scholarly journals Prediction of fracture risk and prophylactic intervention in metastatic bone disease: a systematic review

2018 ◽  
Vol 1 (1) ◽  
pp. 44-49
Author(s):  
Bogdan Ştefan Creţu ◽  
Călin Dragosloveanu ◽  
Dragoş Cotor ◽  
Şerban Dragosloveanu ◽  
Cristian Ioan Stoica
Keyword(s):  
Fracture Risk ◽  
Bone Disease ◽  
Meta Analysis ◽  
Metastatic Bone Disease ◽  
Bone Lesions ◽  
Pathological Fractures ◽  
Element Analysis ◽  
Actual Knowledge ◽  
Number Of Patients

AbstractPathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.

scholarly journals Predicting Fracture Risk in Patients with Metastatic Bone Disease of the Femur: A Pictorial Review Using Three Different Techniques

2021 ◽  
Vol 2021 ◽  
pp. 1-17
Author(s):  
Shannon M. Kaupp ◽  
Kenneth A. Mann ◽  
Mark A. Miller ◽  
Timothy A. Damron
Keyword(s):  
Fracture Risk ◽  
Risk Prediction ◽  
Bone Disease ◽  
Case Series ◽  
Metastatic Bone Disease ◽  
Element Analysis ◽  
Data Set ◽  
Pictorial Review ◽  
Impending Fracture ◽  
Fracture Risk Prediction

One of the key roles of an orthopedic surgeon treating metastatic bone disease (MBD) is fracture risk prediction. Current widely used impending fracture risk tools such as Mirels scoring lack specificity. Two newer methods of fracture risk prediction, CT-based structural rigidity analysis (CTRA) and finite element analysis (FEA), have each been shown to be more accurate than Mirels. This case series illustrates comparative Mirels, CTRA, and FEA for 8 femurs in 7 subjects. These cases were selected from a much larger data set to portray examples of true positives, true negatives, false positives, and false negatives as defined by CTRA relative to the fracture outcome. Case illustrations demonstrate comparative Mirels and FEA. This series illustrates the use, efficacy, and limitations of these tools. As all current tools have limitations, further work is needed in refining and developing fracture risk prediction.

scholarly journals Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ugo Albertini ◽  
Andrea Conti ◽  
Nicola Ratto ◽  
Pietro Pellegrino ◽  
Michele Boffano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Bone Disease ◽  
Metastatic Bone Disease ◽  
Invasive Technique ◽  
Bone Lesions ◽  
Disease Case ◽  
Lytic Bone Lesions

Introduction. Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius. Results. After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient’s quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter. Conclusion. Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.

scholarly journals Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians?

2018 ◽  
Vol 7 (6) ◽  
pp. 430-439 ◽  
Author(s):  
F. Eggermont ◽  
L. C. Derikx ◽  
N. Verdonschot ◽  
I. C. M. van der Geest ◽  
M. A. A. de Jong ◽  
...  
Keyword(s):  
Finite Element ◽  
Fracture Risk ◽  
Bone Disease ◽  
Failure Load ◽  
Metastatic Bone Disease ◽  
Patient Specific ◽  
Finite Element Models ◽  
Fe Model ◽  
Clinical Assessments ◽  
Number Of Patients

Objectives In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians. Methods A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians. Results In institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments. Conclusion FE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines. Cite this article: F. Eggermont, L. C. Derikx, N. Verdonschot, I. C. M. van der Geest, M. A. A. de Jong, A. Snyers, Y. M. van der Linden, E. Tanck. Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians? Towards computational modelling in daily clinical practice. Bone Joint Res 2018;7:430–439. DOI: 10.1302/2046-3758.76.BJR-2017-0325.R2.

Should Levetiracetam or Phenytoin Be Used for Posttraumatic Seizure Prophylaxis? A Systematic Review of the Literature and Meta-analysis

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 775-782 ◽  
Author(s):  
Nickalus R. Khan ◽  
Matthew A. VanLandingham ◽  
Tamara M. Fierst ◽  
Caroline Hymel ◽  
Kathryn Hoes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antiepileptic Drug ◽  
Random Effects ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Seizure Prophylaxis ◽  
Number Of Patients ◽  
Severe Tbi ◽  
Antiepileptic Drug Therapy

Abstract BACKGROUND: Posttraumatic seizure (PTS) is a significant complication of traumatic brain injury (TBI). OBJECTIVE: To perform a systematic review and meta-analysis to compare levetiracetam with phenytoin for seizure prophylaxis in patients diagnosed with severe TBI. METHODS: An inclusive search of several electronic databases and bibliographies was conducted to identify scientific studies that compared the effect of levetiracetam and phenytoin on PTS. Independent reviewers obtained data and classified the quality of each article that met inclusion criteria. A random effects meta-analysis was then completed. RESULTS: During June and July 2015, a systematic literature search was performed that identified 6097 articles. Of these, 7 met inclusion criteria. A random-effects meta-analysis was performed. A total of 1186 patients were included. The rate of seizure was 35 of 654 (5.4%) in the levetiracetam cohort and 18 of 532 (3.4%) in the phenytoin cohort. Our meta-analysis revealed no change in the rate of early PTS with levetiracetam compared with phenytoin (relative risk, 1.02; 95% confidence interval, 0.53-1.95; P = .96). CONCLUSION: The lack of evidence on which antiepileptic drug to use in PTS is surprising given the number of patients prescribed an antiepileptic drug therapy for TBI. On the basis of currently available Level III evidence, patients treated with either levetiracetam or phenytoin have similar incidences of early seizures after TBI.

scholarly journals Użyteczność metod radioizotopowych w leczeniu przerzutów nowotworowych do układu kostnego – przegląd metod

2019 ◽  
Vol 15 (4) ◽  
pp. 126-133
Author(s):  
Roksana Zając ◽  
Paulina Radzińska ◽  
Agata Karolina Pietrzak ◽  
Katarzyna Wiecheć ◽  
Jakub Żurawski ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Therapy ◽  
Clinical Problem ◽  
Bone Lesions ◽  
Neoplastic Disease ◽  
Pathological Fractures ◽  
Oncological Patient ◽  
Important Clinical Problem ◽  
Health Complications

StreszczenieLeczenie dolegliwości bólowych będących konsekwencją przerzutów nowotworowych w układzie kostnym stanowi ważny problem kliniczny z uwagi na istotne obniżenie jakości życia chorego onkologicznego. Towarzyszące zaawansowanej chorobie nowotworowej zmiany przerzutowe oprócz bólu, są także przyczyną złamań patologicznych oraz upośledzenia funkcji ruchowych pacjenta, a nieleczone mogą być przyczyną krytycznych dla życia chorego powikłań. Zastosowanie leczenia radioizotopowego jako jednej z form terapii paliatywnej, jest ważnym i efektywnym sposobem zapobiegania komplikacjom zdrowotnym związanym z rozwojem przerzutów do układu szkieletowego.Abstract  Palliative therapy in patients’ suffering from metastatic bone lesions is an important clinical problem due to a significant reduction in the quality of life of an oncological patient. The metastatic bone lesions regardless pain are also the cause of pathological fractures and impairments of the patient's motor functions and untreated can affect mortality more often than primary neoplastic disease. The palliative therapy using radioisotopes seems to be an important and effective method which might prevent the critical health complications caused by the skeletal tumors.

Sign in / Sign up

Export Citation Format

Share Document