scholarly journals Radiation-induced pathological fractures of the proximal femur: a case series considering an endoprosthetic solution

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jonathan Vogel ◽  
Shaun de Villiers ◽  
Walid Mug la ◽  
Jeannie McCaul ◽  
Keith Hosking ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Pathological Fracture ◽  
Background Radiation ◽  
Case Series ◽  
Definitive Treatment ◽  
Fibular Graft ◽  
Endoprosthetic Replacement ◽  
Pathological Fractures ◽  
Radiation Induced

ABSTRACT BACKGROUND: Radiation-induced pathological fractures of the proximal femur are difficult to treat due to frequent non-union and hardware failure using standard fracture fixation techniques. This case series investigates endoprosthetic replacement as a treatment option METHODS: A retrospective folder review from a private hospital in Cape Town, of patients who had sustained a radiation-induced pathological fracture, was reviewed using descriptive statistics. RESULTS: Six patients met the inclusion criteria. One patient was excluded as the minimum follow-up time of six months was not met. Of the Ave patients that were analysed, all Ave sustained transverse, subtrochanteric femur fractures. Prior to definitive treatment with a proximal femoral replacement, three patients were treated with standard trauma instrumentation prior to referral to the unit, and one patient was treated with a vascularised fibular graft as their initial treatment while at the unit. One patient was treated with an endoprosthetic replacement as their first procedure at the unit. Among the three patients treated with standard trauma fixation and the one patient treated with a vascularised fibular graft, there was a 100% failure rate. One standard trauma instrumentation patient had an ablation due to free musculocutaneous flap failure and periprosthetic infection after endoprosthetic replacement. This was the only complication of endoprosthetic replacement. At a median follow-up of 15 months (min 7, max 55) the median Musculoskeletal Tumour Society score was 74% (min 63%, max 93%. CONCLUSION: This case series seeks to highlight the high failure rates seen when treating this condition with standard trauma instrumentation or biological methods. Further research is needed, but endoprosthetic replacement may be a viable alternative solution Level of evidence: Level 4. Keywords: radiation-induced fracture, pathological fracture, endoprosthetic replacement

scholarly journals Outcomes of proximal femoral locking-plate fixation for pathological fractures of the proximal femur

2020 ◽  
Author(s):  
Kongkhet Riansuwan ◽  
Somkiat Jivasomboonkul ◽  
Rapin Phimolsarnti ◽  
Chandhanarat Chandhanayingyong ◽  
Apichat Asavamongkolkul
Keyword(s):  
Proximal Femur ◽  
Pathological Fracture ◽  
Locking Plate ◽  
Plate Fixation ◽  
Assistive Device ◽  
Locking Plate Fixation ◽  
Pathological Fractures ◽  
Hardware Failure ◽  
The Mean

Abstract Background Intramedullary nailing of long bones is a common technique for management of existing or impending pathological fracture of the proximal femur. This fixation has been shown to be biomechanically superior to the locking-plate system. However, serious complications, including pulmonary embolism, have been reported in patients treated with intramedullary nailing with or without reaming. The purpose of this report was to study the treatment outcomes of proximal femoral locking-plate fixation of pathological fractures of the proximal femur relative to clinical results, implant failure, and surgical complications. Methods From 2007 to 2018, 17 patients (18 femurs) with a diagnosis of impending or existing pathological fracture of the proximal femur were treated with proximal femoral locking-plate fixation. Data collected included operative duration, estimated blood loss, ambulatory status, hardware failure events, and postoperative complications. Results Of the 18 femurs that were included, 13 were existing pathological fractures and 5 were impending fractures. The mean age of patients was 53.7 years (range: 28–89), and 12 of them were female. The mean follow-up was 11.3 months (range: 1–67). Ten of 17 patients (62.5%) had progressive lung disease from pulmonary metastasis or from lung primary. No patient developed oxygen desaturation or cardiac arrest during the intraoperative or postoperative period. Thirteen of 17 patients (76.5%) could walk with or without an assistive device at the time of final follow-up. Two patients required close postoperative monitoring in the ICU due to poor preoperative status, and both of those patients died within one month after surgery from other medical problems. No hardware failure occurred. Conclusion For pathological fracture of the proximal femur, proximal femoral locking-plate fixation is a treatment option that results in fewer perioperative and postoperative cardiopulmonary events and surgical complications. Most patients can ambulate with or without an assistive device at the final follow-up.

scholarly journals Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

2019 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
Saudamini J. Lele ◽  
Mickie Hamiter ◽  
Torrey Louise Fourrier ◽  
Cherie-Ann Nathan
Keyword(s):  
Treatment Option ◽  
Case Series ◽  
Complete Response ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Effective Treatment Option ◽  
Patient Reported ◽  
History Of ◽  
The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

scholarly journals PATHOLOGICAL FRACTURES DUE TO BONE METASTASES FROM LUNG CANCER: RISK FACTORS AND SURVIVAL

2018 ◽  
Vol 26 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Marcelo Bragança dos Reis Oliveira ◽  
Bruno de Carvalho Marques ◽  
Rosa Aurílio Matos ◽  
César Rubens da Costa Fontenelle ◽  
Fernanda Carvalho de Queiroz Mello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Overall Survival ◽  
Bone Metastases ◽  
Pathological Fracture ◽  
Case Series ◽  
Rank Test ◽  
High Morbidity ◽  
Pathological Fractures ◽  
Diagnosis Of Lung Cancer

ABSTRACT Introduction: Pathological fractures are frequent skeletal-related events among lung cancer patients, which result in high morbidity and decreased overall survival and make operative treatment decisions challenging. Objectives: To identify risk factors associated with the occurrence of pathological fractures in patients with lung cancer and to determine survival. Methods: We conducted a retrospective cohort study with 407 lung carcinoma patients diagnosed between 2006 and 2015. The prevalence of bone metastases and pathological fractures was calculated. Statistical analysis was conducted using a chi-squared test, and the odds ratio and 95% confidence interval were calculated. Overall survival was determined using the Kaplan-Meier method and differences were compared using the log-rank test. Results: The prevalence of bone metastases and pathological fractures was 28.2% (n = 115) and 19.1% (n = 22), respectively. Pathological fractures were more frequent among patients with bone metastases at the time of diagnosis of lung cancer (24.7% [n = 20] vs. 5.9% [n = 2]; p < 0.05). The median overall survival following the diagnosis of lung cancer, bone metastases, and pathological fracture was 6, 4, and 2 months, respectively. Conclusions: Pathological fracture was associated with synchronous bone metastases and overall survival times were considerably reduced. Level of Evidence IV, Case Series.

scholarly journals Outcomes of Proximal Femoral Locking-plate Fixation for Pathological Fractures of the Proximal Femur

2021 ◽  
Vol 73 (9) ◽  
pp. 603-608
Author(s):  
Kongkhet Riansuwan ◽  
Somkiat Jivasomboonkul ◽  
Rapin Phimolsarnti ◽  
Chandhanarat Chandhanayingyong ◽  
Apichat Asavamongkolkul
Keyword(s):  
Proximal Femur ◽  
Locking Plate ◽  
Plate Fixation ◽  
Clinical Results ◽  
Assistive Device ◽  
Locking Plate Fixation ◽  
Pathological Fractures ◽  
Hardware Failure ◽  
Estimated Blood Loss

Objective: To study the treatment outcomes of proximal femoral locking-plate fixation of pathological fractures ofthe proximal femur relative to clinical results, implant failure, and surgical complications.Materials and Methods: From 2007 to 2018, 17 patients (18 femurs) with a diagnosis of impending or existingpathological fracture of the proximal femur were treated with proximal femoral locking-plate fixation. Data collectedincluded operative duration, estimated blood loss, ambulatory status, hardware failure events, and postoperativecomplications.Results: Of the 18 femurs that were included, 13 were existing pathological fractures and 5 were impending fractures.The mean age of patients was 53.7 years (range: 28-89), and 12 of them were female. The mean follow-up was 11.3months (range: 1-67). Ten of 17 patients (62.5%) had progressive lung disease from pulmonary metastasis or fromlung primary. No patient developed oxygen desaturation or cardiac arrest during the intraoperative or postoperativeperiod. Thirteen of 17 patients (76.5%) could walk with or without an assistive device at the time of final follow-up.Two patients required close postoperative monitoring in the intensive care unit due to poor preoperative status,and both of those patients died within one month after surgery from other medical problems. No hardware failureoccurred.Conclusion: For pathological fracture of the proximal femur, proximal femoral locking-plate fixation is a treatmentoption that results in fewer perioperative and postoperative cardiopulmonary events and surgical complications.Most patients can ambulate with or without an assistive device at the final follow-up.

More II It than Meets the Eye: Outcomes After Single-Fraction Stereotactic Radiosurgery in a Case Series of Low-Grade Arteriovenous Malformations

2019 ◽  
Author(s):  
Christopher S Graffeo ◽  
Michael J Link ◽  
Scott L Stafford ◽  
Yolanda I Garces ◽  
Robert L Foote ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Proportional Hazards ◽  
Case Series ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
Single Fraction ◽  
Kaplan Meier ◽  
Radiation Induced ◽  
Martin Grade

Abstract BACKGROUND Surgical resection is typically cited as the optimal treatment of patients with Spetzler-Martin Grade I-II arteriovenous malformation (AVM). OBJECTIVE To report our experience with single-fraction stereotactic radiosurgery (SRS) for Spetzler-Martin Grade I-II AVM. METHODS A prospectively maintained registry was reviewed for patients with nonsyndromic Spetzler-Martin Grade I-II AVM having SRS from 1990 to 2011. Patients with <24 mo of follow-up or prior radiotherapy/SRS were excluded, resulting in a study population of 173 patients. Actuarial analysis was performed using the Kaplan-Meier method, and Cox proportional hazards modeling was performed with excellent outcomes (obliteration without new deficits) as the dependent variable. RESULTS Median post-SRS follow-up was 68 mo (range, 24-275). AVM obliteration was achieved in 132 (76%) after initial SRS. Eleven additional patients achieved obliteration after repeat SRS for an overall obliteration rate of 83%. The rate of obliteration was 60% at 4 yr and 78% at 8 yr. Post-SRS hemorrhage occurred in 7 patients (4%), resulting in 3 minor deficits (2%) and 1 death (<1%). Radiation-induced complications occurred in 5 patients (3%), resulting in minor deficits only. One hundred and thirty-seven patients (79%) had excellent outcomes at last follow-up. CONCLUSION SRS is a safe and effective treatment for patients with Spetzler-Martin Grade I-II AVM. Selection bias is likely a contributing factor to explain the superior outcomes generally noted in reported series of microsurgery for patients with low grade AVM.

scholarly journals Rotationplasty for Unplanned Fixation of Pathological Fracture Distal Femoral Osteosarcoma

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Chindanai Hongsaprabhas ◽  
Wittavat Chenboonthai ◽  
Phoomchai Suvaraksakul ◽  
Chris Charoenlap
Keyword(s):  
Pathological Fracture ◽  
Treatment Options ◽  
Distant Metastases ◽  
Definitive Treatment ◽  
Salvage Procedure ◽  
Pathological Study ◽  
First Case ◽  
Complex Procedure ◽  
High Grade Osteosarcoma

Introduction. Rotationplasty had been reported as a salvage procedure for many decades. However, this procedure has not been used for unplanned fixation for pathological fracture of osteosarcoma. Therefore, this is the first case report of rotationplasty for this particular indication. Case Presentation. We report a case of a 22-year-old Thai female patient who sustained a supracondylar fracture at the distal femur and underwent a surgical treatment by open reduction and internal fixation with a distal femoral locking plate and screws. Follow-up radiographic imaging revealed that there were abnormal osteolytic lesions, and conventional high-grade osteosarcoma was diagnosed by a pathological study. There were no distant metastases from Computed Tomography (CT) scan or Technitium-99m bone scintography. After discussing with the patient for treatment options, rotationplasty was chosen for her definitive treatment after 3 courses of neoadjuvant chemotherapy. All of the contaminated tissues were removed during the surgery. The neurovascular bundles were preserved. A standard rotationplasty type A-1 according to the Winkelmann Classification was performed. Postoperative imaging showed satisfactory outcomes, and the wound healed uneventfully. The patient was able to move her ankle as a knee, and external prosthetic fitting was made. Adjuvant chemotherapy was given after a free margin with good tumor necrosis which was achieved as shown in the pathological study. At the patient’s 3-year follow-up visit, she has stable size of lung nodules. She can walk with external prosthesis, limping slightly. Her new knee could move as expected, and she was satisfied with the result of the treatment. Conclusion. Rotationplasty for unplanned fixation of pathological fracture is a complex procedure. Patients often do not select this type of treatment because of the cosmetic acceptance even though it yields a good functional result. Therefore, awareness of the pathological fracture should initially be taken into account to prevent inappropriate fixation which could result in an unnecessary amputation.

Malignant triton tumour (MTT) of the lung with metastasis to the proximal femur

2021 ◽  
Vol 14 (2) ◽  
pp. e237086
Author(s):  
Hany Elbardesy ◽  
Rehan Gul ◽  
Michael Bennett ◽  
Derek G Power
Keyword(s):  
Local Recurrence ◽  
Female Patient ◽  
Proximal Femur ◽  
Multidisciplinary Team ◽  
Pathological Fracture ◽  
Excisional Biopsy ◽  
History Of ◽  
The Right ◽  
Malignant Triton Tumour

A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis. We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later, she presented with local recurrence. We organised a multidisciplinary team between the orthopaedic, histopathology and oncology teams. Then, we decided to treat her with chemotherapy. After 2 months of follow-up, she responded well to the chemotherapy with no further deterioration of her condition.

scholarly journals Fresh Osteochondral Allograft Transplantation for Spontaneous Osteonecrosis of the Knee: A Case Series

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773054 ◽  
Author(s):  
Luís E.P. Tírico ◽  
Samuel A. Early ◽  
Julie C. McCauley ◽  
William D. Bugbee
Keyword(s):  
Conservative Treatment ◽  
Femoral Condyle ◽  
Case Series ◽  
Lesion Size ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Definitive Treatment ◽  
Spontaneous Osteonecrosis ◽  
Fresh Osteochondral Allograft

Background: Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions. Hypothesis: OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle. Study Design: Case series; Level of evidence, 4. Methods: A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm2 (range, 3.24-6.25 cm2), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm2 (range, 3.2-6.3 cm2). Results: The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d’Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant. Conclusion: Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.

scholarly journals Mandibular reconstruction with microvascularized graft after ameloblastoma resection: case series

2021 ◽  
Vol 10 (15) ◽  
pp. e217101522594
Author(s):  
Kaiane Tavares Pontes ◽  
Yasmin Lima Nascimento ◽  
Maelly Vicente Lôbo ◽  
Taysnara Ismaeley de Andrade ◽  
Jonathan Augusto Vidal de Oliveira ◽  
...  
Keyword(s):  
Safety Margin ◽  
Case Series ◽  
Functional Restoration ◽  
The Body ◽  
High Recurrence Rate ◽  
Fibular Graft ◽  
Body Angle ◽  
Recommended Treatment ◽  
Facial Defects

Ameloblastoma is a locally aggressive and highly infiltrative tumor with a high recurrence rate. Its multicystic form the recommended treatment is resection with a safety margin, which results in significant facial defects with esthetic and functionals repercussions. Microvascular surgery revolutionized the reconstruction of significant defects because these grafting techniques allow a more satisfactory aesthetic and functional restoration. This study aimed to report a series of cases of reconstructions of mandibular defects using microvascularized fibular graft after ameloblastoma resection. Six patients were included in this study, and we collected data related to the surgical procedure, diagnosis, complications and follow-up. The patients were characterized as four women and two men, with a mean age of 23.8 years, with a diagnosis of mandibular ameloblastoma located mainly in the body, angle and mandibular ramus. These patients underwent lesion resection, resulting in defects larger than 5 cm, which justified using a microvascularized fibular graft for its reconstruction. The patients evolved well, with good results and without recurrences or complications in a postoperative follow-up of 2 to 5 years. Ameloblastoma is a lesion that reaches large dimensions and causes excellent cosmetic and functional damage. The microvascularized graft is an alternative in reconstructing significant defects and allows satisfactory morphofunctional reestablishment with minimal complications.

Sign in / Sign up

Export Citation Format

Share Document