Eleni Karagergou

Introduction: Giant cell tumor of bone (GCTB), a benign but locally aggressive tumor, may rarely undergo malignant transformation and metastasize. Although local recurrence following surgical excision with intralesional curettage is fairly common and it usually occurs within the first 3–5 years post-operatively, a low-frequency occurrence has been observed after en block resections. Case Report: A case of persistently recurrent GCTB of distal ulnar head is reported. The patient, who had undergone a Darrach procedure for excision of the tumor 40 years ago, presented with a recurrent mass at the same location. Shortly after excision of the lesion, she developed a new recurrence, which was not controlled with the monoclonal antibody denosumab, and required re-excision due to signs of ulnar nerve palsy. Conclusion: The activation of a dormant GCTB, after 40 years of silence, illustrates the need for a long-term follow-up after surgery, even when no clear evidence of tumor relapse is clinically apparent. Considering the aggressive nature of the recurrent GCTB and its potential for malignant transformation and metastasis, our case is emphasizing the importance for frequent follow-up and lifelong surveillance. Keywords: Giant cell tumor of bone, wrist, local recurrence, bone neoplasms, neoplasm metastasis.

Facial penetrating injuries can cause retention of foreign bodies in the frontal sinus. This rare condition can remain underdiagnosed for years, since non-specific symptoms, such as headaches and nasal obstruction, can be developed. So far, removal by an endoscopic approach is the most preferred treatment option because it is less invasive with a short recovery time. However, removal by an open surgical approach remains the method of choice for large foreign bodies, especially in cases of coexistent non-reducible fractures of the anterior table of the frontal bone. We present a case where a combined approach - open and endoscopic - was necessary to successfully remove a retained foreign body from a frontal sinus. With the assistance of a transnasal endoscope, the retained stone was mobilized and removed from the open frontal sinus followed by osteosynthesis of the anterior table. Therefore, in special circumstances, a combination of both techniques should be considered for the optimal outcome.

Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. For this reason, a review of the literature was performed by a thorough search of eight terms using the Pubmed database. In total, seven human studies met the selection criteria, including case-control studies, case-series and one case report. In all studies, intra-articular injection of autologous fat in osteoarthritic thumb CMCJ provided reduction in pain and improvement in hand function. Grip and pinch strength showed variable results, from no change to significant improvement. Fat-processing techniques were based on centrifugation and mechanical homogenization but biological characterization of the injected cells was not performed in any study. Although the results are encouraging, a uniformly standardized method of fat processing and the conduction of randomized controlled trials in the future could better evaluate the effectiveness of this procedure for thumb CMCJ osteoarthritis.

The supracondylar process is a beak-shaped bone spur arising from the anteromedial area of the distal humerus and in the majority of cases, it is connected to the medial epicondyle with a band of connective tissue which is known as ligament of Struthers. The complex of bone spur and ligament creates a ring that may compress the median nerve causing soreness and paresthesia of the hand and fingers. We present a rare case of bilateral supracondylar process compressing the neurovascular bundles in both arms and causing simultaneous bilateral upper limb pain, numbness, and weakness in an otherwise healthy young child. Surgical excision of the bone spurs and release of Struthers' ligaments provided immediate pain relief and complete resolution of symptoms. Three years after the index surgery, no limitations of activities or signs of recurrence were reported. Median nerve compression neuropathy in a child or a young adult should always raise the suspicion of the presence of supracondylar process particularly when bilateral symptoms exist. Although there are limited data about the incidence of recurrence and the extent of bone resection, the supracondylar process should be excised together with the overlying periosteum to minimize the theoretical risk of local regrowth.