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Papanastasiou L, Fountoulakis S, Voulgaris N, Kounadi T, Choreftaki T, Kostopoulou A, Zografos G, Lyssikatos C, Stratakis CA, Piaditis G. Identification of a novel mutation of the PRKAR1A gene in a patient with Carney complex with significant osteoporosis and recurrent fractures. Hormones (Athens) 2016; 15:129-35. [PMID: 27377598 PMCID: PMC7427502 DOI: 10.14310/horm.2002.1627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 09/29/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Carney complex (CNC) is a rare autosomal dominant multiple neoplasia syndrome characterized by the presence of endocrine and non-endocrine tumors. More than 125 different germline mutations of the protein Kinase A type 1-α regulatory subunit (PRKAR1A) gene have been reported. We present a novel PRKAR1A gene germline mutation in a patient with severe osteoporosis and recurrent vertebral fractures. DESIGN Clinical case report. CASE REPORT A 53-year-old male with a medical history of surgically removed recurrent cardiac myxomas was evaluated for repeated low-pressure vertebral fractures and severe osteoporosis. Physical examination revealed spotty skin pigmentation of the lower extremities and papules in the nuchal and thoracic region. The presence of hypercortisolism due to micronodular adrenal disease and the history of cardiac myxomas suggested the diagnosis of CNC; the patient underwent detailed imaging investigation and genetic testing. METHODS Standard imaging and clinical testing; DNA was sequenced by the Sanger method. RESULTS Sequence analysis from peripheral lymphocytes DNA revealed a novel heterozygous point mutation at codon 172 of exon 2 (c.172G>T) of the PRKAR1A gene, resulting in early termination of the PRKAR1A transcript [p.Glu58Ter (E58X)]. CONCLUSION We report a novel point mutation of the PRKAR1A gene in a patient with CNC who presented with significant osteoporosis and fractures. Low bone mineral density along with recurrent myxomas should point to the diagnosis of CNC.
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Laovachirasuwan P, Mootsikapun P, Maleewong W, Intapan PM. INTRAOSSEOUS PROLIFERATIVE SPARGANOSIS PRESENTING AS A PATHOLOGICAL FRACTURE: A CASE REPORT AND REVIEW OF THE LITERATURE. THE SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH 2015; 46:558-563. [PMID: 26867374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of 63-year-old male, who presented with pathological fracture of left distal humerus 3 weeks previously. The radiographic findings showed an ill-defined permeative osteolytic lesion of the left distal humerus. Incisional biopsy and debridement was done; pathological examination revealed a folded cestode larva with calcareous corpuscles in the bone and soft tissue, and increased eosinophils. IgG antibody tests for sparganosis were positive. The patient refused to have surgery for internal fixation and placement of an endoprosthesis.
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Choy WS, Kim KJ, Lee SK, Yang DS, Jeung SW, Choi HG, Park HJ. Surgical treatment of pathological fractures occurring at the proximal femur. Yonsei Med J 2015; 56:460-5. [PMID: 25683996 PMCID: PMC4329359 DOI: 10.3349/ymj.2015.56.2.460] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To analyze the results of surgical treatment for pathological fractures at the proximal femur. MATERIALS AND METHODS Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. RESULTS The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. CONCLUSION Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.
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Golshani AE, Kamdar AA, Spence SC, Beckmann NM. Congenital indifference to pain: an illustrated case report and literature review. J Radiol Case Rep 2014; 8:16-23. [PMID: 25426241 DOI: 10.3941/jrcr.v8i8.2194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Congenital indifference to pain is a rare and debilitating congenital disease. Individuals with the disorder may have one or a combination of sensory or autonomic deficits, which can range from lack of mechanical nociception, diminished ability to detect heat and cool stimulation, to the devastating and fatal form which includes autonomic dysfunction. It is important for radiologists to be able to recognize the radiographic presentations of this rare disorder, as delay in diagnosis can lead to extensive and sometimes unnecessary workup. We present a case of congenital indifference to pain initially interpreted as a mass of the distal femur.
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Mori S. [Justification criteria for vertebral fractures ; year 2012 revision]. CLINICAL CALCIUM 2014; 24:331-338. [PMID: 24576929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Justification Criteria for Vertebral Fractures 2012 version was made based on new clinical findings. Major differences in this version compared to the 1996 version are 1) inclusion of the semi quantitative method (SQ) , 2) statements to improve considerations during radiographic analysis, and 3) the need for more detailed evaluation by MRI. New Justification Criteria aims that the treatment of vertebral fracture in both fracture and osteoporosis is properly performed in daily clinical practice.
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Katakami N, Kunikane H, Takeda K, Takayama K, Sawa T, Saito H, Harada M, Yokota S, Ando K, Saito Y, Yokota I, Ohashi Y, Eguchi K. Prospective study on the incidence of bone metastasis (BM) and skeletal-related events (SREs) in patients (pts) with stage IIIB and IV lung cancer-CSP-HOR 13. J Thorac Oncol 2014; 9:231-8. [PMID: 24419421 PMCID: PMC4132043 DOI: 10.1097/jto.0000000000000051] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bone metastasis (BM) is a frequent complication in patients with advanced lung cancer and it causes skeletal-related events (SREs). Our study aim is to prospectively investigate the incidence of BM, incidence and types of SRE, and predictive factors of BM and SREs. METHODS Newly diagnosed, advanced non-small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC) patients were enrolled into the study. Patients were followed up every 4 weeks to monitor the development of SREs. Treatment for lung cancer was performed at the discretion of the investigator. RESULTS Two hundred seventy-four patients were enrolled in this study between April 2007 and December 2009 from 12 institutions. Patients included 77 cases of SCLC and 197 of NSCLC (stage IIIB/IV = 73/124). Median follow-up time was 13.8 months. The incidence of BM at initial diagnosis was 48% in stage IV NSCLC and 40% in extensive stage (ED)-SCLC. Forty-five percent of patients who developed BM had SREs consisting of pathologic fracture (4.7%), radiation to bone (15.3%), spinal cord compression (1.1%), and hypercalcemia (2.2%). Multivariate analysis revealed that factors predicting BM are stage IV, performance status 1 or greater and higher bone alkaline phosphatase in NSCLC patients, higher lactate dehydrogenase, and lower parathyroid hormone-related peptide in SCLC patients. Factors predicting SREs were stage IV, age 64 or younger, and lower albumin in NSCLC patients. Multivariate analysis of SRE was not performed for SCLC because of the small number of events. CONCLUSION Predictive factors should be taken into consideration in future randomized studies evaluating BM and SREs.
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Schwabe P, Ruppert M, Tsitsilonis S, Melcher I, Schaser KD, Märdian S. Surgical management and outcome of skeletal metastatic disease of the humerus. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2014; 81:365-370. [PMID: 25651290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE OF THE STUDY Evaluation of outcome after surgical treatment of humerus metastases with a focus on tumour and patient derived factors, timing and strategy of intervention, surgical outcome and complications. MATERIAL AND METHODS Sixty-fie patients with a mean age of 64.3 years (range 25-89) with 66 metastases of the humerus were surgically treated in a 7-year time-period and retrospectively reviewed. RESULTS Renal cell carcinoma and breast cancer were the most abundant types of primary tumour. The mean time from diagnosis of primary tumour to fist metastasis was 14.5 months (range 0-173). The mean time from diagnosis of metastasis to surgery was 21.4 months (range 0-173). 38/28 intramedullary nails/locking plates were used for 58/8 manifest/impending pathological fractures. Mean cumulative survival was 16.3 months and implant failure rate was 6.1% with a mean time from initial surgery to revision of 22.2-20.6 months. CONCLUSIONS Our data indicate that treatment with intramedullary fiation or cement augmented plate osteosynthesis is successful for the vast majority of patients, but thorough clinical evaluation and precise decision making adapted to the patient's estimated life expectancy must be applied to avoid overtreatment or risk of implant failure. Key words: bone metastases, skeletal metastatic disease, humerus metastasis, pathologic fracture, impending fracture.
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Oster G, Lamerato L, Glass AG, Richert-Boe KE, Lopez A, Chung K, Richhariya A, Dodge T, Wolff GG, Balakumaran A, Edelsberg J. Natural history of skeletal-related events in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems. Support Care Cancer 2013; 21:3279-86. [PMID: 23884473 DOI: 10.1007/s00520-013-1887-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To document the risk of skeletal complications in patients with bone metastases from breast cancer (BC), lung cancer (LC), or prostate cancer (PC) in routine clinical practice. METHODS We used data from two large US health systems to identify patients aged ≥18 years with primary BC, LC, or PC and newly diagnosed bone metastases between January 1, 1995 and December 31, 2009. Beginning with the date of diagnosis of bone metastasis, we estimated the cumulative incidence of skeletal-related events (SREs) (spinal cord compression, pathologic fracture, radiation to bone, bone surgery), based on review of medical records, accounting for death as a competing risk. RESULTS We identified a total of 621 BC, 477 LC, and 721 PC patients with newly diagnosed bone metastases. SREs were present at diagnosis of bone metastasis in 22.4, 22.4, and 10.0 % of BC, LC, and PC patients, respectively. Relatively few LC or PC patients received intravenous bisphosphonates (14.8 and 20.2 %, respectively); use was higher in patients with BC, however (55.8 %). In BC, cumulative incidence of SREs during follow-up was 38.7 % at 6 months, 45.4 % at 12 months, and 54.2 % at 24 months; in LC, it was 41.0, 45.4, and 47.7 %; and in PC, it was 21.5, 30.4, and 41.9 %. More than one half of patients with bone metastases had evidence of SREs (BC: 62.6 %; LC: 58.7 %; PC: 51.7 %), either at diagnosis of bone metastases or subsequently. CONCLUSIONS SREs are a frequent complication in patients with solid tumors and bone metastases, and are much more common than previously recognized in women with BC.
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Bashtan VP, Mukovoz OI. [Complex treatment of mandibular malignant tumors using a fixing device for prophylaxis of pathological fracture, the early postoperative prosthesis and rehabilitation]. KLINICHNA KHIRURHIIA 2013:43-46. [PMID: 24283045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Even in modern conditions of achievements in the head and neck oncosurgery the restoration of the volume defects of the bone tissue in a jaw-facial region is impossible to do without the orthopedic methods application because of present severe psychoemotional and general state of the patients. The problem of prophylaxis of mandibular pathological fractures in its malignant affection constitute a peculiar place, taking into account a complexity and numerousness of the unsolved issues. There was elaborated and constructed apparatus for the pathological fracture prophylaxis or for fixing of fragments in the angle of a toothless mandibula. After the apparatus being applied in place the patient's quality of life improves: they better tolerate radiation therapy; the conditions for surgical treatment are improving; the acts of chewing and deglutition are not disordered, what improves the patients state significantly; the general image of the face is not disturbed. The methods may be introduced into specialized clinics.
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Osipenkova-Vichtomova TK. [Forensic medical implications of histomorphological changes in the bone and cartilage tissues under effect of radiation]. Sud Med Ekspert 2013; 56:16-21. [PMID: 24428051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of the present work was to study roentgenological, microscopic, and histomorphological changes in the bone and cartilage tissues under effect of different doses of gamma-ray radiation from Gammatron-2 (GUT Co 400) and betatron bremsstrahlung radiation (25 MeV). The total radiation dose varied from 9.6 Gy to 120 Gy per unit area during 5-8 weeks. The study included 210 patients at the age from 7 to 82 years (97 men and 113 women). Histomorphological studies were carried out using samples of bone and cartilage tissues taken from different body regions immediately after irradiation and throughout the follow-up period of up to 4 years 6 months. Control samples were the unexposed bone and cartilage tissues from the same subjects (n = 14). The tissues were stained either with eosin and hematoxylin or by Van Gieson's and Mallory's methods. Gomori's nonspecific staining was used to detect acid and alkaline phosphatase activities. Moreover, argyrophilic substance was identified in the cartilaginous tissue. Best's carmine was used for glycogen staining and Weigert's stain for elastic fibers. Metachromasia was revealed by toluidine blue staining and fat by the sudan III staining technique. In addition, the ultrastructure of cartilaginous tissue was investigated. Taken together, these methods made it possible to identify the signs of radiation-induced damage to the bone and cartilage tissues in conjunction with complications that are likely to develop at different periods after irradiation including such ones as spontaneous fractures, deforming arthrosis and radiation-induced tumours.
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Schwartz G. Spontaneous capital femoral physeal fracture in a cat. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2013; 54:698-700. [PMID: 24155467 PMCID: PMC3685007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A young neutered male cat was presented with a 1-week history of left hind limb lameness. Pain and crepitus were identified on manipulation of the left coxofemoral joint. Radiographic evaluation led to the diagnosis of physeal dysplasia with slipped capital femoral epiphysis of the left femur, which did not respond to conservative management.
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Lee YS, Dan J, Ryu KJ, Kim BK, Han SH, Kim HJ. Case of genochondromatosis type I in an 8-year-old boy. Am J Med Genet A 2013; 161A:1513-6. [PMID: 23613356 DOI: 10.1002/ajmg.a.35924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 02/03/2013] [Indexed: 11/07/2022]
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Verma R, Junewar V, Sahu R. Pathological fractures as an initial presentation of Wilson's disease. BMJ Case Rep 2013; 2013:bcr2013008857. [PMID: 23576656 PMCID: PMC3645778 DOI: 10.1136/bcr-2013-008857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Wilson's disease (WD) has varied phenotypic presentations. Here we report the case of a 16-year-old boy who presented with a history of multiple pathological fractures, severe joint deformities, hepatic dysfunction, cognitive decline and limb dystonia. On examination, the patient had pinched out facies, pallor and leukonychia totalis. Bilateral Kayser Fleischer (KF) ring was present. Musculoskeletal examination revealed pectus carinatum, bilateral genu valgus and gun-stock deformity of the left elbow joint. Splenomegaly and moderate ascites were present. Neurological examination revealed mild rigidity and intermittent episodes of dystonic posturing of all four limbs. On this basis a diagnosis of WD with dystonia with cirrhosis of liver with portal hypertension with renal tubular acidosis with renal rickets was thought likely. Investigations confirmed the diagnosis. The patient was started on treatment but he did not improve. He suffered aspiration pneumonia during his hospital stay and succumbed to the illness.
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Chermiti Ben Abdallah F, Boudaya MS, Chtourou A, Taktak S, Mahouachi R, Ayadi A, Ben Kheder A. [Sternal tuberculosis causing spontaneous fracture of the sternum]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:89-92. [PMID: 23474101 DOI: 10.1016/j.pneumo.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 01/04/2013] [Accepted: 01/21/2013] [Indexed: 06/01/2023]
Abstract
Sternal tuberculosis is an uncommon condition. Few cases have been reported. We report the case of a 74-year-old man, presented with a swelling and pain of the anterior chest wall associated to worsening of general state. All routine investigations were normal. Chest radiograph in lateral view showed sternal and chest wall hypertrophy with spontaneous fracture of the sternum. Computed tomography (CT) scan demonstrated ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture. Tuberculosis diagnosis was confirmed by histological study of the mass biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment.
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Ries MD, Link TM. Monitoring and risk of progression of osteolysis after total hip arthroplasty. Instr Course Lect 2013; 62:207-214. [PMID: 23395026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Osteolysis after total hip arthroplasty (THA) develops in response to particulate wear debris and may not be associated with clinical symptoms. Osteolysis is associated with greater wear volume. Wear increases with the increased use and activity of the joint, so longer in vivo use of a THA implant increases the risk of osteolysis. Patients with non-cross-linked, ultra-high-molecular weight polyethylene implants and younger more active patients are at greater risk for the development of osteolysis. Routine monitoring for osteolysis 5 years after THA, with radiographic imaging every 2 to 3 years thereafter, is recommended. Patients at greater risk for osteolysis should be monitored more closely. If a lesion is seen radiographically, serial radiographs are helpful to determine the relative rate of progression of the lesion. CT with metal artifact reduction can be used to effectively quantitate the lesion size and location. MRI is useful in visualizing osteolytic areas and soft-tissue pathology. Both MRI and CT with metal artifact reduction protocols have been developed to effectively visualize osteolytic lesions in proximity to THA implants and provide supplemental information to plain radiography.
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Murphy CG, Treacy A, Dudeney S, O'Toole GC. Pathological fracture of femur secondary to infected synovial sarcoma. BMJ Case Rep 2012; 2012:bcr2012007453. [PMID: 23175020 PMCID: PMC4544954 DOI: 10.1136/bcr-2012-007453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pathological fracture is not uncommon in musculoskeletal oncological surgical practice. When complicated by infection, it is both limb- threatening and life-threatening problem. Pathological fractures require urgent investigation, not urgent treatment. We present the case of a 75-year-old man who presented with an infected sarcoma causing a pathological fracture of his right femur.
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Jellali MA, Zrig M, Zrig A, Mnif H, Hmida B, Abid A, Golli M. [Pathological humeral fracture revealing bone hydatic cyst]. Med Mal Infect 2011; 41:164-6. [PMID: 21276675 DOI: 10.1016/j.medmal.2010.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 10/25/2010] [Accepted: 12/14/2010] [Indexed: 12/01/2022]
MESH Headings
- Adolescent
- Albendazole/therapeutic use
- Anthelmintics/therapeutic use
- Bone Diseases, Infectious/diagnosis
- Bone Diseases, Infectious/diagnostic imaging
- Bone Diseases, Infectious/drug therapy
- Bone Diseases, Infectious/parasitology
- Bone Diseases, Infectious/pathology
- Bone Diseases, Infectious/surgery
- Combined Modality Therapy
- Curettage
- Echinococcosis/complications
- Echinococcosis/diagnosis
- Echinococcosis/diagnostic imaging
- Echinococcosis/drug therapy
- Echinococcosis/pathology
- Echinococcosis/surgery
- Echinococcosis, Hepatic/complications
- Echinococcosis, Hepatic/drug therapy
- Female
- Fractures, Closed/diagnostic imaging
- Fractures, Closed/drug therapy
- Fractures, Closed/etiology
- Fractures, Closed/parasitology
- Fractures, Closed/pathology
- Fractures, Closed/surgery
- Fractures, Spontaneous/diagnostic imaging
- Fractures, Spontaneous/drug therapy
- Fractures, Spontaneous/etiology
- Fractures, Spontaneous/parasitology
- Fractures, Spontaneous/pathology
- Fractures, Spontaneous/surgery
- Humans
- Humeral Fractures/diagnostic imaging
- Humeral Fractures/drug therapy
- Humeral Fractures/etiology
- Humeral Fractures/parasitology
- Humeral Fractures/pathology
- Humeral Fractures/surgery
- Magnetic Resonance Imaging
- Radiography
- Saline Solution, Hypertonic/administration & dosage
- Therapeutic Irrigation
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Geoffroy V, Chappard D, Marty C, Libouban H, Ostertag A, Lalande A, de Vernejoul MC. Strontium ranelate decreases the incidence of new caudal vertebral fractures in a growing mouse model with spontaneous fractures by improving bone microarchitecture. Osteoporos Int 2011; 22:289-97. [PMID: 20204596 DOI: 10.1007/s00198-010-1193-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 12/23/2009] [Indexed: 01/23/2023]
Abstract
UNLABELLED Young mice over-expressing Runx2 fail to gain bone relative to wild type mice with growth and present spontaneous fractures. It allows, for the first time in rodents, direct assessment of anti-fracture efficacy of strontium ranelate which was able to decrease caudal vertebrae fracture incidence through an improvement of trabecular and cortical architecture. INTRODUCTION The aim was to investigate whether strontium ranelate was able to decrease fracture incidence in mice over-expressing Runx2, model of severe developmental osteopenia associated with spontaneous vertebral fractures. METHODS Transgenic mice and their wild type littermates were treated by oral route with strontium ranelate or vehicle for 9 weeks. Caudal fracture incidence was assessed by repeated X-rays, resistance to compressive loading by biochemical tests, and bone microarchitecture by histomorphometry. RESULTS Transgenic mice receiving strontium ranelate had significantly fewer new fractures occurring during the 9 weeks of the study (-60%, p < 0.05). In lumbar vertebrae, strontium ranelate improves resistance to compressive loading (higher ultimate force to failure, +120%, p < 0.05) and trabecular microarchitecture (higher bone volume and trabecular number, lower trabecular separation, +60%, +50%, -39%, p < 0.05) as well as cortical thickness (+17%, p < 0.05). In tibiae, marrow cavity cross-section area and equivalent diameter were lower (-39%, -21%, p < 0.05). The strontium level in plasma and bone was in the same range as the values measured in treated postmenopausal women. CONCLUSIONS This model allows, for the first time, direct assessment of anti-fracture efficacy of strontium ranelate treatment in rodents. In these transgenic mice, strontium ranelate was able to decrease caudal vertebral fracture incidence through an improvement of trabecular and cortical architecture.
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Abstract
Vertebral fractures are usually the first to occur in osteoporosis, provide indisputable evidence of reduced bone strength, and are frequently a harbinger of further vertebral and nonvertebral fracture. Radiologists are best placed to draw attention to the presence of vertebral fractures, most of which are clinically silent. Magnetic resonance imaging supplemented if necessary by computed tomography is usually sufficient to enable distinction between osteoporotic and non-osteoporotic vertebral fracture, without a need for percutaneous biopsy.
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Wronka KS, Madhusudhan TR, Ramesh B. An innovative technique for long-bone biopsy. Ann R Coll Surg Engl 2010. [PMID: 20425897 PMCID: PMC3080082 DOI: 10.1308/003588410x12664192075134k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Miller PD. Fragility fractures in chronic kidney disease: A clarification of views (December 2009). Cleve Clin J Med 2010; 77:75. [PMID: 20124263 DOI: 10.3949/ccjm/77c:02003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mawatari T, Iwamoto Y. [Bone fracture and the healing mechanisms. Fragility fracture and bone quality]. CLINICAL CALCIUM 2009; 19:691-698. [PMID: 19398837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fracture occurs in bone having less than normal elastic resistance without any violence. Numerous terms have been used to classify various types of fractures from low trauma events; "fragility fracture", "stress fracture", "insufficiency fracture", "fatigue fracture", "pathologic fracture", etc. The definitions of these terms and clinical characteristics of these fractures are discussed. Also state-of-the-art bone quality assessments; Finite element analysis of clinical CT scans, assessments of the Microdamage, and the Cross-links of Collagen are introduced in this review.
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Karaoğlan A, Akdemir O, Erdoğan H, Colak A. A rare emergency condition in neurosurgery: foot drop due to Paget's disease. Turk Neurosurg 2009; 19:208-210. [PMID: 19431139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Paget's disease is a chronic, focal skeletal disorder that usually affects the pelvis and spine. Spinal cases are generally asymptomatic; in the symptomatic cases, the neurological dysfunctions are related to non-compressive vascular defects, hemorrhage, sarcomatoid degeneration, spinal stenosis, or pathological fractures, primarily in the lumbar region. The Neurosurgeon should have a fundamental understanding of the complications of Paget's disease and should be familiar with the indications for treatment, as well as available medical and surgical therapies. In the present paper, we report a case of Paget's disease that presented with an isolated foot drop due to a pathological fracture of L5 vertebra, and then discuss the therapeutic strategies presented in the literature.
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