Presence Of Pathological Fracture Research Articles

Is there an optimal perioperative risk assessment tool for older adult ankle fractures?

To measure the predictive value of three perioperative risk assessment tools (National Surgical Quality Improvement Program-NSQIP, Modified 5-factor Frailty Index-mFI-5, and Score for Trauma Triage in Geriatric and Middle Aged-STTGMA) in predicting postoperative complications in older adult ankle fractures. This is a retrospective study of surgically treated isolated older adult ankle fractures at an academic center between 2007 and 2022. Exclusion criteria included age < 55 years, presence of pathologic fractures, and having multiple orthopaedic injuries. Patient sociodemographic information, injury characteristics, clinical outcomes, and complications were obtained. Data was entered into the NSQIP, mFI-5, and STTGMA calculators. Descriptive statistics and univariable logistic regression models were calculated for each outcome of interest. Area under the receiver operative curves (AUC) were determined as a measure of tool discrimination. 382 patients met inclusion criteria. The average age was 67 years, 33% were male, and 87% ambulated without assistive devices prior to injury. 23.6% of all patients had a complication: 12.8% had at least one minor complication, 15.7% had at least one major complication, and 2.4% had surgical complications. Mortality within 1 year of initial injury was 2.9%. NSQIP was the best predictor of any complication (AUC 0.74) compared to the mFI-5 (AUC 0.68), and STTGMA (AUC 0.72). NSQIP performed better than mFI-5, STTGMA, and CCI for postoperative complications and mortality, but none of the perioperative risk assessment tools performed exceptionally well in the context of isolated older adult ankle fractures.

Therapeutic strategies for mobile spine chordoma: en bloc Versus intralesional surgery with adjuvant charged-particle therapy.

The aim of this retrospective study is to analyze the impact of en bloc resection with negative margins versus intralesional resection plus adjuvant hadron-therapy (HT) on local control (LC) and overall survival (OS) in patients with mobile spine chordomas. Mechanical complications incidence as well as risk factors, and outcome differences are investigated as secondary endpoints. 33 patients in a period from January 2013 to December 2021 were enrolled for the final analysis. The inclusion criteria were: lesions located in the mobile spine (C1-L5), age ≥ 15 years, minimum follow-up of 2 years, en bloc or intralesional surgical resection, virgin or recurrent chordomas, with only one previous surgical treatment. No difference was found in terms of LC between the two groups. The presence of pathologic fracture at pre-operative imaging and the presence of macroscopic residual tumor after surgery, independently from its entity, seemed to be associated with an increased risk of LR. No difference was found between planned en bloc and planned intralesional surgery in terms of mechanical complications occurrence. Eight patients (24.24%) had mechanical complications during the follow up period: male sex, presence of pathologic fracture at baseline, a combined surgical approach, the use of carbon fiber-only hardware appeared to be associated with an increased risk of mechanical complications after the primary surgery. En bloc resection, whenever possible, is always to be preferred for its widely recognized potential in LC and OS improvement. However, technology advances in high-dose conformal charged-particle therapy have allowed improvement of local control rates as an adjuvant therapy of intralesional surgery for mobile spine chordoma, with acceptable acute and chronic toxicity.

Surgical outcomes of proximal femoral bone cysts in pediatric patients: a retrospective study of 41 cases.

The aim of this study was to evaluate the surgical outcomes of proximal femoral bone cysts in pediatric patients. We retrospectively analyzed 41 pediatric patients (31 males and 10 females, mean age 7.47 ± 2.67 years, range 2.03-14.67 years) diagnosed with proximal femoral bone cysts treated at a single institute between March 2009 and November 2021. Data included demographics, preoperative details, intraoperative conditions, surgical techniques, postoperative outcomes, recurrence, and complications. Of the participants, 68% presented with simple bone cysts and 32% with aneurysmal bone cysts. Prior to surgery, 32% exhibited pathological fractures. Surgical methods included lesion curettage, defect filling using allograft bone and Minimally-Invasive Injectable Graft ×3, and varied fixation techniques. Postoperative recurrence (17%) was associated with cyst location between the capital femoral epiphysis and the linea intertrochanterica (P = 0.010). At the final assessment (mean follow-up: 26.51 ± 18.99 months), all showed radiological bony union with 93% rated as "good" and 7% as 'fair' based on Ratliff hip scores. Complications arose in 20% of patients, significantly correlated with prior pathological fractures (P = 0.007) and their association with the linea intertrochanterica (P = 0.004). Those with fractures reported higher intraoperative blood loss (P = 0.015) and longer surgery durations (P = 0.012) compared to those without. Treating pediatric proximal femoral bone cysts using techniques such as lesion curettage, defect filling, and selective internal fixation yields favorable outcomes. The presence of pathological fractures can prolong surgical time, increase intraoperative blood loss, and elevate postoperative complication risks. Hence, early surgical intervention for these cysts is recommended to prevent fractures.

Surrogate markers in assessment of bisphosphonate effectiveness in osteoporosis treatment (bone mineral density, bone turnover markers)

A review of the literature which summarizes our knowledge on the use of surrogate markers of the osteoporosis treatment effectiveness when on bisphosphonate (BP) therapy. Bone mineral density (BMD) and markers of bone turnover, which have been shown to be associated with the clinical fracture end point, have been used as surrogate criteria for the effectiveness of treatment of osteoporosis in randomized controlled trials. When prescribing BP for the treatment of osteoporosis, BMD measurement every 12 months by dual-energy x-ray absorptiometry (DXA) is the well-described surrogate marker of BP efficacy. At the same time, stabilization of BMD is also a criterion for the treatment effectiveness since changes in BMD determined only 16% of the anti-fracture effectiveness of BP. Markers of bone remodeling can be used as surrogate markers after 3 (bone resorption) or 6 (bone formation) months from the start of BP therapy. A decrease of 30% or more is considered to be prognostically effective for both antifracture and BMD gain. There is a direct relationship between the degree of bone remodeling markers decrease and the antifracture effectiveness of BP therapy. The decrease in markers persists throughout the entire period of therapy and, accordingly, they can be used as surrogate markers of effectiveness and adherence to BP therapy throughout the entire treatment period. However, the presence of pathological fractures is a key clinical manifestation of osteoporosis and should be considered first in every decision making compared to any surrogate marker.Thus, when prescribing BP treatment, surrogate markers of changes in BMD and/or markers of bone remodeling can be used to monitor the effectiveness of treatment throughout the entire period of treatment and patients’ monitoring.

Incidence and progression of osteoarthritis following curettage and cementation of giant cell tumor of bone around the knee: long-term follow-up

BackgroundGiant cell tumor of bone (GCTB) is a benign locally aggressive tumor frequently treated with intralesional curettage and cementation. The aim of this study was to investigate the long-term incidence of arthritic changes following curettage and cementation of GCTB around the knee.Materials and methodsThis study was a retrospective review of patients with GCTB around the knee treated with curettage and cementation with a minimum follow-up of 10 years. The functional results were assessed using the Musculoskeletal Tumor Society (MSTS) score. The arthritic changes were classified using the Kellgren–Lawrence (KL) classification system of osteoarthritis.ResultsThis study included 119 patients, 54 males and 65 females, with a mean age of 29.4 ± 9.2 years. There were 35 (29.4%) patients with pathological fractures. There were 84 (70.6%) patients with de novo lesions and 35 (29.4%) with recurrent lesions. The mean follow-up period was 13.2 ± 3.16 years. The mean MSTS score was 28.5 ± 1.9. Overall, 25 (21%) patients developed variable degrees of arthritis of KL grade 1 (n = 7), KL grade 2 (n = 11), KL grade 3 (n = 4), and KL grade 4 (n = 3). Ten patients showed progression of arthritis during the follow-up period. Age at presentation, gender, presence of pathological fracture, whether the tumor was de novo or recurrent, and tumor location were not associated with arthritis incidence.ConclusionsCurettage and cementation can be used safely to treat GCTB around the knee. Arthritis of the knee is a possible complication, but mild grades are expected in most cases. There was no association between arthritis incidence and age, gender, pathological fractures, tumor location, or recurrent tumors.Level of evidenceLevel IV.

Long-term patient rehabilitation and quality of life after oncological endoprosthesis of long bones and joints

Background. Currently, endoprosthesis of large bones and joints is the standard of treatment for patients with tumors in the bones and joints of the upper and lower limbs and pelvis. However, the problem of integrated medical rehabilitation of these patients remains unsolved. In the postoperative period, patients frequently experience such functional abnormalities as limited mobility in the operated joint, pain, deceased locomotor activity in the joints due to prolonged bedrest leading to muscle hypotrophy. These abnormalities interfere with return to full social life affecting patients’ quality of life and making rehabilitation very important. Aim. To evaluate the effect of rehabilitation on patients’ quality of life and social adaptation after oncological endoprosthesis. Materials and methods. The study included 57 patients: 27 (47 %) males and 30 (53 %) females. Mean age was 46 years (19–71 years). In 10 patients, tumors were localized in the bones of the upper limb; in 6 patients, in the pelvic bones; in 41 patients, in the bones of the lower limb. Tumor volume varied between 24 and 3,783 cm3 (median 631 cm3 ). Pathological fractures were observed in 13 (24.5 %) patients, their risk – in 13 (24.5 %) patients. Patient activization was started at day 1–14 after surgery, passive working out of the operated limb on day 2–14. For quality of life evaluation, The Short Form-36 (SF-36) was used allowing to determine patients’ health. Functional results were analyzed using the Musculoskeletal Tumour Society score (MSTS), rehabilitation potential using the Tampa Scale of Kinesiophobia covering both physical and psychological components. Social status was evaluated based on patient’s occupation and social adaptation. Results. Performance of active rehabilitation activities after onco-orthopedic intervention allows 72 % of patients to achieve good and excellent functional results per the MSTS scale (60–97 %) under condition of protective regimen observation, as well as positively affects physical and psychological parts of quality of life. Use of Tampa Scale of Kinesiophobia allows to correct psychological and/or physical parts of kinesiophobia in a timely fashion. Adequately performed rehabilitation allows 46 % of patients to remain socially active, continue working. Conclusion. Scale of surgical intervention, presence of pathological fracture, as well as postoperative complications, affect both functional results and quality of life of patients which in this period in most observations is higher than prior to onco-orthopedic treatment. Tampa Scale of Kinesiophobia allows to evaluate patient motivation towards postoperative recovery and provide psychological help in a timely manner which decreases rehabilitation time.

Initial Characterization of Focal Bone Lesions with Conventional Radiographs or Computed Tomography: Diagnostic Performance and Interobserver Agreement Assessment.

Objectives: To ascertain the role of CT and conventional radiographs for the initial characterization of focal bone lesions.Methods: Images from 184 patients with confirmed bone tumors included in an ethics committee-approved study were retrospectively evaluated. The reference for benign-malignant distribution was based on histological analysis and long-term follow-up. Radiographs and CT features were analyzed by 2 independent musculoskeletal radiologists blinded to the final diagnosis. Lesion margins, periosteal reaction, cortical lysis, endosteal scalloping, presence of pathologic fracture, and lesion mineralization were evaluated. Results: The benign-malignant distribution in the study population was 68.5-31.5% (126 benign and 58 malignant). In the lesions that could be seen in both radiographs and CT, the performance of these methods for the benign-malignant differentiation was similar (accuracy varying from 72.8% to 76.5%). The interobserver agreement for the overall evaluation of lesion aggressiveness was considerably increased on CT compared to radiographs (Kappa of .63 vs .22). With conventional radiographs, 18 (9.7%) and 20 (10.8%) of the lesions evaluated were not seen respectively by readers 1 and 2. Among these unseen lesions, 50%-61.1% were located in the axial skeleton. Compared to radiographs, the number of lesions with cortical lysis and endosteal scalloping was 26-34% higher with CT. Conclusion: Although radiographs remain the primary imaging tool for lesions in the peripheral skeleton, CT should be performed for axial lesions. CT imaging can assess the extent of perilesional bone lysis more precisely than radiographs with a better evaluation of lesion fracture risk.

Reconstruction of postoperative defects using carbon nanostructured implants with intramedullary osteosynthesis after extremity long bone resection for primary and metastatic tumors

Background. Recent studies have shown that a combination of surgery with chemotherapy and radiotherapy can signifcantly improve survival in patients with primary and metastatic bone tumors. Reconstruction of bone defects after resection of long bones is critical for successful functional limb salvage. The choice of the reconstruction technique depends on the tumor location, tumor extension, presence of pathological fracture, and somatic status of the patient. Reconstruction of bone defects in cases with diaphyseal tumor location can pose a surgical challenge. For the reconstruction of diaphyseal bone defects, endoprostheses, alloimplants, and autologous bone grafts are used. To achieve stability of the affected segment of the limb, various options for osteosynthesis are used. Modern technological achievements provide the emergence of materials with characteristics close to those of human bone tissue, however, without the disadvantages inherent in allo- and autologous implants. The purpose of the study was to improve surgical treatment outcomes in patients with long tubular bone tumors. Material and Methods. For the reconstruction of postoperative long bone defects, we used carbon nanostructured implants (СNI) in combination with intramedullary osteosynthesis with a blocked pin. A total of 25 patients underwent surgery (including 9 patients with a pathological fracture), 24 of them had metastases. Results. There were no intraoperative and postoperative complications. All patients had a signifcant decrease in pain 1 month after surgery. At 3 months after surgery, functional outcomes were satisfactory. None of the patients had a local recurrence, instability of the operated limb segment, or a reaction of rejection of a carbon nanostructured implant. Conclusion. Reconstruction of postoperative defects with carbon nanostructured implants after resection of long tubular bones for metastatic cancer provides good functional results and satisfactory local control.

Impact of Patient and Tumor Characteristics on Range of Motion and Recurrence Following Treatment of Enchondromas of the Hand

The approach to the treatment of enchondromas of the hand is varied, and there is no clear consensus on graft source, fixation, or need for intraoperative adjuvant therapy. We reviewed a cohort of patients who underwent curettage and bone grafting with cancellous allograft chips without internal fixation or adjuvant therapy and reported on postoperative range of motion (ROM) and recurrence rates. We performed a retrospective review of patients who underwent surgical treatment for hand enchondroma over a 23-year period. We collected information on demographics and presenting enchondroma characteristics, including Takigawa classification and presence of pathologic fracture or associated syndromes. Patients were treated with open biopsy with curettage and grafting with cancellous allograft chips. Postoperative ROM, complications, and recurrences were recorded. Our series included 111 enchondromas in 104 patients. Seventeen of 104 patients (16%) had a diagnosis of Ollier disease. Average length of follow-up was 3.1 years. Eighty-one percent of patients achieved full ROM. Treatment of patients who presented with preoperative pathologic fracture resulted in a greater frequency of reduced postoperative ROM at 28% (9/32) compared to 15% (11/72) of those patients who did not present with preoperative pathologic fracture. Local recurrence developed in 5 of 50 (10%) patients with a minimum of 2 years of follow-up. Local recurrence occurred at higher-than-average rates in patients with giant form Takigawa classification (43%, 3/7) and Ollier disease (23%, 3/13). Treatment of enchondromas with biopsy, curettage, and allograft results in full ROM in 81% of patients. Patients with preoperative pathologic fracture should be advised of a greater risk of postoperative extension deficit. Recurrence remains rare and is associated with syndromic presentation and giant form lesions. Therapeutic IV.

Метастази анонімного раку в довгі кістки кінцівок: підходи до обстеження та лікування

У статті повідомляється про результати обстеження та лікування 50 пацієнтів із метастазами анонімного раку в кістці. Хворим проводилося комплексне обстеження: рентгенографія вогнища ураження в кістці; рентгенографія та комп’ютерна томографія органів грудної порожнини; ультразвукове дослідження, комп’ютерна або магнітно-резонансна томографія органів черевної порожнини, заочеревинного простору та малого тазу; остеосцинтиграфія; комп’ютерна або магнітно-резонансна томографія головного мозку; позитронно-емісійна томографія. З метою верифікації процесу виконана відкрита або трепанобіопсія метастатичного вогнища в кістці. Лікувальна тактика визначалася з урахуванням загального стану хворого, локалізації метастазів, поширеності пухлинного процесу, морфологічної будови метастатичної пухлини, передбачуваної локалізації первинного вогнища. У 41 пацієнта з множинними метастазами при тяжкому загальному стані та відмові хворих від оперативного втручання здійснювали іммобілізацію ураженої метастазом кінцівки гіпсовою пов’язкою. У 6 пацієнтів із відносно задовільним загальним станом виконані органозберігаючі операції. У 3 хворих виконані операції, що калічили (ампутація й екзартикуляція кінцівки). Після проведених діагностичних, консервативних і хірургічних заходів усі хворі продовжили комплексне (поліхіміотерапія, променева терапія, бісфосфонати) або симптоматичне лікування. Вибір схеми поліхіміотерапії в пацієнтів із метастазами анонімного раку визначався гістологічним типом пухлини. У результаті проведеного лікування встановлено, що середня тривалість життя пацієнтів із метастазами анонімного раку, які отримували комплексне лікування, вища, ніж в осіб, лікування яких обмежилося симптоматичною терапією.

Surgical Treatment Modalities in Pediatric Monostotic Fibrous Dysplasia of Proximal Femur - A Case Series.

Monostotic fibrous dysplasia is a rare genetic non-inherited orthopedic condition presenting at any age with variable presentation. Proximal femur being the most common site, the mechanical factor predisposes it to increased chances of pathological fracture, which makes it challenging to choose an appropriate treatment modality and implant selection in children. In this retrospective case series, six children aged 7-12 years with monostotic fibrous dysplasia with or without fracture were treated with different treatment modalities from 2015 to 2020. Extended curettage and bone grafting and stabilization were done with extramedullary implants such as locking plates and DHS. Autograft alone or combination with allograft was chosen according to size of lesion. Patients without fracture were treated with curettage and artificial bone graft substitute with hip spica. Patients were followed up to 12 months. Revised Musculoskeletal Tumor Society (MSTS) score at each follow-up and Toronto Extremity Salvage Score (TESS) at final follow-up. Mean fracture healing time was 14.8 ± 2.28 weeks. in patients with fracture. Full weight-bearing was started at average 15.67 ± 2.94 weeks. One patient had shortening of 1 cm but none had any surgical site infection, loss of correction, or varus collapse more than 5°. Mean revised MSTS at 12 months was 24.2 ± 2.28 in patients with curettage, bone grafting, and internal fixation, while it was 27 in patients with curettage, grafting with hip spica. Mean TESS was found to be 90 ± 9.41 in internal fixation group, while it was 95 in patient with curettage, grafting with hip spica. Treatment modality should be chosen wisely after analyzing pre-operative radiograph, lesion size, presence of pathological fracture, and each patient profile. Extramedullary fixation devices can be an alternate choice of implant in children and adolescents for monostotic fibrous dysplasia. Long duration follow-up and patient counseling should be done for recurrence of lesion and deformities.

Features of pain syndrome in patients with bone metastasis

Purpose. The purpose of the current study was the search for evaluation criterion for the radiosensitivity of bone metastases of various origins. Materials and methods. The first part of the study presents a modern classification of pain, method of its evaluation, mechanisms and features of metastatic bone pain. The radiobiological patterns of pain relief in low-dose anti-inflammatory radiation therapy were also considered. The analysis of these features testifies in favor of the antitumor mechanism of pain relief in high-dose irradiation. To identify the relationship between pain and other clinical symptoms, 810 cases of bone metastases of various localization and morphology were analyzed. Results. The severity of pain directly correlates with gender, lesion length and little affected by the presence of pathological fracture. The intensity of pain does not depend on the primary tumor and bone metastases localization and does not correlate with the presence of neurological deficit. Conclusion. Completeness and persistence of the analgesic effect may reflect the real radiosensitivity of bone metastases, but taking into account the patient's gender and lesion length in the irradiated area.

The role of puncture biopsy in the treatment of pathological fractures of the cervical vertebrae

The aim is to analyze the data obtained during biopsy of primary and secondary lesions and pathological fractures of the cervical vertebrae and their influence on the tactics of treatment of patients. Evaluation of the effectiveness of biopsy of pathological processes in the cervical vertebrae.&#x0D; Materials. The results of biopsies of 20 patients with lesions of the cervical vertebrae of unknown etiology or with the presence of pathological fractures with compression of the spinal cord and roots by a vertebra or a soft tissue component were analyzed.&#x0D; The following results were obtained: the presence of a secondary lesion of the cervical vertebrae was revealed: metastatic nature – 10, primary tumors – 1, lymphoproliferative tumors – 3, no tumor lesion was detected – 3, not enough material for the study – 3.&#x0D; Conclusion. The results obtained indicate the high efficiency and sufficient safety of puncture biopsy in diagnosing lesions of the cervical vertebrae, even in complex localizations (C2). Revealing the nature of vertebral lesions in the absence of absolute indications for decompression and stabilization interventions significantly affects the tactics and order of treatment of the patient.

Modular endoprosthetic replacement for proximal tibia tumor patients

The major method of malignant bone tumors treatment is surgery. The most important task of an orthopedic surgeon is to preserve an adjacent joint. Currently, there are a large number of various reconstructive surgeries, including structural bone allograft, allocomposite and modular endoprosthetics replacement. The aim: to analyze the results of surgical treatment for proximal tibia malignant tumors using modular endoprosthesis. Materials and methods. The results of proximal tibia (PT) modular endoprosthetic replacement in 48 patients with PT tumor lesions were evaluated. The patients were divided into two groups: I (n = 36) – tumor resection and primary modular endoprosthesis, II (n = 12) – revision modular endoprosthetic replacement due to complications. Complications were divided into oncological, mechanical and non-mechanical. The functional outcomes were measured using the MSTS and TESS scores. Results. During the treatment, 10 (21.2 %) patients underwent myofascioplastic amputation at the middle third of the thigh: due to periprosthetic infection – 8 people and tumor recurrence – 2. It was found that the patients got back to regular way of life on average in 2.0–2.5 months. Functional results on the MSTS score were 73 ± 12 %, on the TESS score – 74 ± 16 %, which corresponds to good functional results. Among the patients, who underwent limb salvage surgery, no tumor recurrence was detected during a follow-up period from 6 months up to 11 years. Conclusions. The choice of surgical treatment depends on the size of tumor, its location, pathohistomorphological picture, age, presence of pathological fractures, vascular and nerve tumor invasion. The use of modern designs of PT modular tumor endoprostheses and perfect surgeries makes it possible to minimize complications.

The incidence and diagnostic relevance of pathological fracture in conventional central chondrosarcoma.

To determine the incidence and diagnostic relevance of pathological fracture in patients with conventional central chondrosarcoma (CC-CS). Retrospective review of patients with CC-CS diagnosed between January 2007 and December 2019. Data collected included age, sex, skeletal location and the presence of pathological fracture at presentation. Histological tumour grade based on surgical resection or needle biopsy was classified as atypical cartilaginous tumour (ACT)/grade 1 CS (ACT/Gd1 CS), high-grade CS (HG-CS) and dedifferentiated CS (DD-CS). The presence of pathological fracture was correlated with age, skeletal location and tumour grade. Three hundred seventeen patients were included (177 males and 140 females with mean age 55.8years, range 9-91years). Mean age of patients without pathological fracture was 54.4years and those with pathological fracture 62.9years (p = 0.002). The major long bones were involved in 171 cases, the flat bones in 112 cases, the mobile spine in 7 cases and the small bones of the hands and feet in 27 cases. There were 81 ACT/Gd 1 CS, 168 HGCS and 68 DD-CS. Pathological fracture was evident at presentation in 51 (16.1%) cases, the commonest bones involved being the femur (n = 21; 41.2%), humerus (n = 10; 19.6%) and acetabulum (n = 7; 13.7%). Pathological facture occurred in 7 cases of ACT/Gd 1 CS (13.7%), 23 cases of HGCS (45.1%) and 21 cases of DD-CS (41.2%) (p = 0.001). Following multivariate analysis, both older age and histological grade were independently significant factors. Pathological fracture was seen in 16.1% of patients with CC-CS. Pathological fractures in the femur, humerus and acetabulum very likely indicate higher tumour grade.

How Are Indeterminate Pulmonary Nodules at Diagnosis Associated with Survival in Patients with High-Grade Osteosarcoma?

How Are Indeterminate Pulmonary Nodules at Diagnosis Associated with Survival in Patients with High-Grade Osteosarcoma?

RETROSPECTIVE ANALYSIS OF PATIENTS WITH SIMPLE BONE CYST

Introduction Simple bone cyst is benign fluid-filled lesion localized mainly in long bones. It is usually diagnosed in the first two decades, the most common in proximal humerus. Unicameral bone cyst is o›en asymptomatic but can cause pathological fracture. Aim of the study The aim of our study was to evaluate clinical, diagnostic and treatment factors concerning patients with simple bone cyst. Material and methods The retrospective analysis was performed on 22 patients treated in Department of Traumatology, Orthopaedics and Hand Surgery in Poznań between 2001 and 2017. We have analyzed epidemiological factors: age and sex; symptoms; clinical examination: range of motion, presence of pain; X-ray: localisation, cyst index of Kaelin and MacEwan and presence of pathological fractures; treatment: methods, number of hospitalizations and effectiveness. Results Mean age of patients was 10.8. From 22 patients 11 were females. Generally bone cyst was diagnosed because of pathological fracture – 18 patients (85.7%). Other reasons of X-ray diagnostic were: pain – 2 patients (9.1%), deformity – 1 patient (4.5%), incidentally – 2 patients (9.1%). The bone cyst was localized in humerus – 21 patients (95.5%), radius – 1 patient (4.5%). Treatment methods were various: 7 patients (31.8%) – Depomedrol injections, 4 patients (18.1%) – marrow injections, 4 patients (18.1%) – marrow and Depomedrol injections, 5 patients (22.7%) – injections with additional bone gra›s, 3 patients (13.6%) – only bone gra›s. Conclusions Simple bone cyst occurs generally in young people (under twenty). The most common problem is a pathological fracture. Treatment is long and multistage.

RETROSPECTIVE ANALYSIS OF PATIENTS WITH SIMPLE BONE CYST

Introduction Simple bone cyst is benign fluid-filled lesion localized mainly in long bones. It is usually diagnosed in the first two decades, the most common in proximal humerus. Unicameral bone cyst is often asymptomatic but can cause pathological fracture. Aim of the study The aim of our study was to evaluate clinical, diagnostic and treatment factors concerning patients with simple bone cyst. Material and methods The retrospective analysis was performed on 22 patients treated in Department of Traumatology, Orthopaedics and Hand Surgery in Poznań between 2001 and 2017. We have analyzed epidemiological factors: age and sex; symptoms; clinical examination: range of motion, presence of pain; X-ray: localisation, cyst index of Kaelin and MacEwan and presence of pathological fractures; treatment: methods, number of hospitalizations and effectiveness. Results Mean age of patients was 10.8. From 22 patients 11 were females. Generally bone cyst was diagnosed because of pathological fracture – 18 patients (85.7%). Other reasons of X-ray diagnostic were: pain – 2 patients (9.1%), deformity – 1 patient (4.5%), incidentally – 2 patients (9.1%). The bone cyst was localized in humerus – 21 patients (95.5%), radius – 1 patient (4.5%). Treatment methods were various: 7 patients (31.8%) – Depomedrol injections, 4 patients (18.1%) – marrow injections, 4 patients (18.1%) – marrow and Depomedrol injections, 5 patients (22.7%) – injections with additional bone grafts, 3 patients (13.6%) – only bone grafts. Conclusions Simple bone cyst occurs generally in young people (under twenty). The most common problem is a pathological fracture. Treatment is long and multistage

Is a Short-course of Preoperative Denosumab as Effective as Prolonged Therapy for Giant Cell Tumor of Bone?

Is a Short-course of Preoperative Denosumab as Effective as Prolonged Therapy for Giant Cell Tumor of Bone?

Prognostic factors affecting survival of patients with pathologic humerus shaft fractures treated with intramedullary nailing without tumor removal

BackgroundIntramedullary nailing is the procedure of choice for pathologic fractures in humeral shaft because it allows early pain relief and mobilization. The aim of this study was to analyze the prognostic factors affecting survival of patients with pathologic humeral shaft fractures treated with intramedullary nailing without tumor removal. MethodsWe performed a retrospective study by evaluating the records of patients treated in our clinic between 2003 and 2018 for pathologic humerus shaft fractures with a minimum follow-up of one year. Kaplan–Meier methods were applied to estimate overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with survival. Results52 patients (56 humeral fractures) were operated. The average age at the time of surgery was 58.9 years. There were 28 women and 24 men. In our series, multiple myeloma accounted for 52% of the cases. At the time of this study, 34 (65.3%) patients had deceased. Survival rates at first month, 6 months and 1 year after surgery were 96.2%, 67.4% and 59.6%, respectively. The median survival after surgery was 7.5 (6 days-84 months) months for deceased patients and 18 (34.7%) surviving patients with a median survival of 68.6 months. Rapid growth tumor, presence of pathological fracture in other extremities and, Eastern Cooperative Oncology Group performance status (ECOG-PS) were independently associated with a worse overall survival. ConclusionMore than 50% of patients with pathological humerus shaft fractures were diagnosed with multiple myeloma. Rapid growth tumors such as lung cancer and renal cell cancer increased mortality by a factor of 1 while presence of operative metastases in other extremities increased mortality by a factor of 3.1 and ECOG-PS increased mortality by a factor 6.8. Rapid growth tumors, ECOG-PS and presence of pathological fracture in other extremities were important prognostic factors influencing overall survival.