Treatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its superiority. The aim of treatment is to obtain long-term bone union, to prevent refracture, and to correct angular deformities and leg length discrepancies. This study retrospectively evaluates the outcome of different reconstructive strategies. Sixty-nine patients were identified who presented to our outpatient department between 1997 and 2019. Twenty-six of these patients underwent reconstructive surgical treatment and were included in this study. The study cohort was divided into three groups. Excision of the pseudarthrosis was performed in all patients in Group A and B, and in two patients of Group C. Group A (six/26 patients) received subsequent bone transport through external fixation maintaining original length. In Group B (15/26 patients), patients underwent either previous, simultaneous, or subsequent extrafocal lengthening through external fixation to reconstitute length. In Group C (five/26 patients), internal fixation with intramedullary nails was applied. Radiological and clinical evaluation was performed to assess bone union and complication rates. Results varied considerably between the study groups. Overall, the primary bone fusion rate was 69.2%. There were four refractures, all occurring in Group B. The long-term bone union rate without refracture was 53.8%. The overall complication rate was 53.8% and 23.1% showed persistent pseudarthrosis. Two secondary amputations were performed due to failed bone fusion. In conclusion, excision of the pseudarthrosis and extrafocal lengthening achieves a satisfying bone union rate and limb reconstruction, while bone transport does not offer significant advantages but shows higher complication rates. Intramedullary stabilization should be applied to maintain bone union, but shows lower bone union rates when used as a stand-alone treatment regimen. Regardless of the primary bone fusion rates, the probability of long-term bone union remains unpredictable.

Background: In the treatment of tall stature, the reduction of excessive predicted final height can either be achieved by hormonal treatment or surgically by temporary (tED) or permanent (pED) epiphysiodesis. The present study evaluates the preliminary results of two novel devices for tED and pED around the knee to reduce the predicted final height. Materials and methods: A retrospective analysis was performed to evaluate the clinical and radiographic outcome after bilateral epiphysiodesis for the treatment of tall stature. A cohort of 34 patients (16 girls, 18 boys) who underwent either tED or pED between 2015 and 2020 were eligible for analysis based on the electronic patient records and picture archiving and communication system of our orthopaedic teaching hospital. tED was conducted in 11 patients (32%) through bilateral implantation of four RigidTacks™ (Merete, Berlin, Germany) around the knee. Twenty-three patients (68%) received pED, performed with an EpiStop™ trephine (Eberle, Wurmberg, Germany). The mean overall follow-up time was 2.9 years. Results: The mean age at surgery was 12.3 years in girls and 13.2 years in boys. Patients had a mean body height of 175.2 cm in girls and 184.7 cm in boys at surgery. The mean predicted final height was 191.4 cm in girls and 210.4 cm in boys. At the last follow-up, 26 patients (76.5%) had achieved skeletal maturity. The mean height of skeletally mature patients was 187.2 cm in girls and 198.5 cm in boys. A mean reduction of the predicted final height of 5.9 cm in girls and 8.7 cm in boys was achieved, corresponding to a reduction in remaining growth of 46% in girls and 38% in boys. Secondary frontal plane deformities of the knee were detected in 5/11 patients (45.5%) in the tED group and 1/23 treatments (4.3%) in the pED group. Conclusions: tED and pED have both proven to be efficient at achieving growth inhibition to reduce excessive predicted height. However, tED has been associated with an increased risk of secondary angular deformities of the knee. Furthermore, the risk of implant-related complications and the necessity of a subsequent surgical intervention for implant removal have led our study group to abandon tED when treating tall stature. Long-term results of both procedures are pending. Level of evidence: 4.

Reconstructing the proximal humerus after tumor removal is challenging due to muscle and bone loss. The current methods often result in poor shoulder function. This study assessed the long-term functional and oncological outcomes of using an inverse proximal humerus prosthesis in 46 patients with bone tumors. The results showed a mean range of motion of 62° in anteversion, 28° in retroversion, and 55° in abduction. Notably, 23 patients achieved over 90° of shoulder abduction, with an average of 140°. The median Musculoskeletal Tumor Society Score was 25. Complications included infection in two radiotherapy patients and single dislocations in seven patients. One patient with recurrent dislocations needed revision surgery. In conclusion, the use of the inverse proximal humerus prosthesis in bone tumor treatment yields excellent shoulder function and high patient satisfaction. This approach is especially beneficial for those with metastatic disease.

Intramedullary limb lengthening via lengthening nails has been performed for more than three decades to overcome leg length inequalities. Plate-assisted bone segment transport (PABST) has recently been described for the reconstruction of segmental bone defects. We modified this procedure by using the ipsilateral fibula as a “biological plate” and report on its technical particularities and application in the reconstructive treatment of adamantinomas of the tibia in two patients. Both patients were successfully treated by wide resection and reconstruction of the tibial bone via bone segment transport through an expandable intramedullary nail using the remaining ipsilateral fibula to provide stabilization and guidance. This procedure was titled “fibula-assisted segment transport” (FAST). This is a new and promising technique that allows an entirely biological reconstruction of large bone defects of the tibia.

Background/Objectives: The World Health Organization’s (WHO) classification of tumors contains around 80 entities of soft tissue sarcomas (STSs). Currently, surgery is the standard treatment for patients with localized STS, but the adequacy of resection margins in soft tissue sarcomas (STSs) remains a topic of intense discussion. Methods: This single-center study retrospectively reviewed 203 patients with primary high-grade soft tissue sarcoma, including a follow-up period of at least 24 months. Patients with prior resection, secondary STS, metastasis at presentation, or those who required amputational surgery were excluded from the study. Patients were categorized based on their margin thickness: positive (n = 13, 6.4%), 0–1 mm (n = 67, 33.0%), 1–5 mm (n = 70, 34.5%), and >5 mm (n = 27, 13.3%). Results: A total of 64 out of 203 (31.5%) patients developed a local recurrence. The estimated 5-year local-recurrence-free survival (LRFS) was 11.5% (CI 4–25%) for positive margins, 58% (CI 51–64%) for margins 0–1 mm, 76% (CI 70–81%) for margins > 1–5 mm, and 93% (CI 88–98%) for margins > 5 mm. No local recurrences occurred in patients with margins > 5 mm and adjuvant radiotherapy. Margin status significantly influenced the development of distant metastasis and overall survival. Adjuvant radiotherapy improved both local control and overall survival. Conclusions: To minimize the risk of local recurrence (LR), a resection margin greater than 5 mm should be attained. When adjuvant radiotherapy is applied, the likelihood of LR decreases even more. In scenarios where preserving critical structures is essential, a resection margin of less than 5 mm can be acceptable for ensuring local control.

(1) Background: Megaprosthetic reconstruction of the knee is frequently required in limb salvage surgery for oncologic indications and in complex revision arthroplasty. The Modular Universal Tumor and Revision System (MUTARS) Total Knee prosthesis is widely used in these situations. The aim of this study was to evaluate revision-free implant survival following MUTARS Total Knee implantation and to compare outcomes between primary implantation and use as a conversion procedure after failure of a previous knee prosthesis. (2) Methods: A retrospective cohort study was performed including 36 patients who underwent MUTARS Total Knee implantation at a single institution. Patients were stratified into primary implantation (n = 24) and conversion after failed prosthesis (n = 12). The primary endpoint was time to first revision. (3) Results: Overall revision-free survival was 51.6% at 2 years and 29.3% at 5 years. No significant difference in revision-free survival was observed between primary implantation and conversion procedures (log-rank p = 0.67). When mechanical failure (Henderson type III) was considered as the sole endpoint, implant survival was substantially higher, with 88.3% survival at 2 years and 57.2% at 5 years. Infection-related implant survival was 72.0% at both 2 and 5 years. Secondary amputation was required in 7 of 36 patients (19.4%), with a higher proportion observed in the primary implantation group (25.0% vs. 8.3%). Most amputations occurred within the early postoperative period. (4) Conclusions: MUTARS Total Knee implantation is associated with a substantial revision burden; however, conversion after failed prosthesis did not result in inferior revision-free survival compared with primary implantation. Endpoint-specific analyses demonstrate that biological complications, particularly infection, represent the dominant drivers of early failure.