pathological fractures
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2021 ◽  
Vol 11 (1) ◽  
pp. 182
Author(s):  
Camilla de Cataldo ◽  
Federico Bruno ◽  
Stefano Necozione ◽  
Mariangela Novello ◽  
Pierpaolo Palumbo ◽  
...  

Previous studies suggest that interventional ablative procedures on bone lesions may weaken the bone, especially when performed through the needle approach. Our purpose was to evaluate, through Computed Tomography (CT), the effects of Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) ablation on painful osteoid osteomas and osteoblastomas in terms of bone density and morphological changes. We retrospectively evaluated patients treated at our institution with MRgFUS for superficial, painful osteoid osteoma or osteoblastoma during the last 9 years. Inclusion criteria were procedural and clinical success, as well as the availability of pre- and postprocedural CT examinations. Imaging features assessed were perilesional/nidus density changes and the occurrence of pathological fractures during the follow-up period. Our study population included 31 osteoid osteomas and 5 intra-articular osteoblastomas in 36 treated patients. We found an increased bone density of the lesions when pre and post-treatment CT- values were compared: these differences were statistically significant, and this finding is consistent with significant bone densification at the post-treatment imaging follow-up. No pathological fractures were observed after ablation during the follow-up. MRgFUS can be considered to be the treatment of choice for benign superficial bone lesions, thanks to its minimal invasiveness, excellent effectiveness, and safety. Pathological fractures, reported in literature as a rare event using needle ablation, never occurred in our MRgFUS treatment series.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Bereket Fantahun ◽  
Seblewongel Desta

Background. McCune–Albright syndrome (MAS) is a rare heterogeneous genetic disorder that is characterized by a triad of polyostotic fibrous dysplasia (FD), café au lait spots (CAL), and multiple hyperfunctional endocrinopathies. In general, it is diagnosed clinically. From the triads, two of the findings are enough to make the diagnosis, but genetic testing can be done if it is available. Case Presentation. We report a female child who was symptomatic since the neonatal period with skin hyperpigmentation, breast enlargement, and vaginal bleeding. She was diagnosed with MAS at the age of five years. She had pathological fractures at multiple sites and had raised thyroid hormones since the age of 3½ years. The child developed severe morbidity as the result of delayed diagnosis and currently became wheelchair dependent. Conclusion. Thorough patient evaluation and appropriate interpretation of findings are crucial steps for timely diagnosis of MAS and better patient care outcomes.


2021 ◽  
Vol 42 ◽  
pp. 101179
Author(s):  
Bin Xu ◽  
David B Anderson ◽  
Eun-Sun PARK ◽  
Lingxiao Chen ◽  
Jae Hyup Lee

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Leah N. Herzog ◽  
Sophia A. Traven ◽  
Zeke J. Walton ◽  
Lee R. Leddy

2021 ◽  
Vol 24 (2) ◽  
pp. 4-47
Author(s):  
Zh. E. Belaya ◽  
K. Yu. Belova ◽  
E. V. Biryukova ◽  
I. I. Dedov ◽  
L. K. Dzeranova ◽  
...  

Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system.Screening to identify groups with a high probability of fracture is recommended using the FRAX® Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX® (B2).It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX®) regardless of the results of spine and hip DXA (В3).It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2).It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score > -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3).All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2).


Author(s):  
Awadh Saeed Alqahtani ◽  
Hayazi Mohammed Alshehri ◽  
Nazim Faisal Ahmed ◽  
Mohammed Hassan Alatawi ◽  
Wurud Muteb D. Alshammari ◽  
...  

Rickets is a worldwide bone disease that is associated with disorders of calcium and phosphate homeostasis and can lead to short stature and joint deformities. Osteomalacia is a major metabolic bone disease that results from a chronic and severe deficiency of vitamin D or phosphate from any cause after growth has stopped. A deficiency of vitamin D or phosphate leads to defective bone mineralization and generalized or localized vague bone pain in various parts of the skeleton and / or proximal muscle weakness. Rickets and osteomalacia are two different clinical diseases with impaired bone mineralization. Rickets occurs throughout the growing skeleton in infants and children, while osteomalacia occurs in adults after fusion of the growth plates. Rickets and osteomalacia are increasingly common in Saudi Arabia, with vitamin D deficiency being the most common etiological cause. Early skeletal deformities can occur in infants, such as soft, thin skull bones, a condition known as craniotabes. In adults, as a result of demineralization, the bones become less rigid (soft bone) with pathological fractures. The diagnosis of both diseases is based on the medical history and physical examination, radiological characteristics, and biochemical tests. Management depends on the underlying etiology.


Author(s):  
Maximilian Peter Forssten ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Yang Cao ◽  
Per Wretenberg ◽  
...  

Abstract Purpose The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day. Methods All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00–17:00) and out-of-hours surgery (17:00–08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality. Results Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00–1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01–1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04–1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01–1.15), p = 0.022] compared to on-hour surgery. Conclusion Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tingting Li ◽  
Junmin Chen ◽  
Zhiyong Zeng

AbstractMultiple myeloma (MM) is a common malignant tumor of plasma cells. Despite several treatment approaches in the past two decades, MM remains an aggressive and incurable disease in dire need of new treatment strategies. Approximately 70–80% of patients with MM have myeloma bone disease (MBD), often accompanied by pathological fractures and hypercalcemia, which seriously affect the prognosis of the patients. Calcium channels and transporters can mediate Ca2+ balance inside and outside of the membrane, indicating that they may be closely related to the prognosis of MM. Therefore, this review focuses on the roles of some critical calcium channels and transporters in MM prognosis, which located in the plasma membrane, endoplasmic reticulum and mitochondria. The goal of this review is to facilitate the identification of new targets for the treatment and prognosis of MM.


2021 ◽  
Vol 73 (9) ◽  
pp. 603-608
Author(s):  
Kongkhet Riansuwan ◽  
Somkiat Jivasomboonkul ◽  
Rapin Phimolsarnti ◽  
Chandhanarat Chandhanayingyong ◽  
Apichat Asavamongkolkul

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.


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