Pathological Fractures Of Long Bones Research Articles

Predicting Risk of 30-day Postoperative Morbidity Using the Pathologic Fracture Mortality Index.

The purpose of this study was to evaluate the ability of the Pathologic Fracture Mortality Index (PFMI) to predict the risk of 30-day morbidity after pathologic fracture fixation and compare its efficacy with those of the American Society of Anesthesiologists (ASA) physical status, modified Charlson Comorbidity Index (mCCI), and modified frailty index (mFI-5). Cohorts of 1,723 patients in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020 and 159 patients from a tertiary cancer referral center who underwent fixation for impending or completed pathologic fractures of long bones were retrospectively analyzed. National Surgical Quality Improvement Program morbidity variables were categorized into medical, surgical, utilization, and all-cause. PFMI, ASA, mCCI, and mFI-5 scores were calculated for each patient. Area under the curve (AUC) was used to compare efficacies. AUCs predicting all-cause morbidity were 0.62, 0.54, and 0.56 for the PFMI, ASA, and mFI-5, respectively. The PFMI outperformed the ASA and mFI-5 in predicting all-cause ( P < 0.01), medical ( P = 0.01), and utilization ( P < 0.01) morbidities. In the 2005 to 2012 subset, the PFMI outperformed the ASA, mFI-5, and mCCI in predicting all-cause ( P = 0.01), medical ( P = 0.03), and surgical ( P = 0.05) morbidities but performed similarly to utilization morbidity ( P = 0.19). In our institutional cohort, the AUC for the PFMI in morbidity stratification was 0.68. The PFMI was associated with all-cause (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.12 to 1.51; P < 0.001), medical (OR, 1.19; 95% CI, 1.03 to 1.40; P = 0.046), and utilization (OR, 1.32; 95% CI, 1.14 to 1.52; P < 0.001) morbidities but not significantly associated with surgical morbidity (OR, 1.21; 95% CI, 0.98 to 1.49; P = 0.08) in this cohort. The PFMI is an advancement in postoperative morbidity risk stratification of patients with pathologic fracture from metastatic disease. III.

Prevalence of primary malignant tumours, rates of pathological fracture, and mortality in the setting of metastatic bone disease.

The modern prevalence of primary tumours causing metastatic bone disease is ill-defined in the oncological literature. Therefore, the purpose of this study is to identify the prevalence of primary tumours in the setting of metastatic bone disease, as well as reported rates of pathological fracture, postoperative complications, 90-day mortality, and 360-day mortality for each primary tumour subtype. The Premier Healthcare Database was queried to identify all patients who were diagnosed with metastatic bone disease from January 2015 to December 2020. The prevalence of all primary tumour subtypes was tabulated. Rates of long bone pathological fracture, 90-day mortality, and 360-day mortality following surgical treatment of pathological fracture were assessed for each primary tumour subtype. Patient characteristics and postoperative outcomes were analyzed based upon whether patients had impending fractures treated prophylactically versus treated completed fractures. In total, 407,893 unique patients with metastatic bone disease were identified. Of the 14 primary tumours assessed, metastatic bone disease most frequently originated from lung (24.8%), prostatic (19.4%), breast (19.3%), gastrointestinal (9.4%), and urological (6.5%) malignancies. The top five malignant tumours resulting in long bone pathological fracture were renal (5.8%), myeloma (3.4%), female reproductive (3.2%), lung (2.8%), and breast (2.7%). Following treatment of pathological fractures of long bones, 90-day mortality rates were greatest for lung (12.1%), central nervous system (10.5%), lymphoma (10.4%), gastrointestinal (10.1%), and non-renal urinary (10.0%) malignancies. Finally, our study demonstrates improved 90-day and 360-day survival in patients treated for impending pathological fracture compared to completed fracture, as well as significantly lower rates of deep vein thrombosis, pulmonary embolism, urinary tract infection, and blood transfusion. This study defines the contemporary characteristics of primary malignancies resulting in metastatic bone disease. These data should be considered by surgeons when prognosticating patient outcomes during treatment of their metastatic bone disease.

Rare case presentation of parathyroid adenoma in a young female presenting as pathological fracture of long bones: A case study

Rare case presentation of parathyroid adenoma in a young female presenting as pathological fracture of long bones: A case study

Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database.

Racial disparities in outcomes after orthopaedic surgery have been well-documented in the fields of arthroplasty, trauma, and spine surgery; however, little research has assessed differences in outcomes after surgery for oncologic musculoskeletal disease. If racial disparities exist in the treatment of patients with pathologic long bone fractures, then they should be identified and addressed to promote equity in patient care. (1) How do wait times between hospital admission and operative fixation for pathologic fractures of long bones differ between Black and non-Hispanic white patients, after controlling for confounding variables using propensity score matching? (2) How does the proportion of patients with 30-day postoperative complication differ between these groups after controlling for confounding variables using propensity score matching? Using the National Surgical Quality Improvement Program database, we analyzed 828 patients who underwent fixation for pathologic fractures from 2012 to 2018. This database not only provides a large enough sample of pathologic long bone fracture patients to conduct the present study, but also it contains variables such as time from hospitalization to surgery that other national databases do not. After excluding patients with incomplete data (4% of the initial cohort), 775 patients were grouped by self-reported race as Black (12% [94]) or white (88% [681]). Propensity score matching using a 1:1 nearest-neighbor match was then used to match 94 Black patients with 94 white patients according to age, gender, BMI, American Society of Anesthesiologists physical status classification, anemia, endstage renal disease, independence in performing activities of daily living, congestive heart failure, and pulmonary disease. The primary outcome of interest was the number of days between hospital admission and operative fixation, which we assessed using a Poisson regression and report as an incidence risk ratio. The secondary outcomes were the occurrences of major 30-day postoperative adverse events (failure to wean off mechanical ventilation, cerebrovascular events, renal failure, cardiovascular events, reoperation, death), minor 30-day adverse events (reintubation, wound complications, pneumonia, and thromboembolic events), and any 30-day adverse events (defined as the pooling of all adverse events, including readmissions). These outcomes were analyzed using a bivariate analysis and logistic regression with robust estimates of variance and are reported as odds ratios. Because any results on disparities rely on rigorous control of other baseline demographics, we performed this multivariable approach to ensure we were controlling for confounding variables as much as possible. After controlling for potentially confounding variables such as age and gender, we found that Black patients had a longer mean wait time (incidence risk ratio 1.5 [95% CI 1.1 to 2.1]; p = 0.01) than white patients. After controlling for confounding variables, Black patients also had greater odds of having any postoperative adverse event (OR 2.1 [95% CI 1.1 to 3.8]; p = 0.02), including readmission (OR 3.3 [95% CI 1.5 to 7.6]; p = 0.004). The racial disparities in pathologic long bone fracture care found in our study may be attributed to fundamental racial biases, as well as systemic socioeconomic disparities in the US healthcare system. Identifying and eliminating the racial, socioeconomic, and sociocultural biases that drive these disparities would improve care for patients with orthopaedic oncologic conditions. One possible way to reduce these disparities would be to implement standardized surgical care pathways for pathological long bone fractures across different institutions to minimize variation in important aspects of care, such as time to surgical fixation. Further insight is needed on the types of standardized care pathways and the implementation mechanisms that are most effective. Level III, therapeutic study.

SAT-LB68 A Rare De Novo Mutation in LRP5 Gene in an Adolescent Female With Juvenile Onset Primary Osteoporosis

Background: Juvenile onset of primary osteoporosis is a rare skeletal disorder with a highly heterogenous clinical presentation and complex poorly understood genetic etiology. Low-density lipoprotein receptor-related protein 5 (LRP5), a Wnt-β-catenin pathway receptor involved in bone mineral density (BMD) regulation, has been reported in children with primary osteoporosis mainly due to missense and frame-shift mutations. To our knowledge, there is only one report of in-frame deletions in exon 21 possibly being implicated in pregnancy related osteoporosis (1). We report the first case of a rare heterozygous de novo in-frame deletion in exon 21 of LRP5 gene in a girl with juvenile onset primary osteoporosis. Clinical Case: A 7.5 yo previously healthy European-African-American female born to non-consanguineous family, was noted to have left ankle and bilateral wrists fractures during sport activities occurring over the span of 1 y. On exam, she was of normal stature, had normal sclerae and vision, but was found to have hypermobile joints. Initial blood work revealed an elevated iPTH 72 pg/mL (9-59), normal Ca 9.6 mg/dL (8.9-10.4), and low 25OH-Vitamin D 17 ng/mL (30-100), which normalized with supplementation to 30.4 ng/mL. By 10.5 yo, she had sustained multiple sports related and pathologic fractures of long bones with progressive bone pain and functional ambulatory impairment. Radiographic evaluation showed osteopenia, multiple healed long bone fractures with presumed non-ossifying fibroma in the distal right femoral metaphysis, and subtle height loss of T4-5 vertebrae. CT bone densitometry at 12 yo showed low mean cancellous lumbar vertebral BMD of 190 mg/cm3 (ref. 285 ± 45) and normal cortical BMD of the femoral midshaft of 1977 mg/cm3 (ref. 2000 ± 60). Genetic testing for Osteogenesis Imperfecta returned negative for COL1A1 and COL1A2 mutations. Whole exome sequencing (WES) revealed a rare, de novo heterozygous mutation in exon 21 that involved deletion of nucleotides 4454 to 4465 resulting in an in-frame deletion of amino acid 1485 to 1488. This mutation is predicted to be deleterious by in silico analysis. Conclusion: We present the first case of a young female with progressive pathologic fractures, functional ambulatory impairment, and low BMD in childhood, consistent with juvenile onset primary osteoporosis. WES revealed a rare de novo heterozygous in-frame deletion mutation in LRP5, providing a plausible biological mechanism for her clinical presentation, and further contributing to the increasing genetic heterogeneity of juvenile onset primary osteoporosis and LRP5-related bone disorders. Reference: (1) Cook, F., Mumm, S., Whyte, M., Wenkert, D. Pregnancy-associated osteoporosis with a heterozygous deactivating LDL receptor-related protein 5 (LRP5) mutation and a homozygous methylenetetrahydrofolate reductase (MTHRF) polymorphism. JBMR. 2014;29 (4): 922-8.

Особливості клініко-рентгенологічного перебігу різних форм фіброзної дисплазії

The aim of the study: to improve the diagnosis of forms of fibrous dysplasia by investigating clinical and radiological features, depending on the disease form, age and sex of the patient. Materials and methods. The research was conducted by analyzing results of examination and treatment of 80 patients with different forms of fibrous dysplasia at Kyiv Institute of Traumatology and Orthopedics by NAMS of Ukraine from 2000 to 2019. The diagnosis was made on the basis of studying features of the medical history of the disease, its clinical course and radiological examination method. There were 56 patients with monoosal disorder, 14 with polyosal, and 10 with Albright syndrome. Clinical-radiological method of the research was used to clarify the diagnosis of the disease and to study features of the disease. The radiological examination was performed on the Multix UP in the department of functional diagnostics «ITO NAMSU» according to the standard technique in direct posterior and lateral projections with capture of adjacent joints. Localization, volume of lesion and condition of cortical layer at pathological dysplastic process of long bones of lower extremities were evaluated. Results . The article specifies clinical-radiological features revealed in various forms of fibrous dysplasia and shows that pathological fractures of the long bones and their deformation depend on the form of the disease, age and sex of patients. The incidence of pathological fractures of long bones of lower extremities was determined depending on the localization, form of the disease and sex of patients with different forms of fibrous dysplasia: femur – 72.3% (proximal part – 76.7%); tibia bones – 27.3% (diaphyseal part – 78.3%); it was found that the number of fractures was significantly greater (49.4%) with the monoosal form of fibrous dysplasia than with the polyosal form (30.1%, p<0.05) and Albright syndrome (20.5%, p<0,5); in males with monoosal form and Albright syndrome, the number of fractures was significantly greater (p<0.05) than in females. Conclusions . Features of the course of clinical and radiological manifestations depending on the form of the disease, age and sex of the patient have been covered in the article, which will allow reducing and eliminating diagnostic errors related to this pathology and create a basis for improvement of the system of orthopedic treatment of this nosology. The research was conducted in accordance with principles of the Declaration of Helsinki. The research protocol was approved by institution’s Local Ethics Committee. Informed consent was obtained from parents of children (or their guardians) for the research.

Pathological fractures of long bones of the skeleton in children and adolescents in benign tumors and tumor-like diseases

This article provides an analysis of 82 patients for the period from 2000 to 2018 aged 5 to 18 years with pathological fractures of the long bones of the skeleton on the basis of benign tumors and tumor-like diseases. Most often, fractures were observed with a solitary bone cysts 24, an aneurysmal bone cyst 19, fibrous dysplasia 20, neosteogenic fibroma 7, Olliers disease 6, osteofibrous dysplasia 2, giant-cell tumor 3, hemangioma 1. On the basis of the Department of Pediatric Bone Pathology and Adolescent Orthopedics of N.N. Priorov National Medical Research Center of Traumatology and Orthopedics all patients underwent a comprehensive physical exams and surgical treatment. The clinical and radiological picture was studied and the features of the course of pathological fractures were revealed depending on the nosology of the tumor process. It is shown that when a pathological fracture occurs, the treatment approach should be individualized depending on the location of the focus, the patients age and nosology.

Effect of Radiation Field Size and Dose on Local Control or Re-fracture Events after Post-Operative Radiation Following Intramedullary Nailing Procedures for Palliation of Bone Metastases

Pathologic fracture of long bones carries a heavy symptomatic burden in patients with metastatic malignancy. Standard therapy typically includes intramedullary nail placement to stabilize the bone, followed by palliative post-operative radiation therapy (PORT) to reduce the risk of re-fracture or local recurrence. The radiation dose and fields for this treatment approach have wide variation without uniform standards. We sought to estimate the distribution of PORT dose/fractionation, and field size, and estimate any potential association with the risk of re-fracture and/or local recurrence. We retrospectively analyzed patients treated at our institution with pathologic fractures of long bones, treated with intramedullary nailing of the femur, tibia, or humerus, followed by post-operative palliative radiation to that site. We stratified patients by radiation fractionation (single vs multi-fraction regimen) and by radiation field size (coverage of whole hardware [full-field] vs partial coverage of hardware [limited field]), to determine if these factors may be associated with the primary endpoint, which was defined as local re-fracture and/or local recurrence of disease within the long bone. Fisher’s exact test was used for statistical comparison due to the relative paucity of events. Eighty-six evaluable patients, treated between 2010 and 2017, were identified. Median patient age was 60 years. Median Karnofsky performance status was 70. Median follow up was 2.6 months (range, 2 weeks to 74 months). Radiation doses ranged from 8 – 30Gy, apart from one patient who received 45Gy in 3 Gy fractions. Thirty-six patients (42%) received 8 Gy in a single fraction, and fifty (58%) received multi-fraction treatment. Ten patients (12%) underwent limited field radiation, while 47 (55%) underwent full field radiation, and 29 (34%) were unevaluable for field size. Nine patients (10%) reached the primary endpoint of local recurrence and/or local refracture, consistent with historical comparison. On Fisher’s two-sided exact test, field size was not found to correlate with local recurrence/re-fracture (p=0.366). Local recurrence/re-fracture was also not significantly associated with multi-fraction radiation, compared to those who received 8 Gy in a single fraction, although was numerically worse in the multifraction group (p=0.073). Increased total dose beyond 8 Gy was not associated with improvement in local control. Similarly, irradiation of the entire hardware was not associated with improved rates of local control as compared to limited field radiation. Our findings suggest that single-fraction, limited-field palliative PORT may be sufficient to achieve adequate rates of local control, thereby allowing for expedient initiation of systemic therapy and minimal RT toxicity. Further evaluation is needed.

Surgery and Functional Results of Pathological Fractures of Long Bones of Lower Extremities in Malignant Tumors

Surgery and Functional Results of Pathological Fractures of Long Bones of Lower Extremities in Malignant Tumors

Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions.

The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population. A retrospective review of surgical databases at three National Cancer Institute (NCI)-designated cancer centers identified 287 patients with a total of 336 impending or pathologic long-bone fractures that were stabilized with intramedullary nailing between February 2001 and April 2013. Statistical analysis was performed utilizing multivariable logistic regression and Fisher exact tests. The overall rate of VTE was twenty-four (7.1%) of the 336; thirteen (3.9%) were pulmonary embolism (PE), and eleven (3.3%), deep venous thrombosis (DVT). In two patients, adequate anticoagulation data were not available. We found no significant relationship between the type of anticoagulant used and VTE. There was a significant positive correlation found between lung-cancer histology and the development of VTE (p < 0.001) or PE (p < 0.001). The absence of radiation therapy approached significance (p = 0.06) with respect to decreased overall VTE risk. Wound complications were documented for 11 (3.3%) of the operations. There is a high rate of VTE among those with skeletal metastatic disease who undergo intramedullary nailing, even while receiving postoperative thromboembolic prophylaxis. Current anticoagulation protocols may be inadequate. Wound-complication risk with anticoagulant use in this population is low and should not be a deterrent to adequate anticoagulant use for this population.

Pycnodysostosis with a patella fracture

A 33-year-old woman was admitted to hospital with an injured right knee. She had a history of fractures and been previously diagnosed with osteopetrosis. She was 136 cm tall with short digits, fl at and grooved nails, and all the facial characteristics of pycnodysostosis. Results of laboratory tests showed no evidence of anaemia. Radiography revealed a patella fracture with increased bone density and acro-osteolysis of the distal phalanges (fi gure A, B). She was diagnosed with pycnodysostosis on the basis of clinical and radiological fi ndings. Surgical repair was undertaken, and low-intensity pulsed ultrasound treatment was initiated postoperatively. Bony union was confi rmed with full range of active knee motion 15 months after surgery. Pycnodysostosis is an autosomal recessive lysosomal storage disorder caused by a mutation in the gene encoding the enzyme cathepsin K. Features of pycnodysostosis include short stature and acroosteolysis. Laboratory results showing no evidence of anaemia can help to diff erentiate pycnodysostosis from osteopetrosis. Pathological fractures of long bones are characteristic of pycno dysostosis, whereas patella fractures are extremely rare.

Obituary: Kevin D. Harrington MD (1938-2013)

Kevin D. Harrington MD (Fig. 1), a long-time member and Past President of the Association of Bone and Joint Surgeons®, passed away on January 7, 2013. Fig. 1 Kevin D. Harrington MD is shown. Few orthopaedic surgeons make lasting contributions to our field, and rarely do they make more than one. Dr. Harrington was an exception. It is difficult to imagine the rudimentary surgical tools available to treat bone cancers in the late 1970s when he started to demonstrate his practical creativity. His novel approaches stood the test of time. He took the recent development of methylmethacrylate cement into the oncology realm, using it to augment fixation, resist tumor growth, and stem bleeding in pathological fractures of long bones. He used similar basic principles to revolutionize the treatment of acetabular metastases, and skeletal metastases. The approach of using Steinmann pins and cement to bypass areas of periacetabular deficiency has become an eponymous procedure. Dr. Harrington identified principles that are seemingly obvious now, but mystified his predecessors. His classic description that metastatic disease of the spine was based predominantly anteriorly in the vertebral body and should be treated by anterior decompression and instrumentation rather than laminectomy, has forever changed spine surgery. His simple spine reconstructions remain among the most economical, effective methods reported. Principles of economy, efficiency, and efficacy guided Dr. Harrington’s work. He adopted the concept of autoclaving resected sarcomatous periacetabular bone to recycle for hip reconstruction. This method is used worldwide, and is getting a new look in the United States due to FDA imposed limits on the manufacture of custom prostheses. Throughout his career, he took a critical approach to problems and procedures. For example, he first confessed the neurological consequences that can occur after vertebroplasty, and raised a clarion call to use careful technique for this new procedure. His simple yet profound contributions will live on. A San Francisco native, Dr. Harrington graduated from Lowell High School (1956), Yale University (1960), and the University of California San Francisco (UCSF) School of Medicine with honors (1964). He interned at the Hospital of the University of Pennsylvania in 1965, served 3 years in the US Army (1966–1969), and worked as an orthopaedic resident at UCSF (1969–1972). He was assistant chief of orthopaedic surgery at San Francisco County Hospital from 1972 to 1977 before entering private practice in San Francisco. Dr. Harrington volunteered at the Albert Schweitzer Hospital in Haiti and at the “Hole in the Wall Gang” camp, a no-fee program for youth with cancer and other serious illnesses, in Connecticut. Finally, after retiring from private practice in 2003, he committed his time, talent, and great enthusiasm to the Marin Community Clinics (MCC), where he spearheaded and expanded orthopaedic services to the underserved of Marin County. He was awarded the “Community Champion” award by the MCC in 2012 for his commitment to the ideal “all patients deserve quality care and attention no matter what their financial circumstances.” Kevin is survived by Margaret (Peggy) Harrington MD, his wife of 32 years, their five children, and other relatives.

CLINICAL OUTCOMES AND ORTHOPEDIC SURGERY FOR BONE METASTASES FROM HEPATOCELLULAR CARCINOMA

Purpose: The aim of the present study was to elucidate the clinical outcomes of hepatocellular carcinoma (HCC) metastases to bone. Methods: The clinical records of 15 patients diagnosed with HCC metastases to bone were retrospectively reviewed. The patients' mean age was 70.8 years. Patients were followed for an average period of 333 days. Clinical features, treatments and outcomes were analyzed. Results: Extrahepatic metastases, except to bone, were detectable in the lymph nodes of three patients (20.0%), the lungs of two patients (13.3%) and the adrenal glands of two patients (13.3%). Radiation therapy was carried out at 31 sites in 13 patients and its efficacy was calculated to be 80.6%. Orthopedic surgery was undertaken at 15 sites in 10 patients. Unexpected mortality due to bleeding occurred suddenly in two patients soon after surgery. Conclusions: Radiation therapy may be the first-choice palliative treatment for bone metastases from HCC. If the condition allows for residual liver function and a coagulative pattern, surgery must be considered for the treatment of some severe pain symptoms, including those caused by pathological fractures of long bones and increased symptoms due to nerve compression caused by spinal metastases. Surgical planning, such as preoperative transarterial embolization or intraoperative cementing, may play an important role in reducing intraoperative bleeding, which can lead to liver failure and death.

Pathologic Fractures in Children with Acute Staphylococcus aureus Osteomyelitis

Osteomyelitis is a common pediatric musculoskeletal infection. This infection can weaken the normal bone structure, resulting in the risk of a pathologic fracture. The purpose of this study was to evaluate the risk factors for pathologic fracture in children with Staphylococcus aureus osteomyelitis. Seventeen children who were treated for a pathologic long-bone fracture secondary to Staphylococcus aureus osteomyelitis between January 2001 and January 2009 at a tertiary-care pediatric hospital were identified. These patients were compared with a control group consisting of forty-nine children with Staphylococcus aureus osteomyelitis without a fracture who were matched for age, sex, and methicillin susceptibility. A retrospective review of the clinical records, magnetic resonance imaging (MRI) studies, and microbiologic findings was performed. Patients who developed a fracture presented with osteomyelitis at a mean age of 8.8 years (range, two to seventeen years). Fifteen of the seventeen patients had methicillin-resistant Staphylococcus aureus (MRSA) isolates, and two had methicillin-susceptible Staphylococcus aureus (MSSA). The mean time from disease onset to fracture was 72.1 days (range, twenty to 150 days). The duration of hospitalization, number of surgical procedures, duration of antibiotic treatment, and total number of complications differed significantly between the two groups. MRI studies at the time of admission demonstrated a significantly greater prevalence of subperiosteal abscess and greater circumferential size of such an abscess in the patients with a fracture. A sharp zone of abnormally diminished enhancement of the marrow was also more common in these patients. The USA300-0114 pulsotype was more commonly associated with an elevated likelihood of fracture. Staphylococcus aureus osteomyelitis is a serious infection that may predispose children to pathologic fractures. Protected weight-bearing and activity restriction are recommended in children with Staphylococcus aureus osteomyelitis who have the risk factors demonstrated in this study.

The invisible nail: A technique report of treatment of a pathological humerus fracture with a radiolucent intramedullary nail

The goal in the treatment of pathological fractures of long bones is to gain functional stability of the limb, improve quality of life and relieve the pain of the broken bone. Metastatic bone disease presents a challenge for orthopaedic surgeons because of the potential for local tumour recurrence and the susceptibility for nonunion of fractures. The carbon-fibre nail possesses special qualities not present in traditionalmetal nails. The use of a radiolucent intramedullary nail has the potential to enhance clinical follow-up of bone healing postoperatively, and improve overall clinical outcomes. We present the technique of intramedullary nailing of a pathological humerus fracture with a radiolucent carbon-fibre nail.

Viewing FOP through rosi-colored glasses

Viewing FOP through rosi-colored glasses

Surgical Treatment of Metastatic Fractures of the Femur: A Retrospective Analysis of 142 Patients

Pathologic fractures of long bones are common complications of the metastatic disease; however, the influence of the primary tumor, the stage of metastatic disease, different surgical techniques, and the postoperative mobility on the postoperative survival has not been clearly defined. The aim of this retrospective study was to evaluate outcome after surgical treatment for pathologic femur fractures. A consecutive series of 142 patients with metastatic fractures of femur were retrospectively studied. The operative treatment was based on intramedullary fixation (n = 94), gliding screws (n = 15), other extramedullary fixation devices (n = 7), and arthroplasty (n = 23). Seventeen percent and 6% of the patients survived 1 year and 2 years, respectively, postoperatively. Postoperative survival was higher in patients with pathologic femur fractures because of breast carcinoma than in patients with other primary tumors. The rate of complications for patients with intramedullary stabilization, gliding screw fixation, and endoprosthetic replacement was 3.2%, 20%, and 8.6%, respectively. Although many studies describe the endoprosthetic replacement as the safer method to treat pathologic femur fractures, our data showed that intramedullary stabilization and endoprosthetic replacement to be safe, and equivalent alternatives to treat complete pathologic fractures of the femur in patients with advanced metastatic disease.

Pathologic fractures of long bones in Nigerian children

Pathologic or spontaneous fractures are recognised causes of morbidity in children. There is a paucity of data on their aetiology and patterns in African children. A combined retrospective and prospective study of 47 children aged 15 and below with pathologic fractures of long bones seen from January 2000 to December 2006. The setting was the Orthopaedic and Traumatology department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A total of 47 patients with a mean age of 5.3 years +/- SD with pathologic fractures of 50 long bones were seen and treated. The most commonly affected bones were the femur (28%), tibia (28%) and humerus (26%). Chronic osteomyelitis following inadequately treated acute haematogenous osteomyelitis was the commonest cause of pathologic fractures (74.5%). The mean duration of fracture union was 6.8 +/- 2.3 months and the outcome was satisfactory in 91.4% of cases. The aetiology of pathologic fractures in the African population is different from their causes in Caucasian children. Chronic osteomyelitis following inadequately treated acute haematogenous osteomyelitis continues to plague many children in our environment.

Protocollo di trattamento delle metastasi ossee da carcinoma

Metastatic bone disease requires a multidisciplinary approach and the goal of the purposed protocol of treatment is to integrate the role of different specialistic figures in the treatment program. The aims of treatment in appendicular skeletal metastases are to prevent and to cure pathologic fractures of long bones, to achieve pain control and to provide an adequate quality of life. The guide lines of protocol resulted helpful in defining when surgery was indicated and what kind of surgery had to be preferred for every single metastatic patient.

Surgical Interventions for Cancer Patients With Impending or Actual Pathologic Fractures

Oncology patients are at risk of developing bone metastases that frequently result in destructive lesions of the skeleton. Treatment options for patients diagnosed with metastatic bone disease depend on the primary cancer site, presence of pain, and fracture risk. Typically, surgical intervention is the best form of management for impending or actual pathologic fractures of long bones because they are associated with considerable mortality. The purpose of this clinical article is to describe the pathogenesis of bone metastases and review the clinical presentation and evaluation. The surgical management of impending and actual pathologic fractures is reviewed with an emphasis on evaluating the risks and benefits associated with the surgical treatment of the femur. Nursing implications for patient assessment, monitoring, and education to minimize the risk of postoperative complications are presented.