Ronald J. Rooney

Hydatid bone disease of the pelvis. A report of two cases and review of the literature.

Hydatid disease is caused by a parasitic tapeworm Echinococcus. This parasite in larval stage can thrive in many parts of the body, most frequently in the liver. Hydatid disease in bone is rare, but in areas where hydatid disease is endemic, it must always be considered in the differential diagnosis. Two cases of hydatid bone disease of the pelvis are reported. The treatment of choice is a combination of chemotherapy and surgery.

Post-traumatic squamous-cell carcinoma.

Between January 1, 1976, and January 1, 1986, we treated sixty-three patients who had histologically proved squamous-cell carcinoma that originated in a pre-existing scar or sinus of an extremity. In 49 per cent of the patients, metastases to regional lymph nodes either were present when the patient was first seen or subsequently developed. The age and sex of the patient, the etiology of the original scar, and the duration of illness bore no relationship to the result. The most significant factor in predicting the outcome was the grade of the tumor: for grade-I (low-grade) lesions, the incidence of metastasis was 10 per cent; for grade-II (moderately well differentiated) lesions, 59 per cent; and for grade-III (poorly differentiated) lesions, 86 per cent. Eleven patients had wide local excision of the lesion, which resulted in local recurrence in four patients and metastasis in three. Thirty patients had therapeutic amputation: one patient had recurrent disease and five patients had metastasis. Radical resection of lymph nodes after metastasis was uniformly unsuccessful in preventing additional metastasis. Ten patients who had a grade-II or grade-III tumor had prophylactic irradiation of the regional lymph nodes after the definitive operative treatment. At an average of thirty-seven months of follow-up, only one of them had metastasis. We recommend that well differentiated squamous-cell carcinoma be considered a low-grade tumor, according to the staging system for musculoskeletal neoplasms, and that more poorly differentiated squamous-cell carcinoma (grades II and III) be considered a high-grade lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Stabilization of the Interphalangeal Joint of the Big Toe: Comparison of Three Methods

Three methods of stabilizing the IP of the big toe were compared. In group A, 10 patients underwent tenodesis of the extensor hallucis longus to the extensor digitorum brevis tendon. All of them developed a toe-drop; two patients had significant symptoms that required IP fusion. In group B, 19 patients underwent IP fusion using smooth or threaded intramedullary Kirschner wire fixation. There were nine nonunions, three requiring refusion. In group C, 32 patients underwent IP fusion using intramedullary screw fixation. There was one nonunion with screw failure that required revision. Although none of our patients considered the toe-drop after extensor hallucis longus tenodesis cosmetically unacceptable, this may not be so in other cultures. All complications following IP fusion with screw fixation were technical and are avoidable. When stabilization of IP is required, we recommend fusion of IP with screw fixation.

Bilateral Dysplasia Epiphysealis Hemimelica: A Case Report

Dysplasia epiphysealis hemimelica is a rare disorder of cartilage growth. Classically, the disease involves a single limb and is isolated to the medial or lateral half of that limb. A patient is described who presented with classic findings of this disease but involvement of both ankles.

Osteosclerotic lesions in sarcoidosis. Report of a case.

In a 36-year-old black American male, sarcoidosis produced multiple osteoblastic lesions instead of the lytic lesion characteristic of the disease.

Proximal tibial extension medial rotation osteotomy to correct knee flexion contracture and lateral rotation deformity of tibia after polio

A proximal tibial extension medial rotation osteotomy was performed on 17 tibias in postpoliomyelitis patients to correct knee flexion contractures simultaneously with the correction of lateral rotation deformity of the tibia through the same osteotomy. Gait improved in 10 patients. Five patients developed recurrence of knee flexion contractures; five more developed greater than 20 degrees genu recurvatum. One patient developed a common peroneal nerve palsy. Because of the high incidence of complications, we recommend that this procedure be abandoned.

Tendoachilles tenodesis to the fibula : a retrospective study

Tendoachilles tenodesis to the fibula was performed in postpolio patients to improve their gait. The charts of 48 patients with 52 tenodeses were reviewed. The mean follow-up was 5.5 years. Gait improved in one-third. When the hindfoot was stabilized, gait improved in 40% of the patients, but when it was not stabilized, only 22% improved their gait. Excessive equinus developed in 18 patients, all of whom were less than age 12 years when operated. We conclude that it is reasonable to use this procedure to improve the gait of postpolio children with flail lower extremity, provided the hindfoot is stabilized.

Giant cell tumor of the metatarsal: a case report and review of the literature

Abstract Most of the literature supports a radical approach to the surgical treatment of giant cell tumor of the metatarsal, i.e. en bloc excision and bone grafting. We are reporting a Campanacci grade III giant cell tumor of the second metatarsal treated successfully with a more conservative surgical approach (curettage and bone grafting).

Therapy for Ewing's Sarcoma: King Faisal Specialist Hospital and Research Centre Experience

ABSTRACT Forty-one patients with histologically confirmed diagnosis of Ewing’s sarcoma were treated between the years 1976 and 1983. Thirty patients without metastasis at diagnosis were treated wit...