We report a method for removing the distal segment of a broken locked intramedullary nail secondary to nonunion of the femur following radiotherapy for fibromatosis. A Kirschner wire with one tip fashioned into a hook was used to remove the distal segment without opening with the nonunion site. Details of the procedure are described.

Giant cell tumours of bone are best treated by extended curettage and filling in of the defect with cement or bone graft. In more advanced stages, when there is extensive loss of cortical bone cover, containment of the filling material is not possible and resection and reconstruction is required. We report a case of a recurrent giant cell tumour of the distal tibia in a 21 year old female with extensive cortical bone loss in which polypropylene surgical mesh was used to contain the bone cement, thus avoidi
Orthopaedic

Osteosarcoma occurring in the humerus is often confined to the proximal part, in which case, reconstruction after excision is less daunting. When the tumour spreads down the medullary cavity distally, a total humeral replacement is often required. This is costly and beyond the means of the average patient in a developing country. An amputation is often the procedure of first resort. We report a 13 year old boy with osteosarcoma originating from the left proximal humerus, with involvement of the marrow reaching down to the distal diaphyseal metaphyseal junction, leaving only 6 cm of the distal humerus intact after wide resection. Reconstruction of the defect was done with a composite cement autoclaved autograft fixed to the remaining humerus with a plate. At 40 months of follow up, the patient is well with normal function of the elbow, wrist and hand. Salvaging the limb despite near total involvement of the humerus by high grade osteosarcoma is possible using material available in the average orthopaedic operating room.
Orthopaedic

Synovial sarcoma of the extremities is an uncommon type of soft tissue sarcoma occurring predominantly in young adults at the para articular regions. We present a series of 10 patients with an average age of 44 years and include a follow up of 39 months. Eight patients had a surgical procedure for a mistaken benign lesion. In contrast to other soft tissue sarcomas, the swellings were associated with pain and most were fixed to the underlying structures. Five patients had a local recurrence after many years, stressing the necessity for close and long term follow up in these patients.
Orthopaedic

We present an elderly patient with a squamous cell carcinoma over the subcutaneous aspect of the leg involving the tibia. En bloc resection of the tumour together with a 10 centimetre segment of the tibia was done. The resected bone was autoclaved, replaced in its original position and stabilized with bone cement and a locked nail. This allowed early ambulation with minimal cost.
Bone Neoplasms/*surgery ; Carcinoma, Squamous Cell/*surgery ; *Replantation ; Soft Tissue Neoplasms/*surgery ; *Sterilization ; Tibia/*surgery

Clear cell sarcoma of soft tissue is a rare type of soft tissue sarcoma. It is derived from melanoblast like cells located within subcutaneous tissue, tendon and aponeuroses. The tumour is also known as malignant melanoma of soft parts because it has similar morphology to malignant melanoma. Unlike malignant melanoma, however, it is not associated with a cutaneous lesion. We report here two cases of this tumour occurring in young adults.
Orthopaedic

Kimura disease is a chronic inflammatory disorder that is prevalent among Asians. It rarely affects the upper limbs or paediatric patients. We report a case of Kimura disease with first presentation as a soft tissue mass in the arm mimicking a soft tissue neoplasm with metastasis in a 12 year old Chinese boy.

This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR). Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.

Improvements in the overall treatment of patients with aggressive, large tumours involving the bone have made it possible to preserve and salvage limbs instead of amputating them. Each patient is unique in his clinical presentation and social circumstance. The different reconstructive options available allow us to choose the most appropriate method suited to the particular patient and with minimal delay, even when resources are limited. The patient and the relatives actively participate in the choice. The early experience of the different techniques for reconstructing these bone defects at our hospital are presented in this paper.
Bone Neoplasms/*surgery ; Reconstructive Surgical Procedures/*methods

Patients with extensive malignancies involving the femur often require total femoral replacement when their limbs can be salvaged. Reported series are small and involve heterogeneity of tumours. We present nine patients with osteosarcomas of the femur treated at our institution between 2003 and 2010 with a mean follow-up of 27 (6 to 56) months. Their ages ranged from 9 to 17 (mean 14 years). They had large volume tumours (mean 911 cm3 ) and presented late with a mean of 5.5 months from the onset of symptoms to definitive treatment. All patients underwent resection and total femur replacement. Six patients have died and two are alive with good function at the time of this report. One was lost to follow-up. These patients require a high level of treatment care and have a guarded prognosis
Osteosarcoma