Purpose: To review the oncologic outcomes following treatment of soft tissue sarcomas in the foot and ankle, and to determine the results of limb salvage surgery in this anatomically constrained area with often expected close pathologic margins.

Method: One hundred twenty-nine patients with soft tissue sarcomas of the foot were treated at our institution since 1986. Average age at presentations was 55 years old. Females and males were equally represented. Most common diagnosis was MFH in 31 patients, followed by leiomyosarcoma in 16 patients, synovial sarcoma in 13, and clear cell sarcoma in 6, the remainder being other soft tissue sarcomas. Most of sarcomas were intermediate or high grade. Our follow-up averaged 58 months.

Results: Limb salvage surgery was possible in 97 patients. Of those, negative margin excision was achieved in 75 patients, 18 patients had micro-positive margins, and 4 had grossly positive margins. Fifty-three patients in the limb salvage group required free tissue transfer for coverage. Of 97 limb salvage patients, 82 received radiation therapy, 5 patients received chemotherapy. Local recurrence occurred in 24 patients. Two of these were amenable to re-excision, the remaining required amputation. Thirty-two patents developed systemic disease. Average disease-free survival for patients with recurrent disease was 23 months. At last follow-up, 78 patients were alive with no evidence of disease and 24 were alive with disease. Seventeen patients died of disease, and the remainder of other causes.

Conclusion: In the setting of soft tissue sarcoma in foot and ankle, amputation rate is higher than in other anatomic areas. However, limb salvage surgery can be achieved with good oncological outcomes despite often unavoidable close margins. Soft tissue reconstructive procedures aid in achieving good surgical results while radiation therapy aids local control. Given these results, limb salvage in soft tissue tumors of foot and ankle should be the goal.

In the past, the treatment of acute elbow fracture-dislocations has emphasized repair to the medial collateral ligament (MCL), with favorable results. We report improved results using a strategy based on lateral-sided repair (lateral collateral ligament, radial head, coronoid) without MCL repair. In forty-seven patients, this strategy resulted in a high degree of success with no residual instability (valgus or otherwise). The dynamic stabilizers of the elbow activated through early postoperative motion, are important adjunct to stability. We have devised a reproducible radiographic method to demonstrate this.

To review the surgical treatment of elbow dislocations without surgical MCL repair, and to determine if early active motion aids in restoring stability and concentric joint reduction.

In the setting of acute fracture-dislocation of the elbow, concentric elbow stability with excellent functional results can be achieved using laterally-based surgical strategy without MCL repair. The dynamic stabilizers of the elbow, activated through the early motion, assist in providing joint congruity and stability.

Forty-seven patients with acute elbow fracture-dislocations requiring operative treatment were treated at two university-affiliated teaching hospitals and evaluated an average of twenty-one months after injury. The protocol consisted of repair of the ulna and coronoid, repair or replacement of the radial head, and repair of the LCL, and early motion. The MCL was not routinely repaired. The LCL origin had been avulsed and reattached in all patients. One patient had a second procedure related to malpositioned radial head prosthesis. A stable mobile (average one hundred and one degree arc) articulation was restored in all patients. There was no evidence of valgus instability in any patient. Early motion was initiated at a mean of two weeks postoperatively. Postoperative ulnohumeral joint space opening improved from 4.9 ± 1.2 mm in the early postoperative period to 2.0 ± 0.5 mm (p < 0.00003) at final follow-up. We believe this is due to the effect of the dynamic stabilizers, which were allowed to function through early motion.