Pathological Femoral Fracture Research Articles

Primary extranodal lymphoma: a report of six cases in a private cancer centre in Nigeria

Primary extra-nodal lymphoma (PENL) refers to lymphomas which present with disease in any organ or tissue other than lymph nodes or spleen. Symptoms at initial presentation are mainly from extra nodal involvement and after routine staging procedures, the extra nodal involvement remains the clinically dominant site of disease with little or no nodal disease [1, 2]. About 25–40% of lymphomas arise at extra nodal sites and with clinical presentation similar to solid tumors [3, 4] creating ambiguity in diagnosis and delays in treatment especially in resource poor settings. We report six cases of PENL seen at a private cancer centre in Lagos, Nigeria between 2021 and 2022. The age range was 32–95 years with five females and one male. Two patients were HIV positive. Five patients had initial symptoms of vague abdominal pain with one patient investigated multiple times for peptic ulcer disease. One patient presented with pathological fracture of left femur. Another patient had previously been diagnosed with an inoperable cholangiocarcinoma. All patients had non-Hodgkin’s lymphoma, DLBCL being most common (83.37%). Four patients started chemotherapy. All treated patients showed good outcomes with complete or good partial response highlighting the importance of accurate diagnosis. Initial histological diagnosis in most of the cases did not suggest lymphoma until immunohistochemistry (IHC) results were received. Cancer care in Nigeria is fraught with difficulties obtaining accurate diagnosis due in part to the limited availability of IHC and molecular testing facilities required to characterize the malignant cells leading to delays in treatment and poorer prognosis [6–8].

THE USE OF A TRAINING 3D-MODEL IN THE TREATMENT OF A PATIENT WITH A PATHOLOGICAL FRACTURE OF THE PROXIMAL PART OF THE FEMUR (CASE FROM PRACTICE)

Prostate cancer is the second most common cause of malignancy in men, with bone metastases being a significant source of morbidity and mortality in advanced cases. Objective. To give a clinical example of a patient with a pathological transtrochanteric fracture of the right femur with displacement of fragments, the presence of metastasis at the fracture site, to emphasize the importance of 3D-training before surgery. Methods. A clinical example with a significant impairment of the function of the right lower extremity against the background of a significant pain syndrome is given. The diagnosis was established: pathological transtrochanteric fracture of the right femur with displacement of fragments, the presence of metastasis at the fracture site. Pre-surgical training was carried out using a 3D-model and total endoprosthetics of the right hip joint with a revision individual implant of the cement fixation type was carried out. The patient fully recovered the function of the right lower limb and hip joint, the pain syndrome was eliminated, and sleep normalized. The use of a 3D-model for preoperative training of surgeons made it possible to rationally limit traumatization of healthy tissues during tumor removal, prevent possible complications and optimize the time of surgical intervention and thus minimize blood loss. Conclusions. The use of a training 3D-model before surgery followed by prosthetics with a special oncological endoprosthesis provided satisfactory functional results and restoration of the patient's quality of life in the given clinical case. The use of a 3D-model is the key to careful preparation for surgical intervention, taking into account the individual anatomical features of the pathological process and adjacent tissues, which allows you to significantly optimize the terms of the operation and reduce blood loss, and also provides valuable experience for further surgical practice.

A clinical example of using a carbon-carbon composite to replace a femur diaphyseal defect

A separate direction in osteosynthesis is the study on the possibilities of bone union after tumor resection. In this regard, the issue of using implants made of metals, polymers, and carbon, which have a high bone binding affinity, is on the agenda for modern oncological orthopedics. Studying carbon composite materials has shown practical effectiveness of their medical use, in particular in orthopedics and traumatology, that can be applied to replace bone defects in oncological traumatology. Aim. To determine the possibility of using carbon composite materials in the femur defect replacement after tumor resection. Clinical case. A case of using an implant made of the carbon composite material for a patient with right femur osteosarcoma and a pathological femoral middle-third fracture is presented. The study was carried out in accordance with the principles of the Declaration of Helsinki. The patient signed the written informed consent form for the study. Conclusions. The results of using the implant made of the carbon composite material have shown its permeability to X-rays and potential use for bone defect replacement in oncological traumatology.

Detection and evaluation of signals for immune-related adverse events: a nationwide, population-based study.

Immune checkpoint inhibitors (ICIs) are one of the main pillars of cancer therapy. Since other studies such as clinical trial and retrospective study have limitations for detecting the immune-related adverse events (irAEs) characterized by unpredictable onset, nonspecific symptoms and wide clinical spectrum, we aimed to identify the incidence of irAEs and to detect and evaluate the signals using real-world data. Cancer patients treated with anticancer medications were analyzed using the nationwide health insurance claims database of South Korea from 2017 to 2019, and Clinical Data Warehouse (CDW) database of Asan Medical Center (AMC), a tertiary referral hospital, from 2012 to 2019. AEs of ICI users were compared with those of non-ICI anticancer medication users. PD-1 inhibitors (nivolumab and pembrolizumab) and PD-L1 inhibitors (atezolizumab) were evaluated. We defined an AE as a newly added diagnosis after the ICI prescription using an ICD-10 diagnostic code. A signal was defined as an AE that was detected by any one of the four indices of data mining: hazard ratio (HR), proportional claims ratio (PCR), claims odds ratio (COR), or information component (IC). All detected signals were reviewed and classified into well-known or potential irAEs. Signal verification was performed for targeted AEs using CDW of AMC using diagnostic codes and text mining. We identified 118 significant signals related to ICI use. We detected 31 well-known irAEs, most of which were endocrine diseases and skin diseases. We also detected 33 potential irAEs related to disorders in the nervous system, eye, circulatory system, digestive system, skin and subcutaneous tissues, and bones. Especially, portal vein thrombosis and bone disorders such as osteoporosis with pathological fracture and fracture of shoulder, upper arm, femur, and lower leg showed high HR in ICI users than in non-ICI users. The signals from hospital database were verified using diagnostic codes and text mining. This real-world data analysis demonstrated an efficient approach for signal detection and evaluation of ICI use. An effective real-world pharmacovigilance system of the nationwide claims database and the EMR could complement each other in detecting significant AE signals.

Femoral metastatic pathological fractures, impending and actual fractures – A patient survival study

IntroductionThe skeleton is a common site for metastases. Prostate, breast, lung, renal and thyroid carcinomas account for 80 % of the original cancers, with the femur being the most affected long bone. With improved oncological treatments, prolonged patient survival leads to an increased prevalence of osseous metastases. This study examines the impact of preventive surgery for impending femoral pathological fracture (IFF), versus treatment of pathological femur fracture (PFF) on patient mortality and morbidity. MethodsRetrospective cohort of 174 patients undergoing surgery due to femoral metastases (2004–2015). Eighty-two patients were with PFF, and 92 were with IFF based on the Mirels' score. The followed-up period was until 2016. Demographic data, oncological, pathological, radiation, surgical reports, outpatient clinical records, and imaging studies were examined. Exclusion criteria included primary tumours and Multiple Myeloma. ResultsThe mean age was 64.8 ± 13.3 and 60.2 ± 11.9 years (p = 0.02) in the PFF and the IFF cohorts, with 62.1 % women and 57 % men. The breast was the most common source of femoral metastases. The average Mirels' score was 10 ± 1.2. There was an association between tumour origin and survival. Carcinoma of the lung had the worst survival, while the prostate had the most prolonged survival. Survival rates differed between IFF and PFF (p = 0.03). Postoperative complications occurred in 26 % of the patient, with no difference between IFF & PFF. ConclusionBreast and lung are the most common tumours to metastasize the femur. Our study revalidates that pathological femoral fractures impede patient survival compared to impending fractures and should undergo preventive surgery. Postoperative complications do not differ between IFF and PFF but remain relatively high. Overall, patients with proximal femoral metastatic disease survive longer than previously published, probably due to improved treatment modalities.

An unusual presentation of Grave's disease with severe osteoporosis and pathological femoral fracture

An unusual presentation of Grave's disease with severe osteoporosis and pathological femoral fracture

Çocukta Patolojik Distal Femur Kırığı: Suçlu Kim?

Çocukta Patolojik Distal Femur Kırığı: Suçlu Kim?

Pathological Fracture of Distal Femur in a Child : What is the Culprit?

Pathological Fracture of Distal Femur in a Child : What is the Culprit?

Safety and Efficacy of a Single-Stage versus Two-Stage Intramedullary Nailing for Synchronous Impending or Pathologic Fractures of Bilateral Femur for Oncologic Indications: A Systematic Review.

Although intramedullary nail (IMN) fixation is the standard of care for most impending and/or complete pathologic fractures of the femur, the optimal timing/sequence of the IMN in cases of synchronous bilateral femoral disease in advanced cancer is not well established. Thus, we compared the outcomes of single-stage (SS) vs. two-stage (TS) IMN of the bilateral femur with a systematic review of the literature on this topic. Bilateral SS and TS IMN cases were identified from 14 studies extracted from four databases according to PRISMA guidelines. Safety (complications, reoperations, mortality, survival, blood loss, and transfusion) and efficacy (length of stay [LOS], time to start rehabilitation and adjuvant therapy, functional scores, and cost) were compared between the groups. A total of 156 IMNs in 78 patients (36 SS and 42 TS) were analyzed. There were one surgical (infection in TS requiring reoperation; p = 0.860) and fifteen medical complications (five in SS, ten in TS; p = 0.045), with SS being associated with lower rates of total and medical complications. Survival, intraoperative mortality, and postoperative same-admission mortality were similar. No cases of implant failure were reported. Data on LOS, rehabilitation, and adjuvant therapy were scarcely reported, although one study favored SS over TS. No study compared cost or functional scores. Our study is the largest and most comprehensive of its kind in supporting the safety and efficacy of a SS bilateral femur IMN approach in these select patients. Further investigations with higher levels of evidence are warranted to optimize treatment protocols for this clinical scenario.

A rare case of neglected long-term pathologic fracture of the distal femur due to a giant cell tumor of bone

Giant cell tumor of bone is a histologically benign bone neoplasia that clinically has an aggressive course. In rare cases, it can give "benign" lung metastases or undergo malignant transformation. The World Health Organization defines this neoplasia as an "aggressive, potentially malignant lesion".
 Herein, we present a rare case of a neglected long-term pathologic fracture of the distal femur in a 20-year-old female patient. After a biopsy, a giant cell tumor of bone was diagnosed. The patient was treated with intralesional curettage, osteoplasty and plate fixation of the fracture. Eight months postoperatively, no local recurrence or metastasis of the tumor was observed.

Intramedullary nailing versus plate compound osteosynthesis in subtrochanteric and diaphyseal pathologic femoral fractures: a retrospective cohort study

PurposePathologic fractures of the extremities due to carcinoma metastases require individual and patient prognosis-related stabilization procedures. Quick remobilization of the patient to restore the quality of life is of high importance, especially in the case of subtrochanteric and diaphyseal femoral fractures. In our retrospective cohort study, we evaluated intraoperative blood loss, length of operation, complication rate, and regain of lower extremity function in plate compound osteosynthesis (PCO) versus intramedullary nailing (IM) for subtrochanteric and diaphyseal pathologic fractures of the femur.MethodsBetween January 2010 and July 2021, we retrospectively reviewed 49 patients who were treated at our institution for pathologic fractures of the subtrochanteric and diaphyseal femurs for group differences in terms of blood loss, length of operation, implant survival, and Musculoskeletal Tumor Society (MSTS) score.ResultsWe included 49 stabilization procedures of the lower extremity due to pathologic fractures of the proximal or diaphyseal femur, with a mean follow-up of 17.7 months. IM (n = 29) had a significantly shorter operation time than PCO (n = 20) (112.4 ± 9.4 and 163.3 ± 15.96 min, respectively). We did not detect any significant differences in terms of blood loss, complication rate, implant survival, or MSTS score.ConclusionBased on our data, pathologic subtrochanteric and diaphyseal fractures of the femur can be stabilized with IM, which has a shorter operation time than PCO, but the complication rate, implant survival, and blood loss remain unaffected.

OUTCOME OF PATHOLOGICAL FRACTURES OF PAEDIATRIC FEMUR FOLLOWING CHRONIC OSTEOMYELITIS TREATED WITH ILIZAROV METHOD

Background: Pathological fracture of the paediatric femur after chronic osteomyelitis presents a challenging situation. It is complicated by the need for radical debridement, often leaving a wide bone gap and instability that is difcult to be managed by the traditional methods. The Ilizarov method due to its versatility is a potential treatment option for this condition. 19 children with pathological femur Materials and methods: fractures following chronic Osteomyelitis were treated with Ilizarov methods. 3 children were excluded, and the nal outcome was measured in 16 children. The mean age of the patients was 6.76±1.93 years, with 12 males (63.15%) and 7 females (36.84%). The Beit cure classication of childhood chronic osteomyelitis was used. The mean follow up after ring removal was 26.06±5.07 months. NEER's criteria was used to assess the radiological and functional outcomes. With a mean union time of 10.94±3.93 weeks, 100% union Results: was achieved in all of the 16 cases. The mean external xator period was 14.25±4.94 weeks. The infection was fully eradicated in all of the cases, except 1 (6.25%) child diagnosed with tubercular osteomyelitis is still having the active infection. According to NEER's functional and anatomical grading, excellent results were found in 6 (37.5%) cases, satisfactory in 8 (50%), and unsatisfactory in 2 (12.5%) cases. Pin tract infection was found in 10 (62.5%) children, axial deformity after ring removal in one (6.25%), and knee stiffness in 2(12.5%) children. In children w Conclusion: ith pathological femur fractures caused by chronic osteomyelitis, the Ilizarov method can be a viable treatment option. It helps to eradicate infection, promotes fracture healing, and produces satisfactory to excellent results.

Hiperparatireoidismo secundário nutricional em filhote de Leopardus geoffroyi (d’Orbigny and Gervais, 1844)

Nutritional Secondary Hyperparathyroidism (NSH) is a metabolic disorder that mainly affects young animals. This disease causes imbalance between the levels of calcium and phosphorus, culminating in bone changes. Wild animals raised in captivity can develop the disease when they are given an inadequate diet. The aim of this study is to report the clinical findings, the complementary exams and the therapeutics utilized in a Leopardus geoffroyi (Geoffroy’s cat) cub originated from captivity. The animal went through complementary imaging exams and biochemical evaluation that respectively revealed generalized osteopenia and pathological fracture of the right femur, reduction of serum calcium level and elevation of serum phosphorus level. After diagnosis, a correction of the diet and mineral and vitamin supplementation was performed. The NSH diagnosis was stablished by associating history, clinical signs, imaging exams findings and serum biochemicals. The early identification of this disease is of paramount importance, because in this way corrections can be made in food management, in order to provide successful clinical recovery and promote quality of life for wild captive animals.

Examining agreement between finite element modelling methodologies in predicting pathological fracture risk in proximal femurs with bone metastases

BackgroundFinite element modelling methodologies available for assessing femurs with metastases accurately predict strength and pathological fracture risk which has led them to being considered for implementation into the clinic. However, the models available use varying material models, loading conditions, and critical thresholds. The aim of this study was to determine the agreement between finite element modelling methodologies in assessing fracture risk in proximal femurs with metastases. MethodsCT images of the proximal femur were obtained of 7 patients who presented with a pathologic femoral fracture (fracture group) and the contralateral femur of 11 patients scheduled for prophylactic surgery (non-fracture group). Fracture risk was predicted for each patient following three established finite modelling methodologies which have previously shown to accurately predict strength and determine fracture risk: non-linear isotropic -based model, strain fold ratio -based model, Hoffman failure criteria -based model. FindingsThe methodologies demonstrated good diagnostic accuracy in assessing fracture risk (AUC = 0.77, 0.73, and 0.67). There was a stronger monotonic association between the non-linear isotropic and Hoffman -based models (τ = 0.74) than with the strain fold ratio model (τ = −0.24 and − 0.37). There was moderate or low agreement between methodologies in discriminating between individuals at high or low risk of fracture (κ = 0.20, 0.39, and 0.62). InterpretationThe present results suggest there may be a lack of consistency in the management of pathological fractures in the proximal femur based on the finite element modelling methodologies.

Intramuscular hemangioma presenting as pathological femur fracture: A case report

Hemangioma is a common benign soft-tissue tumor; however, intramuscular hemangioma presenting with a pathological fracture is an infrequent occurrence. Imaging plays a key role in diagnosing this entity. We report a case of a 30-year-old male who presented with a pathological fracture of the left femur following trivial trauma. Clinical examination was remarkable for a significant soft-tissue swelling which on further radiological investigation revealed a soft-tissue mass lesion in the left thigh muscles having multiple vascular channels and phleboliths extending into femoral cortex and medulla causing a pathological fracture. Diagnosing it as an aggressive hemangioma, the main feeder artery was embolized by polyvinyl alcohol particles. The patient is on traction and follow-up. Intramuscular hemangioma causing pathological fracture is extremely rare. Understanding the typical and atypical radiological findings of an intramuscular hemangioma will impede misdiagnosis, and unnecessary tissue sampling, and allow for expedited and appropriate management.

Primary hyperparathyroidism and skull bone: Dicle sign

Abstract Introduction In primary hyperparathyroidism, a brown tumor may be seen due to excessive osteoclastic activity. We will share the unusual localization of this tumor-like formation that primarily affects the lower and upper extremities. Clinical Case A 20-year-old female patient presented with complaints of weakness, headache, bone pain, and difficulty walking. He had a history of surgery for a pathological femur fracture in the past. In the evaluation, a diagnosis of primary hyperparathyroidism due to ectopic parathyroid adenoma was made. Brown tumor-like formations were also observed in the skull bone in the cranial tomography taken due to severe headache. An adenomectomy was performed on the patient whose parathyroid adenoma localization was detected in the scintigraphic examination. The patient, who developed post-operative hungry bone syndrome, was discharged approximately one month later due to the need for intravenous calcium. It lasted about one year after the patient's oral calcitriol and calcium treatment. She was followed up without treatment. At her last follow-up in June 2022, calcium, phosphorus, and parathormone levels were normal. The patient had no complaints. Conclusion Brown tumor is often seen in the bones of the hands, feet, and long bones. We detected it for the first time in the skull bone.

A Case of Spontaneous Tumor Lysis After Pathologic Femur Fracture in Squamous Cell Lung Cancer.

Tumor lysis syndrome (TLS) occurs when large numbers of tumor cells lyse and release their contents, causing electrolyte derangements and renal injury. It is an uncommon complication of solid tumors and occurs most commonly after cytotoxic therapy rather than spontaneously. In this article, we describe a case of spontaneous TLS in a patient with squamous cell carcinoma of the lung. We also present a literature review of spontaneous TLS occurrence in solid tumors.

Femoral shaft fracture complicating Gaucher disease in adult

Gaucher's disease is a rare disease of progressive evolution characterized by a lysosomal storage disorder. It is rarely responsible for femoral fracture. Patients with Gaucher disease may present with musculoskeletal complications, including osteopenia, medullary bone infarcts, and avascular necrosis. We report a case of femur fracture due to gaucher disease in a 28-year-old woman who underwent two operations for pathological femoral fractures.

Femur Osteomyelitis and Associated Fracture as an Initial Presentation of Aortoenteric Fistula

Aortoenteric fistula is a rare condition. Atypical presentations may cause significant management delays. We present the case of a 64-year-old male who experienced a pathological femoral fracture as an initial presentation of an underlying aortoenteric fistula. The aortoenteric fistula, possibly related to a poor graft tunneling technique, induced femur osteomyelitis and the associated pathological fracture.

Case Report: Pathological fracture in a Li-Fraumeni osteosarcoma patient: "Capasquelet'' femoral reconstruction and tumor vascular analysis with endomucin immunofluorescence multiplexing

We describe the case report of an Osteosarcoma patient, with a Li-Fraumeni Syndrome, presenting with a pathological femoral fracture. The patient was treated with a multidisciplinary approach associating neoadjuvant and adjuvant chemotherapy with excisional surgery. The femoral reconstruction consisted of a ``Capasquelet'' reconstruction combining an induced membrane and a vascularized fibula allograft allowing a good functional result with an early weight-bearing. We managed to complete our histological analysis in this patient, in order to evaluate the tumor vascularization. Indeed, using the syngeneic osteosarcoma MOS-J mouse model, we highlighted previously that CD31+/\ensuremath{\alpha }-SMA+ vessels may be indicators of vasculature normalization and therefore may be used as specific markers of a good therapeutic response. Thus, we search for its interest in this specific case as preliminary work. The aim was to assess the feasibility and technical validity of the vascularization analysis of a human osteosarcoma tumor specimen. Therefore, we propose an immunohistochemistry methodology with multiplexed immunofluorescence to assess the vascularization as a promising marker in human osteosarcoma tissue.