Faculty Bibliography

INTRODUCTION/BACKGROUND:Giant cell tumor of bone (GCTB) is a benign-aggressive tumor that has a high-rate of recurrence with curettage resection alone. Patients with GCTB in underserved regions of the world can have progression of the tumor with significant disability due to a lack of specialty care. We present a case of an en bloc resection of an aggressive, recurrent GCTB of the radius with excellent function and no evidence of tumor recurrence two years after surgery. PRESENTATION OF CASE/METHODS:A 22-year-old right-hand dominant female in Haiti developed an aggressive recurrence of a giant cell tumor of bone (GCTB) of the distal radius. Treatment consisted of en bloc resection of the distal radius with the proximal row of the carpus and centralization of the ulna. At two-year follow-up, the patient maintained good functional capacity with no clinical or radiological evidence of recurrence. DISCUSSION/CONCLUSIONS:GCTB can cause significant destruction of the bone and articular surface if not treated adequately. Treatment options should be considered carefully in underserved regions of the world based on the resources available. This case exemplifies that complex limb-salvage surgery is possible when coordination of care between international and local surgeons is provided with an emphasis on continuity of care post-operatively. CONCLUSION/CONCLUSIONS:En bloc resection with centralization of the ulna remains a viable technique to address aggressive GCTB of the distal radius and can be appropriate in resource-limited settings.

Program/Project Purpose: Although seldom a life-threatening disease in developed countries, osteomyelitis poses a serious threat to life and limb in areas with inadequate resources to provide proper healthcare. Haiti is a country in which very little data exists regarding the prevalence and morbidity associated with osteomyelitis, though anecdotal evidence suggests the burden of the disease is severe. Reports indicate many chronic osteomyelitis patients require prolonged inpatient treatment due to a lack of available treatment resources and may take up a hospital bed for weeks or months at a time. Orthopaedic Relief Services International (ORSI) has provided infrastructural support to Hopital de l'Universite d'Etat d'Haiti (HUEH) to assist in establishing an osteomyelitis clinic staffed by local orthopaedic surgery residents over the past 2 years. Structure/Method/Design: An osteomyelitis clinic adjunct to HUEH was established in an available facility space and stocked with preliminary supplies including antibiotics, debridement tools, and wound dressings. Two orthopaedic surgery residents and one attending physician from HUEH staff the clinic. The clinic is open once a week and receives referrals from the HUEH main hospital both pre- and post-surgically. An attempt to maintain a registry of incoming patients for follow up has been implemented. Currently, a framework for data collection utilizing the support of academic medical centers and involvement of medical students in Haiti and the U.S. for infrastructural support is being designed. Outcomes & Evaluation: To date, approximately 100 patients have been treated in the Osteomyelitis clinic over the past two years. An estimated 10 patients are referred to and treated in the clinic with an average of 2 patients undergoing a surgical procedure related to their condition per week. Difficulties documenting patient follow up have prohibited more robust evaluation of clinical outcomes. The disproportionate disease burden on impoverished patients has presented serious challenges with regards to acquiring antibiotics and treatment supplies and has threatened the financial stability of the clinic. Going Forward: Establishing a formalized, reliable method for data collection and patient follow-up is paramount. ORSI intends to implement a three phase plan moving forward: 1) An epidemiological and cost-analysis study in tandem with relief services 2) implementation