteosarcoma, the treatment entailed surgical resection in combination with chemotherapy, whereas patients with low-grade osteosarcoma underwent only surgery.ResultsThe 5-year overall survival rate among the 33 patients with high-grade central osteosarcoma of the distal upper extremity was 86.2% ± 6.4%. The 5-year event-free survival rate was 65.4% ± 9.6%. Five of the eight patients with secondary metastases were in remission at the time of analysis. Four patients died of their disease, and two patients died of chemotherapy-related complications. The mean overall survival rate was 88.0% ± 6.5% in patients treated by wide or radical tumor resection and was 75.0% ± 21.7% in patients with nonwide margins of resection. Whether amputation or local resection was performed had no significant influence on the prognosis. All six patients whose osteosarcoma was not classified as high-grade central osteosarcoma were in remission at the time of analysis.ConclusionsThe results demonstrate a remarkably high survival rate for patients with high-grade osteosarcoma of the hand and forearm and confirm that multiagent chemotherapy in combination with wide excision is a highly effective treatment for this malignant tumor.

Amount of ulnar resection is a predictive factor for ulnar instability problems after the Sauvé-Kapandji procedure: A retrospective study of 44 patients followed for 1–13 years

Background The Sauvé-Kapandji procedure can result in instability of the proximal ulnar stump Patients and methodsWe reviewed 44 patients (mean follow-up time 6 (0.6–13) years) to investigate predictive factors for ulnar instability after Sauvé-Kapandji operation. We used several scores including an instability score specifically designed for this study Results Patients with a longer proximal ulnar stump had significantly lower instability scores, significantly better Mayo Modified wrist scores and DASH scores, and also less pain than those with shorter proximal ulna Interpretation If the shortening of the proximal stump is less than 35 mm, a reliable improvement in motion and a high patient satisfaction can be expected. The risk of a painful ulnar instability is related to the amount of resection, and can be reduced by creating a long upper ulnar stump.