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Abstract We report the case of a patient with chondrosarcoma involving the right pelvis and contralateral pubic area in a 45-year-old male who underwent an extensive internal hemipelvectomy without bony reconstruction. We demonstrate the technique of using polypropylene mesh graft for soft-tissue reconstruction. Follow-up at 7.5 years showed a good oncological and functional outcome.

Symptomatic slow‐acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium‐ to long‐term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once‐daily dose (1500 mg), which consistently delivers the plasma levels of around 10 μmol/L required to inhibit interleukin‐1‐induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non‐steroidal anti‐inflammatory drugs (NSAIDs), while non‐crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease‐modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long‐term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium‐term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA. [ABSTRACT FROM AUTHOR]

Deals with a study which assessed the prevalence, severity and characteristics of cumulative trauma disorders of the upper extremity amoong rubber tree plantation workers. Materials and methods; Diseases and conditions found in patients with chronic upper extremity pain; Results and discussion; Conclusion.

Presents a study which examined the clinical efficacy and complications of tramadol and paracetamol with codeine in patients who had brachial plexus injury. Characteristics of brachial plexus injury; Improvement in pain severity; Incidences of side-effects of both drugs.

Background: Lateral femoral cutaneous nerve (LFCN) usually passes along the inner surface of the iliac crest and medial 10 the anterior superior iliac spine (ASIS). Many orthopaedic procedures that are operated around ASIS may cause injuries to the nerve. Aim of Investigation: To find out normal variation of the nerve In relationship to the ASIS. Materials nod Methods: The study was carried out as a survey research in preserved 40 Thai cadavers. Dissection was performed on both sides. The ASIS was used us the referent point. The distribution of the serve was dissected from spinal foramens down to iliac crest, ASIS and at about 5 cm below the spine. Distances between the nerve and the iliac crest and MIS were measured. Results: Mean distance between iliac crest and the nerve is 4.52 cm. All nerves ran medial to the iliac crest and interiorly below the ASIS. In all specimens the nerve passed medial to the ASIS. Conclusions: Most of the specimens revealed classical nerve distribution while 2.5% had variation in the course of the nerve no that the nerve might he injured during surgical procedure around the anterior part of iliac crest. [ABSTRACT FROM AUTHOR]

Background: Bangkok Biomaterial Center is the only allogenic bone bank in Thailand, supplying the bones to all medical centers. From a report, a certain number of post-operative complications were found., Objective: To compare pre-protocol revision and post-protocol revision success rates and complications associated with the use of allogenic bone grafts relative to perioperative handling and care of allogenic bone., Material and Method: This retrospective comparative study was conducted at the Bangkok Biomaterial Center, Faculty of Medicine Siriraj Hospital, Mahidol University. All registration forms and surgical follow-up reports relating to the use allogenic bones procured from our bone bank between 2005 and 2015 were reviewed. New recommendations for the use of our allogenic bones were established in 2009. Results and complications after allogenic bone transplantation between 2005 and 2008 were compared with results and complications after transplantation to a new protocol between 2009 and 2015. Descriptive analysis and analysis of variance were used to evaluate the data., Results: Data of 825 patients who underwent deep frozen allogenic bone transplantation and 1,541 patients who underwent freeze-dried allogenic bone transplantation were retrospectively reviewed. Overall, the complication rate was reduced from 14.83% in the pre-protocol revision period to 5.15% in the period after the new recommendations for perioperative graft handling were established and implemented., Conclusion: New recommendations for the handling and care of allogenic bone during the perioperative period significantly reduced post-operative complications in patients who received transplantation with deep frozen allogenic bone. The infection rate in patients who received allogenic bone graft was very low.

Background: Osteoarticular allograft is now commonly used as a reconstructive biomaterial to replace bone defect following removal of aggressive bone tumors and for revision of failed arthroplasty. Good long-term clinical result of allograft replacement has been demonstrated. However, the rate of complications is high, including deep infection, allograft fracture, delayed union or non-union, and joint instability. Prevalence of allograft fracture ranges from 12-54 percent. Many studies recommend avoiding plate and screw fixation, or they advise the use of a modified screw fixation technique that minimizes the number of screws and changes screw alignment., Objective: The objective of this study was to compare the efficacy of the conventional technique with a new method of plate and screw fixation in osteochondral allograft following removal of aggressive bone tumors., Material and Method: From September 1988 to February 2015, 52 patients with primary aggressive benign or malignant bone tumor underwent massive bone allograft reconstruction. There were 25 males and 27 females with a mean age of 27-years. Giant cell tumor and osteosarcoma comprised most of the diagnoses. Thirty-five of the tumors were located around the knee. Average length of allograft was 12.9 cm. Twenty-nine patients were reconstructed using standard technique and 23 patients were fixed using only one dynamic compression plate with limited and 15-degree divergent-angle screw fixation at the allograft., Results: Mean follow-up time in the group treated by conventional fixation was 84.5 months. There were 13 fractures (44.8%) in the conventional fixation group, with a median time to graft fracture of 4.9 months. The 23 patients with new technique fixation were followed-up for a mean duration of 60.5 months. Six fractures (26.1%) occurred in this group, with a median time to graft fracture of 10.40 months. Differences between groups for incidence of allograft fracture and median time to fracture were not statistically significant (p = 0.163 and p = 0.244, respectively). Most patients with allograft fracture were treated surgically using autogenous bone grafting and revision of internal fixation., Conclusion: The new method of osteochondral allograft fixation using single plate, fewer screws, and divergent screw fixation yielded a lower fracture rate and a longer median time to fracture than the conventional method; however the differences between groups did not achieve statistical significance. The results of this preliminary study should be confirmed in a larger group of allografts over a longer follow-up period.

Objective: The study was carried out to evaluate safety and efficacy of once-a-week medication of Kasparalendronate for inhibiting high bone turnover rate., Material and Method: Forty-nine postmenopausal osteoporotic participants were included in the study. This investigation was carried out as an open study. The participants received the drug every weekfor 12 weeks. Pain, drugside effects and bone turnover markers were evaluated at the 6"' week and 12' week after the first visit., Results: None had significant complication and all could complete the trial. Thirteen participants, (26.3%), had minimal side ffects, which the trial drug could be administered until the end ofstudy. At the 12th week follow-up, 42/49 participants (85.7%) had normal serum Beta-crosslab and 45/49 participants (91.8%) had normal serum N-MID osteocalcin. None showed any decrease in serum P1NP All participants had slight reduction in serum alkaline phosphatase., Conclusion: The trial drug could inhibit high bone turnover in about 85% of post-menopausalparticipants within 12 weeks of drug administration and no severe side effect took place.

Background: Giant cell tumor of bone is a common benign aggressive bone tumor. Recurrent rate in the patients who have the tumor with soft tissue invasion is rather high. Use of strong chemicals such as phenol and liquid nitrogen to lessen the recurrent rate might not be used in this lesion., Objective: The experiment was carried out to discover apoptotic effects of thermoablation on giant cell tumor of bone to find out a possibility to use thermoablation in the clinic in the patients with extensive lesion., Material and Method: Tumor cell suspension was prepared from 4 patients who had definite diagnosis of giant cell tumor of bone. The tumor cells were subjected to thermoablation at 45, 47 and 50 degrees C for 10 to 30 minutes before were cultured at 37 degrees C for another 3 days. Osteoblasts and chondrocytes from the last 3 patients were collected,prepared and underwent thermoablation in the same fashion. Apoptosis of tumor cells, chondrocytes and osteoblasts were carried out by the use of flow cytometry., Results: Thermoablation at 47 degrees C for 30 minutes resulted in < 50% chondrocyte and osteoblast apoptosis and 70-90% tumor cells apoptosis of 3/4 patients. Thermoablation at 47 and 50 degrees C for 20 to 30 minutes has more negative effect on giant cell tumor of bone than chondrocytes and osteoblasts., Conclusion: Thermoablation might be a useful tool for local tumor control in the clinic.

Background: Antibiotic prophylaxis is used in all patient underwent total knee arthroplasty to prevent post operative infection which produced poor outcome. The suitable drug should be safe and good efficacy., Objective: To study safety and efficacy of fosfomicin and cefuroxime as antibiotic prophylaxis for total knee arthroplasty., Material and Method: The control trial was performed to find out efficacy and safety of fosfomycin as an antibiotic prophylaxis comparing to cefuroxime. There were 112 patients, 14 male and 98 female, with their ages ranged between 57 and 86 years. They were randomly divided into two groups, the fosfomycin group, 56 patients and the cefuroxime group, 56 patients. All patients underwent elective knee arthroplasty by the authors. The scheduled antibiotics were given perioperatively for 24 hours and all patients were followed-up for 6 months. Physical examination, skin temperature of the operated knee, radiograph and blood tests were carried out in the patients to monitor post operative infection, renal and liver disturbance., Results: One patient in the cefuroxime group had local wound infection which responded well to local treatment and administration of antibiotics. No patients had post operative infection at the 6 months follow-up. No patients had any complication and none had renal and liver function disturbance during the follow-up., Conclusion: Comparing to cefuroxime,fosfomycin is safe and effective for the use as antibiotic prophylaxis in knee arthroplasty.