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Open Journal of Orthopedics 2020年第7期10卷 143-151页

作者： G. Ulrich Exner Pascal A. Schai Orthopaedie Zentrum Zuerich Zuerich Switzerland luzerner kantonsspital wolhusen Wolhusen Switzerland

Background: Simple Unicameral and Aneurysmal Bone Cysts are benign lesions that may heal spontaneously especially after fracture which may be the first symptom. However, often size increases causing pain, and complications of fractures can severely compromise the patient. Aim: The results in a series of cases treated minimally invasive using a new device for the application of allogenic bone material appear highly promising and shall be presented. Patients and Methods: Eight consecutive patients with symptomatic Unicameral Bone Cysts (UBC) were treated by percutaneous instillation of Grafton? DBF Putty (demineralised allogenic bone containing fibers) mixed with autologous bone marrow using the Kyphon? Cement Delivery System (Medtronic), which allows the injection of this high viscosity paste by controlled high pressure. Five patients with Aneurysmal Bone Cysts (ABC) were treated accordingly after inactivation by Aethoxysclerol 3% and lacking bone formation. Using this approach a high rate of bone regeneration was observed in these patients at 8 months to 5 years follow-up (f/u). Conclusion: The presented technique of a minimally invasive biologic treatment led to highly satisfying results using the Grafton? DBF Putty with its higher potential for bone regeneration than demineralized bone matrix not containing fibres (DBM).

关键词： Simple Unicameral Bone Cyst Aneurysmal Bone Cyst DBF Putty Kyphon Cement Delivering System Bone Marrow Percutaneous Treatment

Osteofibrous Dysplasia-Like Adamantinoma of the Tibia Diagnosed at Age 6 Years Progressing into a Classic Adamantinoma over 39 Years, Reconstruction Performed by a Modified Capanna Technique: A Case Report

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Open Journal of Orthopedics 2022年第7期12卷 335-344页

作者： G. Ulrich Exner Pascal A. Schai Tobias C. Bühler Michael O. Kurrer Natasha Forster Orthopaedie Zentrum Zurich Seestrasse Zurich Switzerland luzerner kantonsspital wolhusen spitalstrasse Wolhusen Switzerland Kantonspital Baden Im Ergel Baden Switzerland Pathologikum Zurich Switzerland Zurich Switzerland Swissparc AG Zurich Switzerland

Background: It is generally accepted that there is a spectrum ranging from Osteofibrous Dysplasia (OFD) to Osteofibrous dysplasia-like Adamantinoma (OFD-AD) to “classic” Adamantinoma (AD). However, it is controversial whether OFD may progress into OFD-AD and AD or these pathologic changes reflect sampling issues. We herein report the fifth case of late development of AD from OFD-AD to underline the importance of long-term follow-up. Case: At 6 years bone biopsy of the tibia revealed the diagnosis of OFD-AD, confirmed by repeat biopsies until the age of 18 years. At age 45 years a progressive focal osteolysis was biopsied and showed histologically a classic AD. The affected tibial diaphysis was resected and pasteurized. Reconstruction was performed adapting the “Capanna technique” of inserting the ipsilateral mobilized fibula into the replanted autologous, pasteurized tibial segment as biologic stabilizer. At 1.5 years follow-up, the reconstruction has healed allowing full weight bearing.

关键词： Osteofibrous Dysplasia-Like Adamantinoma Tibia Classic Adamantinoma Capanna Technique Pasteurized Autograft

Intraarticular Nodular Fasciitis in the Knee Joint with <i>USP6</i>-Gene Rearrangement<br/>—A Case Report with Special Attention to Diagnostics of Intraarticular Lesions

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Open Journal of Orthopedics 2020年第6期10卷 124-136页

作者： G. Ulrich Exner Beata Bode-Lesniewska Pascal A. Schai Orthopaedie Zentrum Zuerich Zuerich Switzerland Pathologie Institut Enge Zuerich Switzerland luzerner kantonsspital wolhusen Wolhusen Switzerland

Background: Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossificans. The presented case is of interest as this is a rare site of presentation of NF;so far only few single cases of intraarticular NF have been reported with documented USP6-gene rearrangement. Intraarticular neoplasias of the knee joint are rare;the most frequent being tenosynovial giant cell tumor (TSGCT). Given a nationwide annual incidence rate of 14 for the lower extremity and about 75% affecting the knee joint about 10 new cases involving the knee joint can be expected per 1 million persons/year. All other types of benign neoplasms are comparably rare while malignant intraarticular processes are extremely rare with most of them reported as single case studies. Aim: We report our case to emphasize the importance of preoperative diagnostics including the option of biopsy. Intraarticular malignant processes are extremely rare and frequently are operated on accidently with negative consequences for the patient. Tactics and techniques to treat benign processes depend on the correct pathologic diagnosis. Case presentation: The 38 year old man noticed slowly increasing swelling of his left knee joint after wakeboarding. Because of continuing discomfort 2 months later MRI diagnostic revealed, apart from retropatellar cartilage lesions, a popliteal mass compatible with a Baker cyst. The lesion of interest (later diagnosed as NF) was neither recognized by the radiologist nor the treating clinician. During the following 8 months the patient felt increasing swelling of the knee joint. The repeat MRI documented the crescent intraarticular solid synovial mass in the medial patellofemoral recess without signs of hemosiderin impregnation. A percutaneous sonographically guided 16G needle biopsy was performed. Histologically, bland myofibrobl

关键词： Nodular Fasciitis Knee Arthroscopy Intra-Articular Lesions

Osteosarcoma of the Humerus Developing as Second Malignancy in the Irradiation Field Outside the Primary Tumor: 11 Years after Ewing Sarcoma of the Scapula and 29 Years after Breast Cancer

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Open Journal of Orthopedics 2023年第9期13卷 370-378页

作者： Pascal A. Schai Elmar Fritsche Michael Brück Anja Schmitt G. Ulrich Exner luzerner kantonsspital wolhusen Wolhusen Switzerland luzerner kantonsspital Luzern Luzern Switzerland Implantcast Suisse SA Basel Switzerland Pathologikum Gemeinschaftspraxis für Pathologie Zuerich Switzerland Orthopaedie Zentrum Zuerich Klinik Hirslanden Zuerich Switzerland

Purpose: Development of sarcoma is a known late rare negative side effect of radiotherapy. We add two cases to emphasize the need for open-end follow-up and critical evaluation to avoid misinterpretation. Patients, Methods, and Results: Two patients developed osteosarcoma as a second malignancy in the humerus after adjuvant radiotherapy of a primary tumor not directly involving the later affected bone. The first patient had a Ewing sarcoma of the scapula at age 13 years. Though after neoadjuvant chemotherapy the resected specimen showed only fibrotic necrotic areas within clear resection margins, the study group indicated adjuvant radiotherapy in a field including the shoulder joint. At age 24 years she developed an osteosarcoma of the humeral head, which was resected and reconstructed with a proximal humerus endoprosthesis. She is alive without disease at age 32 years. The second patient presented with an osteosarcoma of the proximal humerus 29 years after irradiation for breast cancer including the shoulder joint. The sarcoma was misinterpreted as radiation-induced necrosis and the patient was treated with a reverse shoulder endoprosthesis. Pathologic examination of the resected humeral head then showed a typical osteosarcoma. Two years later the humeral reverse shoulder implant was resected and a proximal humerus tumor prosthesis implanted leaving the original glenosphere. Conclusions: In both cases radiation-induced osteosarcoma developed in bone not affected by the primary cancer. Protecting uninvolved structures must be warranted in the planning of radiotherapy. The long latency between the primary and second cancer mandates long-term—best indefinite—follow-up, as with appropriate treatment of a radiation-induced osteosarcoma good healing rates comparable to those of primary osteosarcoma can still be achieved.

关键词： Radiation-Induced Osteosarcoma Ewing Sarcoma Breast Cancer Humerus

Osteotomy of the Margo Medialis Scapulae to Approach Subscapular and Subrhomboid Tumors. A Technical Note

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Open Journal of Orthopedics 2022年第8期12卷 351-356页

作者： G. Ulrich Exner Jan Leuzinger Christoph Sternberg Alexander Metzdorf Pascal A. Schai Orthopaedie Zentrum Zuerich Zuerich Switzerland Etzelclinic Pfaeffikon Switzerland Clinica Luganese Moncucco Lugano Switzerland luzerner kantonsspital wolhusen Wolhusen Switzerland

Purpose: The approach to resect subscapular and subrhomboid tumors needs elevation of the scapula. This is usually performed by detaching the muscles from the margo medialis of the scapula. We wish to communicate our technique of a longitudinal osteotomy of the margo medialis for improved refixation of the muscles. Patients and Methods: 5 patients with subscapular and one patient with a subrhomboid benign tumor were operated on using this technique. Results: All patients achieved stable healing and full functional recovery;only in one patient there was slightly reduced elevation of the arm. Conclusion: Elevation of the muscles inserting into the medial scapular margo with a small rim of bone facilitates refixation and allows for excellent restitution of function.

关键词： Subscapular/Subrhomboid Tumors Surgical Access Osteotomy of Margo Medialis Scapulae

Salvage of Failed Osteoarticular Tibia Allografts with Knee Arthroplasties

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Open Journal of Orthopedics 2020年第4期10卷 67-76页

作者： G. Ulrich Exner Pascal A. Schai Tobias C. Bühler Theodore I. Malinin Orthopaedie Zentrum Zuerich Zuerich Switzerland luzerner kantonsspital wolhusen Wolhusen Switzerland kantonsspital Baden AG Baden Switzerland Department of Orthopaedics University of Miami Miller School of Medicine Miami USA

Background: Limb preservation in musculoskeletal tumor surgery has largely replaced amputation. Biologic reconstructions are now performed as preferred choice;if not feasible options are “megaprostheses”, allografts or composites. Endoprosthetic reconstructions usually provide immediate function, but fail at long term. Osteochondral allografts allow for one-to-one restoration and have potential for incorporation;however degeneration of the cartilage requiring revision almost inevitably will occur. In most cases, revision is then done by endoprosthetic replacement. Aim: In our patients, resurfacing of retained allografts failed. Problems encountered are presented and solutions proposed. Case Presentation: Resurfacing over retained allografts in the 2 index cases has resulted in failures related to fractures and instability. Revision with massive constrained endoprostheses was needed. Based on the experience with these failures, primary endoprosthetic replacement anchored in vital bone in a following case resulted in stable function. Conclusion: Knee replacement for advanced degeneration of the osteochondral allograft apparently needs choosing increased femoro-tibial constraint systems and stem extensions anchored to vital host bone.

关键词： Tumor Allograft Arthroplasty

Enchondromas of Long Bones and Other Skeletal Lesions Found Incidentally Need Critical Evaluation, But Rarely Systematic Follow-Up

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Open Journal of Orthopedics 2022年第2期12卷 66-78页

作者： G. Ulrich Exner Pascal A. Schai Nadja Mamisch-Saupe Michael O. Kurrer Orthopaedie Zentrum Zuerich Zuerich Switzerland luzerner kantonsspital wolhusen Wolhusen Switzerland Radiologie Klinik Hirslanden Klinik Hirslanden Witellikerstr Zuerich Pathologikum Gemeinschaftspraxis für Pathologie Seefeldstr Zuerich

Purpose: Incidental bone lesions are a challenge for the specialist, who has to give recommendations for further management. This review of our cases will assist in the decision whether the lesion can be “neglected”, needs further active follow-up or direct initiation of treatment. Patients and Methods: 153 cases of incidental bone findings were presented to our musculoskeletal tumor service for evaluation from July 2008 through June 2021. 73 of them were cartilaginous tumors and 63 of these were diagnosed as enchondroma of a long bone based on X-Ray and MRI. Results: Follow-up imaging of the enchondroma patients was available for 35 patients at 1 to 13 years (mean 4.3 y), with no change in size except for one femoral diaphyseal enchondroma with increasing diameter from age 18 to 20 years. 14 additional patients answered written contact stating that they remained asymptomatic at 2 to 12 years (mean 5.6 y). None of the patients has been reported to the Swiss Confoederation Cancer Registry to have developed malignancy. Among the 10 other cartilaginous tumors were one chondrosarcoma grade II exhibiting different imaging, 3 non-long-bone localizations (pelvis, scapula and rib), 2 Ollier-type enchondromas, and 2 osteochondromas. Incidental findings other than cartilaginous tumors were fibrous dysplasia (n = 31), non-ossifying fibroma (n = 31) and 18 other “sporadic” entities. Conclusions: Incidentally found enchondromas not exhibiting aggressive features need no systematic follow-up and patients can be “discharged” with the advice to present, if symptoms would develop. This also applies to fibrous dysplasia and the other sporadic lesions. 6 cases with other diagnoses needed specific treatment.

关键词： Incidental Bone Lesions Enchondroma Fibrous Dysplasia Non-Ossifying Fibroma

Perforator propeller flaps in lower limb reconstruction: a literature review and case reports

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Plastic and Aesthetic Research 2019年第11期6卷 41-50页

作者： Mario F.Scaglioni Aljosa Macek Department of Hand-and Plastic surgery Luzerner KantonsspitalLucerne 6000Switzerland Department of Surgery Spital ManedorfManedorf 8708Switzerland

Perforator-pedicled propeller flaps, which base their blood supply on isolated perforators, have been gaining popularityamong plastic surgeons over the past two decades. They have proven to be of great value in the reconstruction of soft tissue defects in different areas of the body but are, thanks to their maximal mobility, mostly used in the reconstruction of extremities. In this article, we focus on perforator-pedicled propeller flaps in lower limb reconstruction, where they can be implemented in the coverage of primary as well as secondary soft tissue defects. Firstly, a brief literature review on evolution of propeller flap use in lower extremity is provided. Moreover, we present our surgical technique including the use of indocyanine green real-time angiography for reliable flap transfer. In addition, we report 3 cases of patients in whom we used a local propeller flap for the closure of skin defects in different parts of the leg.

关键词： Propeller flap perforator flap local flap lower limb reconstruction microsurgery

Acoustic cardiography to improve detection of coronary artery disease with stress testing

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World Journal of Cardiology 2010年第5期2卷 118-124页

作者： Michel Zuber Paul Erne Division of Cardiology Luzerner KantonsspitalLucerneKantonsspitalCH-6000 Luzern 16Switzerland

AIM:To assess if performance of 12-lead exercise tolerance testing(ETT) can be improved by simultaneous acoustic cardiography and to compare the diagnostic performances of electrocardiography(ECG) during ETT and acoustic cardiography for detection or exclusion of angiographically proven coronary artery disease(CAD).METHODS:We conducted an explorative study with retrospective data analysis using a convenience sample of consecutive patients(n = 59,mean age:62 years) from an outpatient clinic in Switzerland,who were referred for ETT by their general practitioner on suspicion of CAD,and in whom,coronary angiography was carried *** included sensitivity,specificity,likelihood ratios and receiver operating characteristic curves.A standard,symptom-limited,12-lead ECG exercise tolerance test was performed by independent persons with simultaneous acoustic cardiography and subsequent cardiac angiography for determination of significant ***:Thirty-four of the 59 adult subjects(58%) had a final diagnosis of CAD by angiography,and in 25 subjects,CAD was excluded by ***/specificity of ST segment depression in the group was 29%/92%,whereas the most powerful acoustic cardiographic parameter was the strength of the fourth heart sound(S4),with corresponding sensitivity/specificity of 53%/92%.The disjunctive combination of the S4 and ST depression had sensitivity/specificity of 68%/84%.CONCLUSION:In this preliminary pilot study,the use of acoustic cardiography alone during ETT or disjunctively with ST depression has been shown to be a simple and convenient method for the detection of CAD,which was superior to ST depression on the standardized ECG.

关键词： Heart sounds Electrocardiography Stress testing Coronary artery disease Acoustic cardiography

Continuous respiratory monitoring for sleep apnea screening by ambulatory hemodynamic monitor

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World Journal of Cardiology 2012年第4期4卷 121-127页

作者： Roger Dillier Markus Baumann Mabelle Young Susanne Erne Bernhard Schwizer Michel Zuber Paul Erne Division of Cardiology Luzerner Kantonsspital6000 Lucerne 16Switzerland Division of Pneumology Center of Sleep DisordersLuzerner Kantonsspital6000 Lucerne 16Switzerland

AIM:To validate the sleep-disordered breathing components of a portable electrocardiography and hemodynamic monitor to be used for sleep apnea ***:Sleep-disordered breathing(SDB) is associated with cardiovascular *** with existing cardiovascular disease may have unrecognized SDB or may develop SDB while under the care of a cardiologist.A screening device for SDB,easy to use and appealing to cardiologists,would assist in referral of appropriate patients for full polysomnography(PSG).A cardiac and respiratory monitor(CPAM) was attached to patients undergoing PSG and an apnea/hypopnea index(AHI) *** CPAM device produced respiration rate,snoring rate,individual apnea/hypopnea events and an SDB severity score(SDBSS).In addition to AHI,an expert over-reader annotated individual breaths,snores and SDB breathing events to which the automated algorithms were ***:The test set consisted of data from 85 patients(age:50.5 ± 12.4 years).Of these,57 had a positive PSG defined as AHI ≥ 5.0(mean:30.0 ± 29.8,negative group mean:1.5 ± 1.2).The sensitivity and specificity of the SDBSS compared to AHI was 57.9% and 89.3%,*** correlation of snoring rate by CPAM compared to the expert overreader was r = 0.58(mean error:1.52 snores/min),while the automated respiration rate had a correlation of r = 0.90(mean error:0.70 breaths/min).CONCLUSION:This performance assessment shows that CPAM can be a useful portable monitor for screening and follow-up of subjects for SDB.

关键词： Portable monitor Sleep-disordered breathing Polysomnography Sleep apnea Hemodynamic monitor