Treatment Of Pathological Fractures Research Articles

Balloon kyphoplasty for the treatment of pathological fractures in the thoracic and lumbar spine caused by metastasis: one-year follow-up

To evaluate the clinical and radiographic outcomes of balloon kyphoplasty in patients with fractures of the thoracic and lumbar spine caused by metastatic disease. 64 balloon kyphoplasty procedures were performed in 31 patients (18 females and 13 males with bone metastasis), 28 of whom were followed up over a period of 1 year. Symptomatic levels were identified by clinical presentation, magnetic resonance imaging (MRI), radiographs, and computed tomography (CT). In the prospective 1-year follow-up, visual analog scale (VAS) and Oswestry Disability Score were documented. Radiographs were performed pre- and postoperatively, and at 3, 6, and 12 months. Vertebral height and kyphotic deformity were measured to assess restoration of the sagittal alignment. The median pain scores (VAS) decreased significantly (P<0.05) from pre- to post-treatment, as did the Oswestry Disability Score (P<0.05). Polymethyl methacrylate (PMMA) cement leakage was detected in eight of 64 vertebral bodies (12.5%), but did not have any clinical relevance. During 1-year follow-up, balloon kyphoplasty stabilized vertebral height and prevented further kyphotic deformity. Balloon kyphoplasty is an effective, minimally invasive procedure for the stabilization of pathological vertebral fractures caused by osteolytic lesions of vertebral bodies due to metastatic disease. It gives a statistically significant reduction of pain and prevents further kyphotic deformity of the spine.

The use of Ilizarov frames in the treatment of pathological fracture of the femur secondary to osteomyelitis: A review of three cases

The overall incidence of acute osteomyelitis in adults is declining. Infection can be classified as acute, subacute and chronic. Fractures through acutely infected bone are very rare but have been previously reported.7

Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients.

Due to the advances in oncological therapy, the life expectancy of patients with malignant tumours and the incidence of pathological fractures have increased over the last decades. Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in patient's survival and postoperative complications after the treatment of pathological fractures of the long bones. Eighty-eight patients with 96 pathological fractures of the long bones were analysed retrospectively. Seventy-five patients with 83 fractures received surgical treatment. The operative treatments used were intramedullary fixation, gliding screws, plate osteosynthesis or arthroplasty. Five patients were still alive at the end of data collection at a median time of 42.5 months, and 16.2% survived 1 year, 7% 2 years and 4% more than 3 years postoperatively. All surgically treated patients had a reduction of local pain and were able to walk after the operation. The overall rate of complications was 8%. Early palliative treatment of pathological fractures of the long bones is indicated in most patients in the advanced stage of metastatic disease. The low complication rate, reduction of local pain and early mobilisation justify the surgical stabilisation of fractures in this cohort of patients.

Treatment of pathological fracture of the femur due to diffuse haemangioma in the lower limb

We describe two patients with a diffuse haemangioma of the lower limb complicated by pathological fracture of the femoral shaft, one of whom was treated by a bone graft and immobilisation in a cast, and the other by external fixation and injection of bone marrow. A review of the literature identified difficulty in control of bleeding and obtaining bony union.

Modern treatment of pathological fractures in children

Pathological fractures in children occur from a variety of causes. The clinician has to develop an individual strategy that weighs up the pros and cons of treatment, considering the bone biology and the biomechanics at the fracture site. Determining the lesional pathology is paramount, whether it is in the form of a neoplastic or non-neoplastic entity, so that bone healing can be maximized. Time-efficient protection and reconstruction of the child's musculoskeletal system is the aim of the surgeon's intervention. The whole strategy must be individualized to every situation. Combinations of diseases, fracture sites, and children are many, whereas treatment options are fewer. Options include non-operative management with observation, and intralesional resection with or without bone grafting, and with or without internal fixation. A thoughtful, disciplined, and systematic approach will be successful most often. The goals of treating a child's pathological fracture are all based on establishing a diagnosis. Only after establishing the diagnosis with certainty can a proper treatment strategy be formulated. Fracture management is then based on five points: (a) pain relief and comfort of the child; (b) achieve Local control or containment of the pathological lesion; (c) skeletal stabilization, preservation of growth, and maintain anatomical alignment; (d) fracture union; and (e) restoration of function. Maintaining perspective will facilitate optimal patient care and minimize the confounding variables that seem to plague the treatment of pathological fractures.

Percutaneous Treatment of Vertebral Body Pathology

Percutaneous vertebral body injection procedures currently are used to stabilize and reinforce weakened or fractured bone resulting from metastatic disease and severe osteoporosis. Both vertebroplasty and kyphoplasty can reinforce the structure of a vertebral body and provide pain relief, but the procedures have technical differences. Kyphoplasty improves vertebral height to varying degrees in nearly three quarters of patients. Kyphosis is improved more effectively when the procedure is performed within 3 months from the onset of fracture pain. To date, it is unknown whether vertebroplasty with preprocedure postural reduction can provide similar improvement of deformity. Complications are relatively infrequent with both vertebroplasty and kyphoplasty. Cement leakage from the vertebral body is more likely with vertebroplasty than with kyphoplasty. Leakage is more common in the treatment of pathologic fractures resulting from metastatic disease. Clinical complications caused by cement leakage and neural compression are infrequent. Specific indications for these injection procedures need to be more clearly refined. Long-term outcomes, including the fate of the injected material and the effect on adjacent vertebrae, have yet to be determined.

Management of pathologic fractures of the proximal femur: state of the art.

Metastases to bone are the most common cause of a destructive lesion of the skeleton in an adult. The proximal femur is the most commonly affected bone with metastatic disease in the appendicular skeleton. A systematic approach to patient management is critical, so as to avoid complications that will delay systemic therapy. The orthopedic traumatologist is often the first physician to see the patient with a pathologic fracture. As a result, the surgeon must be aware of the indications for resection versus internal fixation, as well as options for reconstruction. Polymethyl methacrylate and curettage can be useful in the appropriately selected patient. Postoperative external beam irradiation can significantly reduce disease progression and subsequent loss of fixation. A multidisciplinary approach to this patient group will help optimize prognosis as well as function. This article reviews the evaluation, management, and complications of treatment of pathologic fractures of the proximal femur, with an emphasis on metastatic disease and multiple myeloma.

General principles of external beam radiation therapy for skeletal metastases.

Radiation therapy plays a major role in the treatment of patients with bone metastases. The primary goals of treatment include pain relief and relief of neurologic symptoms, if present. Approximately 70% of patients will achieve pain relief with palliative external beam radiotherapy. Improvement in the severity of pain may occur within as few as 48 to 72 hours of initiation of therapy, but in some patients significant relief of pain may not occur for 4 weeks after completion of therapy. Treatment schemes ranging from 800 cGy in a single treatment to 3000 cGy in 10 treatments have not been shown to result in major differences in outcome. Treatment decisions must be individualized based on factors such as the patient's performance status, life expectancy, location of the lesion, and size of area to be treated. External beam radiotherapy is recommended after surgical treatment of pathologic fractures or impending fractures to decrease the need for a second surgical procedure and improve the patient's functional outcome. External beam radiotherapy continues to be an important component of the palliative treatment of bone metastases. Its integration with newer therapeutic modalities such as vertebroplasty and radiofrequency ablation currently is being studied.

Expression of inducible nitric oxide synthase in bone metastases

Aims: The signalling molecule nitric oxide (NO), produced predominantly in cancer by the enzyme inducible NO synthase (iNOS), has been implicated in the pathophysiology of many human tumours. The increased NO concentrations found in many human cancers may facilitate both angiogenesis and tumour dissemination. NO also plays a concentration-dependent role in bone re-modelling by acting on osteoclasts. Although iNOS has been studied extensively in most primary tumours, there are no reports that have investigated its expression in metastatic bone disease. Methods: An immunohistochemical study was performed using a monoclonal antibody to iNOS in 27 cases of breast, renal and lung bone metastases, biopsied at the time of treatment for pathological fracture. Results: iNOS expression was found in 14 cases and was predominantly localised to tumour cells in the metastatic deposits. A significant difference was found between iNOS expression in metastases and adjacent bone ( p<0.001), where immunostaining was rarely seen and confined to immune cells. No microscopic differences in bone architecture could be seen between iNOS positive and negative metastases, and no correlations were found between iNOS expression and clinico-pathological variables. Conclusions: iNOS expression is not a pathognomonic finding in bone metastasis. Its role in the behaviour of bone metastases requires further investigation.

Restorative treatment for pathological fracture of the acetabulum in a patient with neurofibromatosis

Skeletal pathology as a manifestation of type I neurofibromatosis is relatively rare in 1520% of patients, and each case of neurofibromatosis bears the stamp of individual uniqueness [1, 2]. Among the indications of the involvement of bone structures in the destructive process, we did not find a description of a pathological fracture of the acetabulum and methods for restoring the support ability of the pelvis and hip in this disease.

Multiple Myeloma

Multiple Myeloma

Surgical treatment for pathologic fracture

Surgical treatment for pathologic fracture

Treatment for pathological fractures of the humerus by Ender nailing

Treatment for pathological fractures of the humerus by Ender nailing

Alarming wear of the first-generation polyethylene liner of the cementless porous-coated Biomet Universal cup: 107 hips followed for mean 6 years.

Wear of the socket liner and resulting osteolysis are the major causes of failure in cementless hip arthroplasties. We report alarming wear of the first-generation polyethylene liner of the cementless porous-coated Biomet Universal cup. Radiographs of 107 primary hip arthroplasties were analyzed retrospectively. The mean follow-up time was 74 (47-91) months. The linear wear of the polyethylene liners was assessed using a modification of the Livermore method. The median linear wear was 1.0 (0-6.2) and the median linear wear rate was 0.17 mm/year. There was a statistically significant difference between the 28 mm and 32 mm femoral head groups both in the volumetric wear and in the volumetric wear rate. The median linear wear was 0.28 mm/year and 0.14 mm/year for the 32 mm and 28 mm heads, respectively. So far, 14 revisions have been performed or have been scheduled because of excessive wear of the polyethylene liner. In regression analysis, the factors related to the wear rate were the 32 mm size of the femoral head and screw fixation of acetabular shell. We found that the cases with calcar rounding were associated with significantly greater wear. Possible reasons for increased wear of the Hexloc liner may be the cylindrical design, thin polyethylene, and poor quality of the polyethylene. Regular clinical and radiographic follow-ups are recommended especially for hips with 32 mm femoral heads or with screw fixation. If progressive wear of the liner is observed, revision must be considered.

Surgical emphysema formation during intramedullary reaming of a humerus

Intramedullary nailing is an accepted method of treatment for pathological fractures of a humerus [ 1 Crolla R.M.P.H. de Vries L.S. Clevers G.J. Locked intramedullary nailing of humeral fractures. Injury. 1993; 24: 403-406 Abstract Full Text PDF PubMed Scopus (67) Google Scholar , 2 Harrington K.D. Orthopaedic management of extremity and pelvic lesions. Clin. Orthop. 1995; 312: 136-147 PubMed Google Scholar ].

Surgical treatment for skeletal breast cancer metastases: a population-based study of 641 patients.

The objective of this article was to assess the occurrence of symptomatic bone metastases in a defined population of patients with breast carcinoma and to characterize the clinical outcome with reference to surgical treatment for pathologic fracture or neurologic deficit. The authors identified all patients in the Stockholm Breast Cancer Database (population base 1.8 million) with a diagnosis of bone metastases during 1989--1994. These cases were linked with the Stockholm County Council Hospital Discharge Diagnosis Registry that includes information on in-patient care and discharge diagnoses. This enabled us to identify patients who had undergone surgical treatment for their bony metastases at any of the six departments of orthopedics in the region, or who had been treated at the one department of neurosurgery. Six hundred forty-one patients with breast carcinoma presented with symptomatic skeletal metastasis during 1989--1994, and 107 (17%) were operated on. Metastases were located in long bones (77), spine (14), and pelvis (6). The median survival postoperatively was 6 months. The total reoperation rate was 0.12. Hip screws and glide-screw plates were associated more often with failure as was location in the distal femur. Pain decreased postoperatively in 77% of the patients, and function improved in 65%. One in 10 patients with breast carcinoma developed symptomatic bone metastases, and one-fifth of these patients required surgery for pathologic fracture or neurologic deficit. There was a high failure rate in those hospitals in which few patients were operated on.

Limb salvage surgery for pathological fractures in osteosarcoma.

The local treatment of pathological fracture in patients with a primary osteosarcoma remains controversial. In this paper we report the oncological outcome of the treatment of pathological fractures in 18 patients suffering from this disease. There were ten male and eight female patients, and the average age at diagnosis was 17 years. All patients received adjuvant chemotherapy. Wide resections were performed in 17, but in one there was 'contamination' of the margins of the excision. Skeletal reconstruction was performed with a locally designed and manufactured custom 'mega' prosthesis. The average follow-up was 33 months (range: 12-93 months), and 14 patients were alive on completion of the study. Local recurrence appeared in two patients, while three developed pulmonary metastases.

Spinal instability secondary to metastatic cancer.

Galasko, C. S. B. M.Sc., Ch.M., F.R.C.S., F.R.C.S.E.‡; Norris, Heather E. B.A., R.G.N.‡; Crank, Stella M.Sc.‡ Author Information

Treatment of Pathologic Fractures of the Humerus With Seidel Nailing

A retrospective study is presented of 14 patients with pathologic fractures of the humerus (12 established, two impending) treated with Seidel nailing from 1988 through 1995 in the authors' institution. There were nine women and five men whose average age was 59.5 years. Breast, prostate, and kidney hypernephroma accounted for the majority of the primary lesions. All but one lesion were located in the middle shaft of the humerus. Ten lesions were considered large (> 5 cm long). In five cases an open curettage and allografting were done. Early pain relief was successful in 85% of the patients. The worst complication found was definite nerve palsy in two (14.28%) patients. Ten fractures healed and two failed to heal. Two thirds of the patients had good functional results. The average survival was 12 months. Intramedullary fixation of pathologic fractures improves the quality of life by controlling pain for most patients.

Operative Treatment for Pathological Fracture of Long Bone

Operative Treatment for Pathological Fracture of Long Bone