Histological specimens were re-examined by a consultant musculoskeletal oncology pathologist. Radiographs were re-reported by a consultant musculoskeletal radiologist.
All patients presented with localised swelling. Pain was present in 5 and trauma in 2. 9 lesions affected the hand, 3 the foot, and 1 the tibial tuberosity. 12 lesions were excised and 1 curetted. There were 7 recurrences of which 6 were excised. 1 patients’ recurrence was not treated. 1 lesion recurred a second time. This was excised. There were no metastases. Radiographs typically showed densely mineralised lesions contiguous with an uninvolved cortex. Cortical breakthrough was present in 1 case and scalloping in another. Histology characteristically showed: hypercellular cartilage with pleomorphism and alcification/ossification without atypia; bone undergoing maturation; and a spindle-cell stroma.
Minor antecedent trauma was present in only 2 cases. In agreement with Nora et al. we feel that trauma is unlikely to represent an aetiological factor. Recurrence was over 50% in this series. Although this is similar to that found in other reports, it may indicate that more extensive resection is required for this aggressive lesion. Finally, although radiological/histological findings are often bizarre there have been no reported metastases and so it is important that BPOP is not mistaken for, or treated as, a malignant process such as chondrosarcoma.
In OA patients, satisfaction was highest, but function was poor. Patients with out cuff tear pre-operatively did not develop it later. They may thus benefit from a TSR compared to HHR. RA patients had the least pain, best function and high satisfaction. Most had evidence of either primary or secondary cuff dysfunction. In them patients HHR may be the preferred option. Trauma patients did poorly in all respects. More anatomical reconstruction and greater emphasis on salvage of the humeral head is required in this group.
Osteosarcoma – Age at presentation ranged from 4–14 Yrs (mean 10.3Yrs). 70 % involved 10–14 Yrs. Male: Female incidence was 1.5:1. 75% of lesions involved the proximal humerus.15 % presented with pathological fractures. The mean cumulative 5 year survival was 20%. Death was usually due to pulmonary metastasis.65% had pulmonary metastasis at a mean 6.3 mts after diagnosis. Mean survival in these patients was 14mts. Survival was superior with adjuvant chemotherapy and wide excision. Ewing’s Sarcomas- Age at presentation ranged from 7–14 (mean 11.2Yrs).71.4% involved 10–14Yrs. Male: Female was 1.6:1. 62.5% lesions involved the humerus and 25 % the radius and 12.5% the scapula. The mean cumulative 5 year survival was 37.5%.Death was due to pulmonary or skeletal metastasis (mean 21.5mts). All patients had radiotherapy and chemotherapy. Chondrosarcoma- A rare low-grade chondrosarcoma of the proximal humerus was encountered. Excision and grafting yielded good results.
Unicameral cysts- Age at presentation ranged from 3–14 yrs (mean 9.4).Male: Female incidence was 7.3:1. 92% involved the proximal humerus. 88 % presented with fracture. Recurrence rate after curettage was 20% at a mean of 10.8 mts. Aneurysmal cysts – Age at presentation ranged from 5–14 yrs (mean 9.3). 55% involved the proximal humerus, and 20% hand bones. 45% presented with fracture. Recurrance rate after curettage was 31.8% at a mean of 15.1mts. Chondromas- Age at presentation ranged from 3–14 yrs (mean 10.4).20 lesions were solitary and 11 multiple. Among solitary lesions, 16 were central (75% hand) and 4 parosteal. Osteochondromas- Age at presentation ranged from 1–14 yrs (mean 10.1).Male: female ratio was 2.75:1. 53.3% involved the proximal humerus. Osteoid Osteoma- Age at presentation ranged from 5–13 yrs (mean 10.14). Male: female ratio was 1:6. 42% involved the hand.
Despite the lack of long-term data, the relative absence of complications and the potential benefits justify its continued use. We believe the future is very promising for this procedure.
We have investigated the annual incidence of Perthes’ disease in Dumfries and Galloway (Southwest Scotland), in relation to the population density and socio-economic status. The incidence of Perthes’ disease in rural Scotland is comparable with that in urban areas (15.4 per 100 000). There was a direct association between the incidence of Perthes’ disease and deprivation scores, with the highest incidence in the most deprived areas. A higher incidence of Perthes’ disease was noted in areas with a lower population density compared with those with a higher density. We found no correlation between population density and deprivation scores for individual electoral wards within the region.