scholarly journals Intramedullary Nailing for Pathological Fractures of the Proximal Humerus Caused by Multiple Myeloma: A Case Report and Literature Review

2021 ◽  
Author(s):  
guoqiang xu ◽  
gang wang ◽  
xiaodong bai ◽  
zhenyu liu ◽  
xinjia wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Proximal Humeral Fracture ◽  
Pathological Fracture ◽  
Proximal Humerus ◽  
Combined Treatment ◽  
Bone Destruction ◽  
Humeral Fracture ◽  
Whole Body ◽  
Left Shoulder ◽  
Im Nailing

Abstract Background: Multiple myeloma bone disease(MMBD) is indicative of multiple myeloma (MM), and it will reduce patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM represents an essential treatment pillar within the framework of supportive therapy measures and is the task of orthopedic tumor surgery. Nevertheless, there are few reports about applying intramedullary (IM) nailing in treating MM-induced proximal humeral fracture to prevent fixation loss. This paper aims to describe a case of pathological fracture of the proximal humerus caused by multiple myeloma effectively treated with IM nailing without removal of tumors and review the current literature.Case presentation: This study reported a 64-year-old male patient complaining of serious left shoulder pain and limited movement. X-ray films showed left proximal humeral fracture accompanying with osteoporosis and bone destruction. During the preoperative examinations, tumor markers, whole-body bone imaging and bone marrow biopsy were performed. The patient was finally diagnosed with multiple myeloma (IgAλ, IIIA/II). After the treatment of pathological fracture with IM nailing, the patient's function recovered and the pain was relieved rapidly. The visual analogue scale (VAS) reduced by 7 points to 2 points postoperatively compared with that preoperatively. Histopathological examination results presented plasma cell myeloma. Next, the patient received chemotherapy in the hematology department. Humeral fracture displayed good union in the 40-month follow-up, with complete healing of fracture, and the clinical outcome was still satisfactory.Conclusion: The pathological fracture of proximal humerus caused by multiple myeloma should be treated by surgery early. IM nail can be used for this kind of fracture without removal of tumors, bone cement augmentation for bone defect or local adjuvant therapy was also employed. Under the combined treatment, the proximal humerus fracture can eventually heal.

scholarly journals Intramedullary Nailing for Pathological Fractures of the Proximal Humerus caused by Multiple Myeloma: A Case Report and Literature Review

2021 ◽  
Author(s):  
guoqiang xu ◽  
gang wang ◽  
xiaodong bai ◽  
zhenyu liu ◽  
xinjia wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Proximal Humeral Fracture ◽  
Pathological Fracture ◽  
Proximal Humerus ◽  
Combined Treatment ◽  
Bone Destruction ◽  
Humeral Fracture ◽  
Whole Body ◽  
Left Shoulder ◽  
Im Nailing

Abstract BackgroundMultiple myeloma bone disease(MMBD) is indicative of multiple myeloma (MM), and it will reduce patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM represents an essential treatment pillar within the framework of supportive therapy measures and is the task of orthopedic tumor surgery. Nevertheless, there are few reports about applying intramedullary (IM) nailing in treating MM-induced proximal humeral fracture to prevent fixation loss. This paper aims to describe a case of pathological fracture of the proximal humerus caused by multiple myeloma effectively treated with IM nailing without removal of tumors and review the current literature.Case presentationThis study reported a 64-year-old male patient complaining of serious left shoulder pain and limited movement. X-ray films showed left proximal humeral fracture accompanying with osteoporosis and bone destruction. During the preoperative examinations, tumor markers, whole-body bone imaging and bone marrow biopsy were performed. The patient was finally diagnosed with multiple myeloma (IgAλ, IIIA/II). After the treatment of pathological fracture with IM nailing, the patient's function recovered and the pain was relieved rapidly. The visual analogue scale (VAS) reduced by 7 points to 2 points postoperatively compared with that preoperatively. Histopathological examination results presented plasma cell myeloma. Next, the patient received chemotherapy in the hematology department. Humeral fracture displayed good union in the 40-month follow-up, with complete healing of fracture, and the clinical outcome was still satisfactory.ConclusionThe pathological fracture of proximal humerus caused by multiple myeloma should be treated by surgery early. IM nail can be used for this kind of fracture without removal of tumors, bone cement augmentation for bone defect or local adjuvant therapy was also employed. Under the combined treatment, the proximal humerus fracture can eventually heal.

scholarly journals Hypoxia-induced CREB cooperates MMSET to modify chromatin and promote DKK1 expression in multiple myeloma

Oncogene ◽  
2021 ◽  
Author(s):  
Yinyin Xu ◽  
Jing Guo ◽  
Jing Liu ◽  
Ying Xie ◽  
Xin Li ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Combined Treatment ◽  
Hypoxia Inducible Factor ◽  
Bone Destruction ◽  
Bone Lesions ◽  
Myeloma Cells ◽  
Downstream Target ◽  
Dkk1 Expression

AbstractMyeloma cells produce excessive levels of dickkopf-1 (DKK1), which mediates the inhibition of Wnt signaling in osteoblasts, leading to multiple myeloma (MM) bone disease. Nevertheless, the precise mechanisms underlying DKK1 overexpression in myeloma remain incompletely understood. Herein, we provide evidence that hypoxia promotes DKK1 expression in myeloma cells. Under hypoxic conditions, p38 kinase phosphorylated cAMP-responsive element-binding protein (CREB) and drove its nuclear import to activate DKK1 transcription. In addition, high levels of DKK1 were associated with the presence of focal bone lesions in patients with t(4;14) MM, overexpressing the histone methyltransferase MMSET, which was identified as a downstream target gene of hypoxia-inducible factor (HIF)-1α. Furthermore, we found that CREB could recruit MMSET, leading to the stabilization of HIF-1α protein and the increased dimethylation of histone H3 at lysine 36 on the DKK1 promoter. Knockdown of CREB in myeloma cells alleviated the suppression of osteoblastogenesis by myeloma-secreted DKK1 in vitro. Combined treatment with a CREB inhibitor and the hypoxia-activated prodrug TH-302 (evofosfamide) significantly reduced MM-induced bone destruction in vivo. Taken together, our findings reveal that hypoxia and a cytogenetic abnormality regulate DKK1 expression in myeloma cells, and provide an additional rationale for the development of therapeutic strategies that interrupt DKK1 to cure MM.

scholarly journals Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement

2015 ◽  
Vol 33 (6) ◽  
pp. 657-664 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Jens Hillengass ◽  
Saad Usmani ◽  
Elena Zamagni ◽  
Suzanne Lentzsch ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Magnetic Resonance ◽  
Bone Destruction ◽  
Whole Body ◽  
Focal Lesion ◽  
Resonance Imaging ◽  
Pelvic Mri ◽  
Symptomatic Disease ◽  
Osteoporotic Vertebral Fractures

Purpose The aim of International Myeloma Working Group was to develop practical recommendations for the use of magnetic resonance imaging (MRI) in multiple myeloma (MM). Methods An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations for the value of MRI based on data published through March 2014. Recommendations MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. Thus, MRI detects bone involvement in patients with myeloma much earlier than the myeloma-related bone destruction, with no radiation exposure. It is the gold standard for the imaging of axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures. MRI has the ability to detect spinal cord or nerve compression and presence of soft tissue masses, and it is recommended for the workup of solitary bone plasmacytoma. Regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have > one focal lesion of a diameter > 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, to date, this does not change treatment selection.

scholarly journals Treatment of a patient with multiple myeloma of the femur

2021 ◽  
Vol 27 (2) ◽  
pp. 265-269
Author(s):  
K.V. Shevyrev ◽  
◽  
V.P. Voloshin ◽  
D.A. Shavyrin ◽  
T.A. Mitina ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Destruction ◽  
Pathologic Fracture ◽  
Lower Limbs ◽  
Left Femur ◽  
Multiple Myeloma Patient ◽  
Early Weight Bearing ◽  
Pathologic Fractures ◽  
The Right ◽  
Im Nailing

Introduction Multiple myeloma (MM) is a malignant tumor that causes widespread bone damage. The bone is involved in 90 % of MM patients, and 60% of patients develop pathologic fractures. Material and methods We report a case of combined surgical treatment and chemotherapy of a multiple myeloma patient who sustained a pathological diaphyseal fracture of the left femur and later presented with a lytic myeloma lesion in the right femur. Closed reduction and interlocking intramedullary (IM) nailing of the left femur was performed for the patient who was diagnosed with bone destruction in the shaft of the right femur a few months later. The right femur was fixed with interlocking IM nail for prophylaxis. Results The left femur consolidated at 6 months. The patient had no pain in the right femur, and enlargement in the bone destruction was not seen in the femur. The patient could ambulate with a cane with signs of deforming arthritis in the adjacent joints of the lower limbs. Discussion Three common surgical approaches used for bone tumors being complicated or not complicated by a pathologic fracture include nailing/plating, bone replacement and joint arthroplasty. Bone tumor replacement with oncological endoprostheses can be produced in specialized oncological orthopaedic units and is not available with regular trauma and orthopaedic services for different reasons. The operating orthopedic surgeon is to choose the appropriate implant to address the tumor involvement. Conclusion Interlocking IM nailing can be the method of choice for a pathologic fracture or for prophylactic bone fixation with appropriate indications identified with the Mirels's scoring system. Intramedullary nailing offers the advantage of minimally invasive stability for the operated limb and early weight-bearing in contrast to plate fixation treatment for fractures and prophylactic plating.

scholarly journals External fixation in the treatment of shooting proximal humeral fracture with bone defect: A case report

2011 ◽  
Vol 139 (5-6) ◽  
pp. 370-375 ◽  
Author(s):  
Zoran Golubovic ◽  
Zoran Vukasinovic ◽  
Vojkan Stanic ◽  
Sasa Stojanovic ◽  
Predrag Stojiljkovic ◽  
...  
Keyword(s):  
External Fixation ◽  
Bone Defect ◽  
Proximal Humerus ◽  
Humeral Fracture ◽  
Primary Treatment ◽  
Coracoid Process ◽  
Humeral Shaft ◽  
Left Shoulder ◽  
Wound Debridement ◽  
Close Range

Introduction. Shooting injuries of shoulder with destruction of proximal humerus are rare and severe orthopaedic injuries. Case Outline. A 74-year-old patient was wounded at close range by a shotgun. He was wounded in the left shoulder and suffered a massive defect of the proximal humerus and soft tissue. The neurocirculatory finding of the injury extremity was normal. After a short resuscitation, x-ray of the thorax and the left shoulder registered a complet destruction of humeral head. After the primary treatment of the wound under general endotracheal anesthesia, the shoulder was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins, where two pins were placed in the neck of scapula and two in the humeral shaft, because the left scapular acromion was fractured by shotgun projectiles. Conclusion. After radical wound debridement, external fixation is the method of choice for shoulder stabilisation in shooting injury of shoulder with bone defect. If this is not possible, pins of the left external skeletal fixator should be placed into the coracoid process and acromion. The pins can be also placed into the humeral shaft, as done in the presented case, and by which a good stability of the injured proximal humerus, easy approach to the wound for bandaging and reconstructive surgery can be achieved.

scholarly journals Analyzing Longitudinal wb-MRI Data and Clinical Course in a Cohort of Former Smoldering Multiple Myeloma Patients: Connections between MRI Findings and Clinical Progression Patterns

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 961
Author(s):  
Markus Wennmann ◽  
Thomas Hielscher ◽  
Laurent Kintzelé ◽  
Bjoern H. Menze ◽  
Georg Langs ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Destruction ◽  
Growth Dynamics ◽  
Whole Body ◽  
Mri Findings ◽  
Diffuse Infiltration ◽  
Smoldering Multiple Myeloma ◽  
Local Bone ◽  
Mri Features ◽  
Progression Patterns

The purpose of this study was to analyze size and growth dynamics of focal lesions (FL) as well as to quantify diffuse infiltration (DI) in untreated smoldering multiple myeloma (SMM) patients and correlate those MRI features with timepoint and cause of progression. We investigated 199 whole-body magnetic resonance imaging (wb-MRI) scans originating from longitudinal imaging of 60 SMM patients and 39 computed tomography (CT) scans for corresponding osteolytic lesions (OL) in 17 patients. All FLs >5 mm were manually segmented to quantify volume and growth dynamics, and DI was scored, rating four compartments separately in T1- and fat-saturated T2-weighted images. The majority of patients with at least two FLs showed substantial spatial heterogeneity in growth dynamics. The volume of the largest FL (p = 0.001, c-index 0.72), the speed of growth of the fastest growing FL (p = 0.003, c-index 0.75), the DI score (DIS, p = 0.014, c-index 0.67), and its dynamic over time (DIS dynamic, p < 0.001, c-index 0.67) all significantly correlated with the time to progression. Size and growth dynamics of FLs correlated significantly with presence/appearance of OL in CT within 2 years after the respective MRI assessment (p = 0.016 and p = 0.022). DIS correlated with decrease of hemoglobin (p < 0.001). In conclusion, size and growth dynamics of FLs correlate with prognosis and local bone destruction. Connections between MRI findings and progression patterns (fast growing FL—OL; DIS—hemoglobin decrease) might enable more precise diagnostic and therapeutic approaches for SMM patients in the future.

scholarly journals Comparison of clinical evaluation of post-operation patients of open reduction internal fixation (ORIF) plating proximal humerus using conventional methods and minimally invasive plate osteosynthesis (MIPO) in Surabaya

2020 ◽  
Vol 4 (2) ◽  
pp. 165
Author(s):  
Musa Arafah ◽  
Heri Suroto ◽  
Erwin Ramawan
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Proximal Humeral Fracture ◽  
Proximal Humerus ◽  
Plate Osteosynthesis ◽  
Operative Therapy ◽  
Humeral Fracture ◽  
Open Reduction Internal Fixation ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Conventional Methods

ABSTRACT There are several kinds of approaches in the installation of implants for proximal humerus therapy. At present, minimally invasive surgery is gaining in popularity; this is supported by increasingly good technological developments to optimal the postoperative outcome is more optimal than conventional methods. This study used an analytic retrospective design with samples of post-ORIF Plating MIPO and posted ORIF due to proximal humeral fracture. Evaluation using the instrument of VAS Score, ASES Score, and measurement of range of motion. Statistical tests showed that there was a significant difference in the VAS score at the first evaluation (p = 0.002); the last review was not significant. In ASES Score, abduction, flexion, and external rotation, there were significant differences during the first and last evaluations. Adduction, extension, and internal rotation have no significance. The method of minimally invasive plate osteosynthesis (MIPO) on proximal humeral operative fracture therapy had a better clinical outcome and operating time than post-ORIF plating with conventional methods. As well, the MIPO method on proximal humeral fracture operative therapy based on radiological features has the same union rates compared to post ORIF plating with conventional methods. The method of minimally invasive plate osteosynthesis (MIPO) in operative therapy of neer 2 and 3 proximal humeral fracture has a better clinical outcome than conventional methods.Keywords: proximal humeral fracture, Minimal Invasive Plate Osteosynthesis (MIPO), Open Reduction Internal Fixation (ORIF)Correspondence to: [email protected]   

scholarly journals PHILOS Plate as a Fixation of Proximal Humeral Fracture: A Revisit

2019 ◽  
pp. 39
Author(s):  
Mohd Shaffid Md Shariff ◽  
Hanizah Ngadiron ◽  
Firdaus Hayati ◽  
Nornazirah Azizan ◽  
Affirul Chairil Ariffin
Keyword(s):  
Proximal Humeral Fracture ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Surgical Intervention ◽  
Motor Vehicle ◽  
Humeral Fracture ◽  
The Elderly ◽  
Sport Injuries ◽  
Vehicle Accidents ◽  
Philos Plate

Fracture is common after trauma. Proximal humeral fracture can occur in the elderly after fall and in youngsters after motor vehicle accidents (MVA) and sport injuries. A 37-year-old man was admitted with a fracture of his left proximal humerus following an MVA. He sustained a 3-part fracture and treated surgically using a PHILOS plate. There are few options in managing proximal humerus fracture ranging from conservative to surgical intervention based on its severity. We reminiscent the usage of PHILOS plate as a mode of treatment of such fracture. 

Axillary Artery Pseudoaneurysm following Severely Displaced Proximal Humerus Fracture: Delayed Presentation and Management

2010 ◽  
Vol 2 (2) ◽  
pp. 100-102
Author(s):  
Thomas Kurien ◽  
Amol Tambe ◽  
David I. Clark
Keyword(s):  
Proximal Humeral Fracture ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Axillary Artery ◽  
Humeral Fracture ◽  
Delayed Presentation ◽  
Artery Pseudoaneurysm ◽  
Novel Approach ◽  
Life Threatening ◽  
Life Threatening Complication

Delayed presentation of axillary artery injuries after displaced proximal humeral fractures are rare. We present a report on an 88 year old female who developed a pseudoanersym of the axillary artery 3 weeks after a proximal humeral fracture and a novel approach to the management of this potentially limb and life threatening complication.

scholarly journals A First Report on [18F]FPRGD2 PET/CT Imaging in Multiple Myeloma

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Nadia Withofs ◽  
François Cousin ◽  
Bernard De Prijck ◽  
Christophe Bonnet ◽  
Roland Hustinx ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Fdg Pet ◽  
Low Dose ◽  
Bone Lesion ◽  
Bone Destruction ◽  
Whole Body ◽  
Newly Diagnosed ◽  
Low Dose Ct ◽  
Pet Ct ◽  
Fdg Pet Ct

An observational study was set up to assess the feasibility of [F18]FPRGD2 PET/CT for imaging patients with multiple myeloma (MM) and to compare its detection rate with low dose CT alone and combined [F18]NaF/[F18]FDG PET/CT images. Four patients (2 newly diagnosed patients and 2 with relapsed MM) were included and underwent whole-body PET/CT after injection of [F18]FPRGD2. The obtained images were compared with results of low dose CT and already available results of a combined [F18]NaF/[F18]FDG PET/CT. In total, 81 focal lesions (FLs) were detected with PET/CT and an underlying bone destruction or fracture was seen in 72 (89%) or 8 (10%) FLs, respectively. Fewer FLs (54%) were detected by [F18]FPRGD2 PET/CT compared to low dose CT (98%) or [F18]NaF/[F18]FDG PET/CT (70%) and all FLs detected with [F18]FPRGD2 PET were associated with an underlying bone lesion. In one newly diagnosed patient, more [F18]FPRGD2 positive lesions were seen than [F18]NaF/[F18]FDG positive lesions. This study suggests that [F18]FPRGD2 PET/CT might be less useful for the detection of myeloma lesions in patients with advanced disease as all FLs with [F18]FPRGD2 uptake were already detected with CT alone.

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