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Solou K, Cosentino M, Atherley O'Meally A, Aso A, Aiba H, Donati DM, Bordini B, Errani C. Risk of complications and implant survival of surgical treatment of proximal femoral metastasis: a meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1779-1794. [PMID: 38578441 DOI: 10.1007/s00590-024-03930-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The patients with femoral metastasis in the inter- or subtrochanteric area could be treated with intramedullary nailing or prosthetic reconstruction, however, it is controversial which surgical treatment could offer less complications and implant failure. Our purpose was to define the risk of complications and implant survival in patients treated with intramedullary nailing or prosthetic reconstruction. METHODS We analyzed studies reporting the risk of complications, reoperations and removal of the implant in patients treated with intramedullary nailing, hemiarthroplasty, arthroplasty or megaprosthesis. RESULTS We analyzed 27 studies (1346 patients) reporting patients treated with intramedullary nail (51%), hemiarthroplasty (15%), arthroplasty (2%), megaprosthesis with (25%) or without (7%) acetabular component. No difference was found in the overall risk of complications between patients treated with intramedullary nailing 6%, hemiarthroplasty or total hip arthroplasty 7% and megaprosthesis 11% (p = 0.23). However, patients treated with megaprosthesis had increased risk of reoperation due to infection (70%), compared to the patients treated with intramedullary nail (13%), and patients treated with hemiarthroplasty or total hip arthroplasty (23%) (p = 0.02). Revision due to disease progression was required in 61% of the patients treated with intramedullary nail, but not in patients treated with hemiarthroplasty, total arthroplasty, and megaprosthesis (p = 0.03). CONCLUSION Patients treated with megaprosthesis had higher risk of reoperation due to infection, while patients treated with intramedullary nailing had higher risk of revision due to disease progression. Regarding patients treated with megaprosthesis, the risk of reoperation due to dislocation was higher in those treated with acetabular component.
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Affiliation(s)
- Konstantina Solou
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy
- University of Patras, Patras, Greece
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ahmed Atherley O'Meally
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy
- Department of Orthopaedic Surgery, Complejo Hospitalario Metropolitano CSS, Panama, Panama
| | - Ayano Aso
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Hisaki Aiba
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy
- Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan
| | - Davide Maria Donati
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli N 1, 40136, Bologna, Italy.
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Jiang X. Application of the Locking Compression Pediatric Hip Plate™ in children with proximal femoral tumors. J Orthop Surg Res 2022; 17:536. [PMID: 36503578 PMCID: PMC9743614 DOI: 10.1186/s13018-022-03433-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pediatric proximal femoral tumors often present with accumulative and severe bone destruction and are often complicated by pathological fractures and malunion. Such tumors are treated clinically by lesion scraping and graft reconstruction with autologous iliac bone alone or in combination with artificial bone. This study aimed to determine the efficacy of the Locking Compression Pediatric Hip Plate™ in treating pediatric proximal femoral tumors. METHODS From 2012-2017, the Locking Compression Pediatric Hip Plate™ was applied for internal fixation in 28 children in the Department of Pediatric Surgery. The complications were pathological fractures in 19 patients and multiple lesions in 5 patients. Tumors were removed by tumor curettage and reconstruction with autogenous iliac bone or artificial bone graft. The Locking Compression Pediatric Hip Plate™ was then applied. Postoperative pathological examination confirmed the diagnosis. RESULTS The cohort comprised 20 males and 8 females (mean age 7.8 ± 2.9 years). The mean follow-up duration was 26.1 ± 8.1 months (range 18-48 months). Post-treatment radiography showed that the lesions and local pathological fractures were healed in 3.2 ± 0.4 months (range 3-4 months), with no complications. Four patients continued to receive antineoplastic therapy postoperatively. Four patients experienced recurrence in situ, while another four developed distant metastases. The radiographic and joint function findings indicated that the affected limbs had excellent function. The mean Enneking score was 28.7 ± 1.0 points (range 27-30 points). CONCLUSIONS Internal fixation with the Locking Compression Pediatric Hip Plate™ in children achieves good therapeutic effects. Moreover, the Locking Compression Pediatric Hip Plate™ resolves the shortcomings of external fixation by traditional plaster casts and internal fixation by Kirschner wires and elastic intramedullary screws.
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Affiliation(s)
- Xin Jiang
- grid.13291.380000 0001 0807 1581Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
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Rajani AM, Rajani K, Mittal AR, Shah UA, Rajani KA, Rajani KA. Allograft Impaction and Supplementary Plating for the Management of Epi-Metaphyseal Enchondroma: A Rare Case Report. J Orthop Case Rep 2022; 12:6-9. [PMID: 36873325 PMCID: PMC9983407 DOI: 10.13107/jocr.2022.v12.i09.2992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/05/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Enchondroma is a common bone tumor; however, its location in the proximal epi-metaphyseal region of the tibia is a rare finding. Its management is complicated by the weight-bearing nature of the site and despite an array of available treatment modalities in the literature, there is no fixed consensus. Case Report Through this case, we report a 60-year-old female who was evaluated for bilateral knee osteoarthritis. On plain radiography, a lytic lesion was noted which on CT guided biopsy was confirmed to be an enchondroma of the right proximal tibia. The patient underwent extensive curettage, allograft impaction, and supplementary fixation by a poly ethyl ether ketone plate. Following a period of immobilization, she was able to walk full weight-bearing after 3 weeks of the surgery and carry out her daily activities at 2 months. At 1 year postoperatively, the patient achieved excellent clinical, radiological, and functional outcomes without any complications. Conclusion Management of an enchondroma in weight-bearing regions of long bones can pose multiple challenges. Timely diagnosis and management by thorough curettage, uncompromised allograft impaction, and supplementary fixation by a PEEK plate give excellent short-term and long-term results.
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Affiliation(s)
- Amyn M Rajani
- Department of Orthopaedic, OAKS Clinic, Mumbai, Maharashtra, India
| | - Kareena Rajani
- Department of Clinical Research, OAKS clinic, Mumbai, Maharashtra, India
| | - Anmol Rs Mittal
- Department of Orthopaedics, OAKS Clinic, Mumbai, Maharashtra, India
| | - Urvil A Shah
- Department of Orthopaedics, OAKS Clinic, Mumbai, Maharashtra, India
| | - Khushi A Rajani
- Department of Clinical Research, OAKS clinic, Mumbai, Maharashtra, India
| | - Kashish A Rajani
- Department of Clinical Research, OAKS clinic, Mumbai, Maharashtra, India
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The Use of Carbon Fiber Implants for Impending or Existing Pathologic Fractures. J Orthop Trauma 2022; 36:e260-e264. [PMID: 35727005 DOI: 10.1097/bot.0000000000002320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the utility and complications of using carbon fiber implants (CFIs) compared with standard titanium alloy (TI) intramedullary implants for stabilization of impending or existing pathologic fractures. DESIGN Retrospective comparison. PATIENTS/PARTICIPANTS Ninety-four patients undergoing intramedullary fixation of 100 impending or existing pathologic fractures between 2014-2019 were identified for inclusion. MAIN OUTCOME MEASUREMENTS The primary outcome was postoperative complications. Other outcomes included implant type, pathology, indication, and adjuvant therapy. RESULTS Fifty-three percent of cases used a CFI, whereas 47% of cases used a TI. There were no differences between groups with regard to anatomic location (P = 0.218), indication for surgery (P = 0.066), histology (P = 0.306), or postoperative adjuvant therapy (P = 0.308). Nineteen percent of cases incurred a postoperative complication in each group (P = 0.530), and no differences were noted with regard to complication type including implant failure (P = 0.442) and wound complications (P = 0.322). There was a cost saving of $400 with TI implants compared with CFI. CONCLUSIONS This is a high-risk population for postoperative complications after stabilization of pathologic fractures. Although there were no statistical differences in complications between CFI and TI, implant choice depends on patient characteristics and surgeon preference. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Hoban KA, Downie S, Adamson DJ, MacLean JG, Cool P, Jariwala AC. Mirels’ Score for upper limb metastatic lesions: Do we need a different cut-off for recommending prophylactic fixation? JSES Int 2022; 6:675-681. [PMID: 35813136 PMCID: PMC9264023 DOI: 10.1016/j.jseint.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Katie A. Hoban
- NHS Tayside, Ninewells Hospital & Medical School, Dundee, United Kingdom
- Corresponding author: Katie A. Hoban, BSc (Hons), MBChB, MSc, MRCS (Glasg), Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital & Medical School, Dundee DD1 9SY, United Kingdom.
| | - Samantha Downie
- NHS Tayside, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | | | | | - Paul Cool
- The Robert Jones and Agnus Hunt Orthopaedic Hospital, Gobowen, Oswestry, United Kingdom
- Keele University, Keele, Staffordshire, United Kingdom
| | - Arpit C. Jariwala
- University Department of Orthopaedics and Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
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Abbott A, Kendal JK, Hewison C, Puloski S, Monument M. Longitudinal survival trends of patients with cancer with surgically managed appendicular metastatic bone disease: systematic review. Can J Surg 2021; 64:E550-E560. [PMID: 34728520 PMCID: PMC8565884 DOI: 10.1503/cjs.015520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Advances in systemic cancer therapies have improved survival for patients with metastatic carcinoma; however, it is unknown whether these advances have translated to improved survival for patients with appendicular metastatic bone disease (A-MBD) after orthopedic interventions. We conducted a study to evaluate the trend in overall survival for patients who underwent orthopedic surgery for A-MBD between 1968 and 2018. METHODS A systematic search of Embase and Medline to identify studies published since 1968 evaluating patients treated with orthopedic surgery for A-MBD was conducted for a previously published scoping review. We used a meta-regression model to assess the longitudinal trends in 1-, 2- and 5-year overall survival between 1968 and 2018. The midpoint year of patient inclusion for each study was used for analysis. We categorized primary tumour types into a tumour severity score according to prognosis for a further meta-regression analysis. RESULTS Of the 5747 studies identified, 103 were retained for analysis. Meta-regression analysis showed no significant effect of midpoint study year on survival across all time points. There was no effect of the weighted average of tumour severity scores for each study on 1-year survival over time. CONCLUSION There was no significant improvement in overall survival between 1968 and 2018 for patients with A-MBD who underwent orthopedic surgery. Orthopedic intervention remains a poor prognostic variable for patients with MBD. This finding highlights the need for improved collection of prospective data in this population to identify patients with favourable survival outcomes who may benefit from personalized oncologic surgical interventions.
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Affiliation(s)
- Annalise Abbott
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Joseph K Kendal
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Christopher Hewison
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Shannon Puloski
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
| | - Michael Monument
- From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
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MacDonald DRW, Stevenson I. Intramedullary femoral nail fixation for A pathological fracture distal to A resurfacing arthroplasty. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211039519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Traumatic femoral shaft fractures distal to a hip resurfacing arthroplasty (HRA) are rare. Only four cases have been described in which an intramedullary nail was used to treat the fracture. We present the first case in the literature of a pathological femoral shaft fracture distal to a HRA, and describe its treatment with an anterograde intramedullary femoral nail with proximal locking screws placed into the femoral head overlapping the HRA stem. This demonstrates that the presence of a hip resurfacing arthroplasty does not preclude from utilising an intramedullary nail with recon screws to stabilise a pathological fracture.
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Ononuju U, Hamilton DA, Washington A, Vaidya R. A pituitary cup biopsy is more accurate than reamings for histological diagnosis of intramedullary lesions during nailing of impending and pathologic fractures: a retrospective matched cohort analysis. INTERNATIONAL ORTHOPAEDICS 2021; 45:2735-2740. [PMID: 34401932 DOI: 10.1007/s00264-021-05087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Histologic diagnosis of the lesion is important while intramedullary nailing of a pathologic or impending fracture of a long bone. A biopsy can be performed extramedullary using a targeted sampling device such as a pituitary rongeur or intramedullary from the bone removed from the reamer during preparation of the intramedullary canal. The purpose of this study is to compare a cup pituitary rongeur vs. a reaming biopsy from the intramedullary canal during the treatment of pathologic bone lesions with an intramedullary nail. METHODS An IRB approved retrospective case control study was performed on 46 consecutive patients who underwent an IMN for pathologic fracture or impending pathologic fracture with an obvious lytic lesion with a known metastatic primary. A laryngeal cup pituitary forceps' rongeur was used in 25 patients and the intramedullary reamer as it passed the lesion was used in 21 patients. Histopathology reports were assessed for (1) adequacy of bone sample (defined as containing sufficient bone and marrow-derived tissue to allow complete histological analysis) and (2) tumor tissue diagnosis. A standard approach for IMN was used. RESULTS Twenty-three of 25 cup biopsy cases (92%) had positive pathology that corresponded to the primary cancer. Eleven of 21 reaming cases (52.4%) had positive pathology that corresponded to the primary cancer (p = 0.0117). CONCLUSION The use of an intramedullary cup biopsy forceps is better than reamings to diagnose pathological lesions of impending and pathological fractures in long bones caused by metastatic lesions.
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Affiliation(s)
- Ucheze Ononuju
- Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA
| | - D Alex Hamilton
- Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Rahul Vaidya
- Department of Orthopaedic Surgery, Detroit Medical Center, 5Th Floor Heart Hospital, 311 Mack Avenue, Detroit, MI, 48201, USA.
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Intramedullary Fixation With a Short Nail in a Young Patient Presenting With a Pathological Proximal Femur Fracture. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e21.00055-7. [PMID: 34077396 PMCID: PMC8174550 DOI: 10.5435/jaaosglobal-d-21-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
An 18-year-old man presented with a pathological fracture of the right proximal
femur. Desmoplastic fibroma was diagnosed through histological studies. Surgical
management involved extended intralesional curettage and fracture stabilization
by open reduction with intramedullary nailing, using a short Gamma nail. At
42-month follow-up, the patient presented no limitations or recurrence. Internal
fixation after prior intralesional curettage is a valid treatment strategy for
pathological fractures in young patients. A short nail was chosen to prevent
direct tumor cell seeding throughout the femur and future recurrence. Fracture
consolidation was achieved because of the healing potential of a young
patient.
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Fujita Y, Kawashima H, Ariizumi T, Watanabe Y, Aoki K, Imai H, Umezu H, Endo N. Successful resuscitation from cardiac arrest due to histologically revealed tumor embolism following bilateral intramedullary nailing of metastatic femoral lesions. J Orthop Sci 2021; 26:510-513. [PMID: 30293917 DOI: 10.1016/j.jos.2018.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Yutaka Fujita
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan; Department of Orthopedic Surgery, Tsuruoka Municipal Shonai Hospital, 4-20 Izumi-cho, Tsuruoka, 997-8515, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Takashi Ariizumi
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yo Watanabe
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Kenji Aoki
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hidekazu Imai
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hajime Umezu
- Department of Pathology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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Phull SS, Yazdi AR, Ghert M, Towler MR. Bone cement as a local chemotherapeutic drug delivery carrier in orthopedic oncology: A review. J Bone Oncol 2021; 26:100345. [PMID: 33552885 PMCID: PMC7856326 DOI: 10.1016/j.jbo.2020.100345] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Metastatic bone lesions are common among patients with advanced cancers. While chemotherapy and radiotherapy may be prescribed immediately after diagnosis, the majority of severe metastatic bone lesions are treated by reconstructive surgery, which, in some cases, is followed by postoperative radiotherapy or chemotherapy. However, despite recent advancements in orthopedic surgery, patients undergoing reconstruction still have the risk of developing severe complications such as tumor recurrence and reconstruction failure. This has led to the introduction and evaluation of poly (methyl methacrylate) and inorganic bone cements as local carriers for chemotherapeutic drugs (usually, antineoplastic drugs (ANPDs)). The present work is a critical review of the literature on the potential use of these cements in orthopedic oncology. While several studies have demonstrated the benefits of providing high local drug concentrations while minimizing systemic side effects, only six studies have been conducted to assess the local toxic effect of these drug-loaded cements and they all reported negative effects on healthy bone structure. These findings do not close the door on chemotherapeutic bone cements; rather, they should assist in materials selection when designing future materials for the treatment of metastatic bone disease.
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Affiliation(s)
- Sunjeev S. Phull
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
| | - Alireza Rahimnejad Yazdi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
| | - Michelle Ghert
- Department of Surgery, McMaster University, Hamilton L8V 5C2, Ontario, Canada
| | - Mark R. Towler
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
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12
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Downie S, Stillie A, Moran M, Sudlow C, Simpson AHRW. A prospective longitudinal study investigating outcomes including patient-reported outcome measures after surgery for metastatic bone disease. Bone Jt Open 2021; 2:79-85. [PMID: 33573398 PMCID: PMC7925207 DOI: 10.1302/2633-1462.22.bjo-2020-0173.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aims Surgery is often indicated in patients with metastatic bone disease (MBD) to improve pain and maximize function. Few studies are available which report on clinically meaningful outcomes such as quality of life, function, and pain relief after surgery for MBD. This is the published protocol for the Bone Metastasis Audit — Patient Reported Outcomes (BoMA-PRO) multicentre MBD study. The primary objective is to ascertain patient-reported quality of life at three to 24 months post-surgery for MBD. Methods This will be a prospective, longitudinal study across six UK orthopaedic centres powered to identify the influence of ten patient variables on quality of life at three months after surgery for MBD. Adult patients managed for bone metastases will be screened by their treating consultant and posted out participant materials. If they opt in to participate, they will receive questionnaire packs at regular intervals from three to 24 months post-surgery and their electronic records will be screened until death or five years from recruitment. The primary outcome is quality of life as measured by the European Organisation for Research and the Treatment of Cancer Quality of Life questionnaire (EORTC-QLQ) C30 questionnaire. The protocol has been approved by the Newcastle & North Tyneside 2 Research Ethics Committee (REC ref 19/NE/0303) and the study is funded by the Royal College of Physicians and Surgeons of Glasgow (RCPSG) and the Association for Cancer Surgery (BASO-ACS). Discussion This will be the first powered study internationally to investigate patient-reported outcomes after orthopaedic treatment for bone metastases. We will assess quality of life, function, and pain relief at three to 24 months post-surgery and identify which patient variables are significantly associated with a good outcome after MBD treatment. Cite this article: Bone Jt Open 2021;2(2):79–85.
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Affiliation(s)
- Samantha Downie
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh, UK
| | - Alison Stillie
- Department of Clinical Oncology, Western General Hospital, Edinburgh, UK
| | - Matthew Moran
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh, UK
| | - Catherine Sudlow
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK
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Colello MJ, Hunter MD, Tanner SL, Porter SE. Intramedullary Nail Fixation for the Treatment of Pathologic Humeral Shaft Fractures. Orthopedics 2020; 43:e389-e398. [PMID: 32602913 DOI: 10.3928/01477447-20200619-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/03/2019] [Indexed: 02/03/2023]
Abstract
The goal of this study was to report the clinical outcomes of pathologic humeral shaft fractures treated with reamed or unreamed intramedullary nail fixation in an era of longer patient survival. A retrospective review was conducted of all patients who underwent intramedullary nail fixation performed by a single surgeon for pathologic humeral shaft fractures at a Level I trauma center from 2009 to 2017. Of the 25 patients who were identified, 9 were excluded. Groups were categorized according to whether they underwent reamed or unreamed fixation, and they were evaluated for evidence of union, complications, and reoperation. Of the patients, 11 underwent an unreamed procedure and 5 underwent a reamed procedure. Mean length of follow-up was 51.5 weeks. Of the patients who participated, 12 (75%) showed evidence of union and 2 patients (12.5%) showed evidence of nonunion, with no statistical difference between the groups. Five patients (31.3%) had complications. One nonunion occurred in the reamed group and did not require reoperation. In the unreamed group, complications consisted of 1 delayed union, 1 nonunion treated with revision intramedullary nail fixation, and 2 cases of disease progression that required reoperation. Intramedullary nail fixation of pathologic humeral shaft fractures achieves rates of union parallel to those seen with fixation in a healthy population. The length of follow-up in the current study was longer than the life expectancy reported by previous authors, which can be attributed to improvements in the treatment of cancer. The current authors argue that unreamed fixation is the optimal technique because it yields similar outcomes to a reamed approach and is faster and potentially safer. [Orthopedics. 2020;43(5):e389-e398.].
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Fernandes PX, Medeiros DM, Teixeira RC, Nunes AM, Seco AS, Caetano AC. Injury to the Superior Gluteal Artery during Intramedullary Fixation of a Proximal Femoral Fracture - A Case Report. J Orthop Case Rep 2020; 9:27-31. [PMID: 32548023 PMCID: PMC7276602 DOI: 10.13107/jocr.2019.v09.i06.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Proximal femoral fractures represent a health problem of global proportions. Iatrogenic vascular lesion in the treatment of these fractures is an unusual potentially lethal complication, reported in only 0.2% of trochanteric fractures treated with intramedullary implants. Superior gluteal artery injury is extremely rare, with only two cases reported in literature. Case Report A 66-year-old Caucasian woman, with metastatic disease, was admitted with a right pertrochanteric fracture. She underwent closed reduction and long intramedullary nail fixation. Five days post-operatively, a sudden hemoglobin drop occurred. A computed tomography demonstrated an extensive hematoma. Angiography confirmed an arterial bleeding from the superior gluteal artery and subsequent selective embolization was successfully performed. Conclusion The presence of anemia and thigh hematoma that progressively worsens post-operatively should raise the diagnostic suspicion of an iatrogenic vascular injury. To the best of our knowledge, this is only the third case reported of superior gluteal artery injury after intramedullary fixation of a proximal femoral fracture. We describe the post-operative course and management strategy and hope this will contribute to the global knowledge and increase awareness of these rare injuries.
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Affiliation(s)
- Pedro Xavier Fernandes
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
| | - Duarte Manuel Medeiros
- Department of Vascular Surgery, Hospital de Egas Moniz,Centro Hospitalar de Lisboa Ocidental, R. da Junqueira 126, 1349-019 Lisbon, Portugal
| | - Raquel C Teixeira
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
| | - Andreia Mercier Nunes
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
| | - Antonio Sousa Seco
- Department of Orthopaedic Surgery, Hospital Lusiadas, R. Abílio Mendes 12, 1500-458 Lisbon, Portugal
| | - Afonso Cevadinha Caetano
- Department of Orthopaedic Surgery, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1495-005 Lisbon, Portugal
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Abstract
Aims The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. Methods This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. Results There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. Conclusion This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72–81
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Affiliation(s)
- Samantha Downie
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Florence Y. Lai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Judith Joss
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Douglas Adamson
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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Han Q, Zhao X, Wang C, Chen B, Wang X, Zhang Z, Zhang K, Zheng Y, Wang J. Individualized reconstruction for severe periprosthetic fractures around the tumor prosthesis of knee under assistance of 3D printing technology: A case report. Medicine (Baltimore) 2018; 97:e12726. [PMID: 30334957 PMCID: PMC6211891 DOI: 10.1097/md.0000000000012726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Periprosthetic femoral fractures (PFF) around tumor prosthesis of knee are stubborn problems for surgeons, huge bone defect and inappropriate biomechanics of the revision implant design can be disaster for reconstruction. With the development of three-dimensional (3D) printing technology, surgeons participate more in precise preoperative design and simulation for treatment of such fractures. In this study we explored an accurate and feasible way to restore normal anatomy and function of the knee joint with 3D printing technology. CASE PRESENTATION Rationale: This report explored an accurate and feasible way to treat PFF around tumor knee prosthesis in a 32 years old women with 3D printing technology, which restored normal anatomy and function of the knee joint. Patient concerns: Pain in left thigh lasted for 10 months after resection of left femoral chondroma and knee joint replacement four years ago. Diagnoses: periprosthetic femoral fractures (PFF) around tumor knee prosthesis. INTERVENTIONS CT images of the patient were collected and reconstructed. Parameters of bilateral femurs were virtually sliced and measured. Novel femoral stem and nail paths were specially designed by doctors according to these parameters. The prosthetic femoral stem components and navigator were customized by engineers according to the doctor's design. The residual femoral resin model, customized components and navigator were printed with Stereo Lithography Apparatus 3D printer. The shape-preconcerted allograft bone was selected as patch for the bone defect before operation with the printed bone model. All the steps were simulated preoperatively with the models printed, and then the operation was carried out. OUTCOMES The operation was successfully performed. The postoperative x-ray image, MSTS93 scores were examined and the function restoration sustained well in the follow-up period from 1 month to 27 months. LESSONS 3D printing and medical interaction are key points in complex PFF cases. CONCLUSION As for PFF of the complex tumor of knee, preoperative design and simulation with 3D printing technology may provide more accurate and effective operative outcome than traditional methods, which might be considered as a method suitable for popularization in complex and severe cases.
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Affiliation(s)
- Qing Han
- Orthopedics Center, The Second Hospital of Jilin University
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Orthopedics Center, The Second Hospital of Jilin University
| | - Bingpeng Chen
- Orthopedics Center, The Second Hospital of Jilin University
| | - Xiaonan Wang
- Orthopedics Center, The Second Hospital of Jilin University
| | - Ziyan Zhang
- Orthopedics Center, The Second Hospital of Jilin University
| | - Kesong Zhang
- Orthopedics Center, The Second Hospital of Jilin University
| | - Yuhao Zheng
- Orthopedics Center, The Second Hospital of Jilin University
| | - Jincheng Wang
- Orthopedics Center, The Second Hospital of Jilin University
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Putnam DS, Philipp TC, Lam PW, Gundle KR. Treatment Modalities for Pathologic Fractures of the Proximal Femur Pertrochanteric Region: A Systematic Review and Meta-Analysis of Reoperation Rates. J Arthroplasty 2018; 33:3354-3361. [PMID: 30232017 DOI: 10.1016/j.arth.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The proximal femur represents the most common site of metastatic bone disease in the appendicular skeleton, and associated pathologic pertrochanteric femur fractures contribute to cancer-related morbidity and mortality. Controversy exists as to whether these injuries are best managed with intramedullary nailing (IMN) or with arthroplasty. METHODS A systematic review of the literature was performed using a PubMed search following PRISMA guidelines to identify studies performed within the last 20 years regarding treatment of proximal femur metastatic lesions with either nailing or arthroplasty with a reported reoperation rate. Sixteen studies were selected for inclusion containing 1414 patients. Pooled estimates and 95% confidence intervals (CIs) for reoperation rates associated with IMN and endoprosthetic reconstruction (EPR) were separately calculated. RESULTS The pooled estimate for reoperation for IMN was a median of 9% (95% CI, 5%-14%) and the pooled estimate for reoperation for EPR was a median of 7% (95% CI, 5%-11%). Significant heterogeneity was present in studies reporting on both treatment modalities: for IMN, I2 = 55%, and for EPR, I2 = 51%. CONCLUSION This systematic literature review identified 16 eligible, nonrandomized, retrospective studies that reported on the results of surgical treatment for proximal femur metastatic disease. The pooled estimate of reoperation was similar between patients treated with IMN and EPR. Inconsistencies among follow-up and the study designs used limited evidence-based conclusions. As the oncologic care of patients with metastatic disease continues to evolve and improve, patient-specific needs must be carefully considered when selecting an optimal treatment strategy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- David S Putnam
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR; Portland VA Medical Center, Operative Care Division, Portland, OR
| | - Travis C Philipp
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR; Portland VA Medical Center, Operative Care Division, Portland, OR
| | - Phillip W Lam
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR; Portland VA Medical Center, Operative Care Division, Portland, OR
| | - Kenneth R Gundle
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR; Portland VA Medical Center, Operative Care Division, Portland, OR
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Marques LM, Alves MM, Eugénio S, Salazar SB, Pedro N, Grenho L, Mira NP, Fernandes MH, Montemor MF. Potential anti-cancer and anti-Candida activity of Zn-derived foams. J Mater Chem B 2018; 6:2821-2830. [PMID: 32254235 DOI: 10.1039/c7tb02726e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Zinc (Zn)-derived foams have been prepared from an alkaline electrolyte solution by galvanostatic electrodeposition under different conditions. A detailed physico-chemical characterization was performed by Raman spectroscopy, X-ray diffraction (XRD) and scanning electron microscopy (SEM). A pioneer application of these foams in medical implant-related applications was investigated. The in vitro behaviour of these Zn-derived foams in simulated physiological conditions was studied. The results revealed that the presence of zinc oxide was important enough to change the in vitro behaviour of these materials. The potential of these Zn-derived foams in inhibiting bone cancer cell proliferation - osteoscarcoma cells - and important pathogenic fungi responsible for implant-related infections -Candida albicans- was examined. Furthermore, the foams were evaluated for cytocompatibility with normal human osteoblasts. The results obtained allowed us to conclude that Zn-derived foams have an interesting potential for anti-cancer and anti-Candida activity, targeted for bone-related implant applications, suggesting that this novel material may have potential for further clinical studies.
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Affiliation(s)
- L M Marques
- CQE, Instituto Superior Técnico, Departamento de Engenharia Química, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisboa, Portugal.
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Zhou X, Zhao B, Keshav P, Chen X, Gao W, Yan H. The management and surgical intervention timing of enchondromas: A 10-year experience. Medicine (Baltimore) 2017; 96:e6678. [PMID: 28422880 PMCID: PMC5406096 DOI: 10.1097/md.0000000000006678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Enchondroma, reportedly the most common primary tumor of the long bones of the hand, usually develops during the first till fourth decades of life. However, there has no consensus been reached regarding the surgical intervention timing for these patients. We aim to evaluate the optimal surgical intervention timing for the patients with fractures due to enchondromas, investigate the impact of pathological fractures on the treatment and outcomes in these patients.Medical records and X-rays of patients treated for enchondroma of the hand from 2005 to 2015 were retrospectively reviewed. We collected 148 cases in total and 92 of them had complete information including X-rays, medical records, and files of follow up.There were no significant differences in terms of consolidation time after surgery, recurrence rate, and DASH scores between the groups with and without fractures; the treatment costs were higher in the group with fractures than those without fractures; however, patients without fractures were able to resume work earlier than those with fractures.The pathological fractures associated with enchondromas have no significant impact on the treatment outcomes compared to those with simple nonfractured enchondromas. Although the cost was more expensive for patients treated primarily with pathological fractures due to enchondromas, these patients could resume their work normally much earlier than those treated by delayed surgery. Early surgical intervention is recommended for better results and no increased risks for patients with pathological fractures caused by enchondromas.
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Affiliation(s)
- Xijie Zhou
- Division of Plastic and Hand Surgery, Department of Orthopedics
| | - Bin Zhao
- Division of Postanesthesia Care Unit, Department of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Poonit Keshav
- Division of Plastic and Hand Surgery, Department of Orthopedics
| | - Xinglong Chen
- Division of Plastic and Hand Surgery, Department of Orthopedics
| | - Weiyang Gao
- Division of Plastic and Hand Surgery, Department of Orthopedics
| | - Hede Yan
- Division of Plastic and Hand Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Zhang Y, Li JZ, Lu XC, Zhang Y, Zhang HS, Shi HL, Lei Z, Feng G, Fu WP. Intramedullary Nailing Combined with Bone Grafting for Benign Lesions of the Proximal Femur. Orthop Surg 2017; 9:97-102. [PMID: 28300344 DOI: 10.1111/os.12311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/20/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of intramedullary nailing for benign lesions of the proximal femur. METHOD A retrospective analysis was carried out on 68 cases of benign lesions in the proximal femur at our hospital from April 2002 to April 2013 (38 men and 30 women). Mean age at surgery was 35.5 years (range, 22-56 years). The cases were divided into two groups: curettage of the lesion with bone grafting only as the grafting group (32 cases) and internal fixation after removal of the lesion as the fixation group (36 cases). For the grafting group, lesions were scraped out, deactivated and washed thoroughly with normal saline, then the allogeneic bone was implanted. For the fixation group, after the lesions were scraped, the intramedullary nails were implanted, and allogeneic bone was implanted into the scraped cavity with compaction. RESULTS Pathological examination showed that 24 out of 68 cases (35.3%) had simple bone cysts (suffered from pathological fracture in 2 cases); 21 (30.9%) fibrous dysplasia; 18 (26.5%) aneurysmal bone cysts; 3 (4.4%) chondroblastoma, 2 (2.9%) out of which were combined with aneurysmal bone cysts. All patients were followed up for 12-96 months (56 months for mean). In the grafting group, 4 patients had postoperative complications (1 pathological bone fractures and 3 deep vein thrombosis), but only 1 patient of the fixation group (deep vein thrombosis) (P < 0.05). The average bedridden time after surgery was 11.4 ± 7.6 days for the grafting group, and for the other group was 7.5 ± 5.4 days ( P < 0.05). CONCLUSION Both treatments are effective for benign lesions in the proximal femur, but the fixation group facilitated the functional recovery of patients and reduced postoperative complications.
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Affiliation(s)
- Yan Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-Zhen Li
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Chang Lu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huai-Shuan Zhang
- Department of Orthopaedics, Orthopaedics Hospital of Zhengzhou, Zhengzhou, China
| | - Hai-Long Shi
- Department of Orthopaedics, Orthopaedics Hospital of Zhengzhou, Zhengzhou, China
| | - Zheng Lei
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guang Feng
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei-Ping Fu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Shen H, Tu R, Li W, He G, Huang W, Qin Z, Wang C, Yu S. Comparison of the Clinical Efficacy of Retroperitoneal Laparoscopic Partial Nephrectomy and Radical Nephrectomy for Treating Small Renal Cell Carcinoma: Case Report and Literature Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e23912. [PMID: 28182157 PMCID: PMC5287050 DOI: 10.5812/ircmj.23912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 06/30/2015] [Accepted: 07/23/2015] [Indexed: 01/17/2023]
Abstract
Background Renal cell carcinoma (RCC) is a common malignancy of the urinary system with high rates of morbidity and mortality. Objectives This study aimed to investigate and analyze the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy and laparoscopic radical nephrectomy for the treatment of small RCC. Methods In this retrospective study of 45 patients with small RCC, the patients were divided into two treatment groups: Group A (retroperitoneal laparoscopic partial nephrectomy, 25 cases) and Group B (retroperitoneal laparoscopic radical nephrectomy, 20 cases). Results There were no statistically significant differences in the operative time, amount of intraoperative blood loss, length of hospital stay, preoperative creatinine level, postoperative creatinine level after 24 hours, and survival rate after 1, 2, and 3 years between the two groups (P > 0.05). Conclusions There were no significant differences in the survival rates and short-term postoperative complications between the laparoscopic partial nephrectomy group and the laparoscopic radical nephrectomy group for small RCC, but the former was slightly more effective.
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Affiliation(s)
- Hongfeng Shen
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Ruisha Tu
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Wei Li
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Geng He
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Wei Huang
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Zhenchang Qin
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Chongfeng Wang
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Shuyong Yu
- Department of Urology, 187 Hospital of PLA, Hainan, China
- Corresponding Author: Shuyong Yu, Department of Urology, 187 Hospital of PLA, Hainan, China. Tel: +86-13876769088, Fax: +86-13876769088, E-mail:
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Anract P, Biau D, Boudou-Rouquette P. Metastatic fractures of long limb bones. Orthop Traumatol Surg Res 2017; 103:S41-S51. [PMID: 28089230 DOI: 10.1016/j.otsr.2016.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/27/2016] [Accepted: 11/02/2016] [Indexed: 02/02/2023]
Abstract
The diagnosis of pathological fracture should be considered routinely in patients with long limb-bone fractures. Investigations must be performed to establish the diagnosis of pathological fracture then to determine that the bone lesion is a metastasis. In over 85% of cases, the clinical evaluation combined with a detailed analysis of the radiographs is sufficient to determine that the fracture occurred at a tumour site. Aetiological investigations establish that the tumour is a metastasis. In some patients, the diagnosis of metastatic cancer antedates the fracture. When this is not the case, a diagnostic strategy should be devised, with first- to third-line investigations. When these fail to provide the definitive diagnosis, a surgical biopsy should be performed. The primaries most often responsible for metastatic bone disease are those of the breast, lung, kidney, prostate, and thyroid gland. However, the survival gains provided by newly introduced treatments translate into an increased frequency of bone metastases from other cancers. The optimal treatment of a pathological fracture is preventive. The Mirels score is helpful for determining whether preventive measures are indicated. When selecting a treatment for a pathological fracture, important considerations are the type of tumour, availability of effective adjuvant treatments, and general health of the patient. Metastatic fractures are best managed by a multidisciplinary team. The emergent treatment should start with optimisation of the patient's general condition, in particular by identifying and treating metabolic disorders (e.g., hypercalcaemia) and haematological disorders. Treatment decisions also depend on the above-listed general factors, location of the tumour, and size of the bony defect. Prosthetic reconstruction is preferred for epiphyseal fractures and internal fixation for diaphyseal fractures.
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Affiliation(s)
- P Anract
- Département de chirurgie orthopédique, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
| | - D Biau
- Département de chirurgie orthopédique, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - P Boudou-Rouquette
- Département d'oncologie médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris cité, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Janssen SJ, Teunis T, Hornicek FJ, van Dijk CN, Bramer JAM, Schwab JH. Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies. J Surg Oncol 2016; 114:507-19. [PMID: 27374478 DOI: 10.1002/jso.24345] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/13/2016] [Indexed: 12/17/2022]
Abstract
Endoprosthetic reconstruction, intramedullary nailing, and open reduction internal fixation (ORIF) are the most commonly practiced surgical strategies for treatment of metastatic proximal femoral fractures. This review describes functional outcome, local, and systemic complications. All three surgical strategies result in reasonable function on average; however, wide ranges indicate that both poor and good functional levels are obtained. We found that the overall reoperation rate was comparable for endoprosthesis and intramedullary nailing, but was higher for ORIF. J. Surg. Oncol. 2016;114:507-519. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Teun Teunis
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
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Cazzato RL, Koch G, Buy X, Ramamurthy N, Tsoumakidou G, Caudrelier J, Catena V, Garnon J, Palussiere J, Gangi A. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus. Cardiovasc Intervent Radiol 2016; 39:1455-63. [DOI: 10.1007/s00270-016-1389-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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