< Back Tibial Osteotomies tibial-osteotomies Previous Next

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< Back Dr. Ali Erkan Yenigul Principles of Surgical Resection & Margins Tumour resection aims to achieve oncologic control while preserving function; margin status is critical for local recurrence risk. Historical Background Pre-1940s → Amputation was standard treatment. 1940s sonrası → Tumour resection 1970s → Chemotherapy + Radiotherapy + Limb-sparing surgery standard of care. Basic Principles Wide surgical margin = most important factor for local control. All imaging must be completed before surgery. Surgical planning should be based on imaging close to surgery date . Enneking’s Margin Classification Intralesional Curettage / piecemeal debulking / Macroscopic disease remains Marginal Shelling out via pseudocapsule- reactive zone / May leave satellite or skip lesions Wide En bloc with cuff of normal tissue / Adequate, but skip lesions possible Radical En bloc removal of whole compartment / No residual local disease Natural Barriers Bone: Cortical bone, articular cartilage Joint: Articular cartilage, capsule Soft tissue: Fascial septa, tendon origins/insertions Barrier effect : Fascia, tendon sheath, vascular sheath, cartilage act as protective margins Critical Points in Limb-Sparing Surgery Poor biopsy incision Major vascular involvement Motor nerve sacrifice Preoperative infection Expected poor motor function after resection ➡️ These complicate but do not always contraindicate limb-sparing surgery. Advanced Techniques Microsurgical reconstruction Tendon transfers, nerve/vessel grafts Flap coverage after large resections Role of Adjunctive Therapies Neoadjuvant chemotherapy/radiotherapy → may shrink tumour, improve margin status. Wide margins still required even after neoadjuvant treatment. Practical Margin Rules Bone tumours: ≥ 3 cm bone marrow margin on T1 MRI. Soft tissue tumours: Aim for ≥ 2 cm margin. References Enneking WF. Musculoskeletal Tumor Surgery. New York: Churchill Livingstone; 1983. Simon MA, Springfield DS. Surgery for Bone and Soft-Tissue Tumors. Philadelphia: Lippincott-Raven; 1998. Healey JH, Lane JM. Operative Techniques in Orthopaedic Surgical Oncology. Philadelphia: Lippincott Williams & Wilkins; 1996. (For the figures and the margin classification) Mankin HJ, Hornicek FJ. Diagnosis, classification, and management of soft tissue sarcomas. Cancer Control. 2005;12(1):5–21. O’Donnell RJ, Springfield DS, Motwani HK, et al. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am. 1994;76(12):1827–33. Previous Next

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< Back Charcot Arthropathy charcot-arthropathy Previous Next

About About OrthoRico OrthoRico is a non-commercial educational platform created by and for orthopaedic professionals. Our goal is simple: To empower orthopaedic surgeons, residents, and medical professionals with reliable, practical, and structured educational content. 🎯 What We Offer 📚 Structured Core Topics based on clinical relevance 🛠️ Step-by-step Surgical Guides illustrated with high-quality images 👨⚕️ Expert Contributions from dedicated doctors across various subspecialties 🔒 Free and secure access — only for verified medical professionals 🤝 Why OrthoRico? We believe in sharing knowledge without barriers. OrthoRico is not affiliated with any institution or commercial brand. There are no subscriptions, no paid courses — just high-quality, peer-reviewed orthopaedic knowledge. We’re building a collaborative space where education comes first, and doctors grow together. 👩⚕️ Join the Community If you are a medical doctor, specialist, or trainee and wish to contribute or access premium content, you are welcome to Join Us. Together, let’s shape the future of orthopaedic education.

< Back Alper DUNKI Biomaterials Biomaterials are synthetic substances, derived from organic or inorganic components, designed to interact with biological systems. Their properties are determined by their structure (elemental composition, atomic bonding, crystalline configuration) and their processing methods (casting, forging, extrusion, sintering, etc.). Classes of Biomaterials Metals: Strong, durable, conductive materials; may exist as single elements (Cu, Ag) or alloys (e.g., stainless steel). Ceramics: Hard, brittle, corrosion-resistant; typically metal oxides (Al₂O₃, ZrO₂). Polymers: Carbon-based chain structures, flexible, corrosion-resistant (polyethylene, PTFE, silicone, hydrogels). Composites: Mixtures of two or more distinct phases, engineered for specific properties (fiberglass, concrete). Natural biomaterials: Plant/animal-derived tissues, proteins, polysaccharides. Applications and Requirements in Orthopedics Used in fracture fixation, osteotomy, arthrodesis, wound closure, tissue replacement, and prostheses. They must be biocompatible, corrosion/degradation resistant, and possess adequate mechanical strength and wear resistance. Biocompatibility The ability of a material to elicit an appropriate biological response in vivo. Inert: Minimal tissue response (e.g., stainless steel). Bioactive/interactive: Promote favorable responses (e.g., porous titanium allowing bone ingrowth). Living: Contain cells and undergo remodeling. Reseeding constructs: Donor tissues re-implanted following culture. Biologically incompatible: Induce undesirable reactions. Corrosion and Degradation Resistance The physiological environment may induce corrosion. Types of corrosion: Pitting, crevice, fatigue, stress cracking, galvanic, and fretting. Polymer degradation: Depolymerization, oxidation, hydrolysis, additive leaching, cracking. Mechanical Properties Basic concepts: Compression/tension, shear, torsion; stress, strain, strength, toughness. Elastic modulus: Defines stiffness; yield point marks onset of plastic deformation. Material types: Brittle: Fail with minimal deformation (ceramics, glass). Ductile: Sustain significant deformation (steel, titanium alloys). Fatigue fracture: Failure due to repetitive loading; highly relevant in orthopedics. Anisotropy: Direction-dependent properties (bone, tendon). Viscoelastic behavior: Time-dependent deformation (creep, stress relaxation). Specific Biological and Medical Materials a. Bone: Composed of inorganic (calcium phosphate) and organic (type I collagen) phases. Both anisotropic and viscoelastic. Cortical bone density ~1.8 g/cm³; trabecular bone 0.1–1.0 g/cm³. With aging, both mass and elasticity decline. b. Tendon: Rich in type I collagen; transmits muscle forces to bone and redirects force. Anisotropic and viscoelastic. Failure often occurs at the bone- or muscle-tendon junction. c. Ligaments: Composed primarily of type I collagen; connect bone to bone. Insertional regions play a key role in mechanical strength. d. Metals: Crystalline structure with high conductivity; can form alloys. Stainless steel (316L): Low cost, ductile; nickel and chromium may cause allergic reactions. Cobalt alloys: High strength, long service life. Titanium: Lightweight, highly biocompatible; pure titanium suitable for low-load applications, alloys for high-load regions. Tantalum: Corrosion resistant, supports osseointegration. e. Polymers: Properties determined by monomer composition, molecular weight, and crystallinity. PMMA: Bone cement, may be loaded with antibiotics. UHMWPE: High impact resistance, widely used in joint prostheses. Biodegradable polymers: PLA, PGA; provide controlled degradation and drug delivery. Hydrogels: High water content, low friction, promising in tissue engineering. f. Ceramics: Ionic compounds of metals and non-metals; hard, brittle, with high compressive strength. Bearing surfaces: Alumina and zirconia, with low wear rates. Bone substitutes: Hydroxyapatite (slow resorption), tricalcium phosphate (faster resorption, higher biological activity). References: 1. Im, G. I., & Lee, Y. (2020). Biomaterials in orthopaedics: the past and future with immune modulation. Biomaterials Research, 24 , 10. https://doi.org/10.1186/s40824-020-0185-7 2. Zhang, Y., Lu, H., Wang, S., & He, C. (2024). Advancement in biomedical implant materials — a mini review. Frontiers in Bioengineering and Biotechnology, 12 , 1400918. https://doi.org/10.3389/fbioe.2024.1400918 3. Allizond, V., Comini, S., Cuffini, A. M., & Banche, G. (2022). Current knowledge on biomaterials for orthopedic applications modified to reduce bacterial adhesive ability. Antibiotics, 11 (4), 529. https://doi.org/10.3390/antibiotics11040529 Previous Next