Analysis on Biomechanical Relationship Between Calcaneal Cyst Lesion Size and Pathological Fracture / 医用生物力学

Objective To investigate the relationship between lesion size of solitary bone cyst ( SBC) and pathological fracture of calcaneus, so as to provide references for the treatment of SBC. Methods The three dimensional (3D) finite element model of foot and ankle was established based on CT images. Four models with gradient spherical bone defects were constructed in the focal area to simulate different SBC lesion sizes, and the biomechanical characteristics of calcaneus in different gait phases were analyzed. Results With the increasement of SBC size, the kinematics of calcaneus did not change significantly, but the peak stress of calcaneus increased gradually. When the SBC size exceeded 75% of the calcaneal width, the stress in calcaneal sulcus and cortical bone below SBC increased by 1. 48 times and 7. 74 times, respectively. Conclusions The risk of pathological fracture increases when the SBC diameter exceeds 75% of the calcaneal width, and early surgical intervention should be recommended. The calcaneal sulcus and the cortex bone below SBC are stress concentration regions and can be used as important areas to evaluate pathological fractures.

Epidemiological and Clinical Characteristics of Fibrous Dysplasia of Bone / 肿瘤防治研究

Objective To describe the epidemiological and clinical characteristics of fibrous dysplasia of bone admitted to a single center in the past 30 years. Methods We analyzed the clinical features of 744 patients with bone fibrous dysplasia diagnosed by pathology, including age, gender, disease location, monostotic or polyostotic lesions, pathological fracture and malignant transformation. Results There were 1183 lesions in 744 patients. The mean age at admission was 31.1±13.5 years old. The ratio of male to female was close to 1:1. The most common site was the lower extremities (916(77.4%)), followed by the upper extremities (106(9.0%)). The most common sites of lower extremities were the femur (645(54.5%)) and the tibia (224(18.9%)). Polyostotic cases accounted for 25.4%, and monostotic cases accounted for 74.6%. Pathological fracture occurred in 163 (13.8%) patients. There were 6 (0.8%) patients with malignant transformation. The mean age was 40.5 years old. The mean time of malignant transformation was 7.7 years. Conclusion Fibrous dysplasia of bone is a rare group of benign bone tumors, with typical epidemiological and clinical features.

Vertebroplasty in bone fragility fractures and tumor fractures: risks and benefits / Vertebroplastia em fraturas por fragilidade óssea e tumorais: riscos e benefícios / Vertebroplastia en fracturas por fragilidad ósea y tumorales: riesgos y beneficios

ABSTRACT Objective: To evaluate the results of percutaneous vertebroplasty (PV) in spinal fragility fractures (osteoporosis/tumor), analyzing possible complications. Method: We evaluated 33 patients with spinal fractures (FXV) due to osteoporosis or tumor who underwent PV between January and November 2021. A physical examination was performed, obtaining the history and risk factors for bone fragility/tumor and a radiological evaluation of the spine to verify FXV. Genant's semiquantitative method was used for postoperative classification, the VAS score, and a disability questionnaire (ODI). A radiologist evaluated tomographic control to quantify vertebral filling and extravasation, determining where they occurred. Results: 46 vertebrae of 33 patients were operated on, with a mean age of 71 years, and 11 patients with more than one level of surgery. Of the total, 13 patients had tumor fractures, and 20 had fractures due to insufficiency. PMMA extravasation was observed in 31 vertebrae, most frequently in the External Vertebral Venous Plexus (23), Discal Body (9), Anterior Epidural Recess (4), Pulmonary Vessels (4), Internal Vertebral Venous Plexus (3), Inferior Cava (2), Adipose Plane (2) and Azygos Vein (1). No patient had clinical complications. Furthermore, the mean preoperative VAS was eight, the postoperative one was 3, the mean preoperative ODI was 56, and the postoperative one was 30. Conclusion: PMMA extravasation was frequent in several locations and levels without any clinical complications. VP proved to be effective in improving pain and function. Level III; Longitudinal Retrospective Cohort Study.

RESUMO Objetivo: Avaliar os resultados da vertebroplastia percutânea (VP) em fraturas por fragilidade da coluna (osteoporose/tumoral), analisando possíveis complicações. Método: Foram avaliados 33 pacientes com fratura da coluna vertebral (FXV) por osteoporose ou tumor, entre janeiro e novembro de 2021, submetidos à VP. Foi realizado exame físico junto à obtenção da história e fatores de risco para fragilidade óssea / tumor, além de avaliação radiológica da coluna para constatação de FXV. O método semiquantitativo de Genant foi empregado para a classificação no pós-operatório, além do score EVA e do questionário de incapacidade (ODI). O controle tomográfico foi avaliado por médico radiologista para quantificação do preenchimento vertebral e extravasamento, determinando para onde ocorreram. Resultados: Foram operadas 46 vértebras de 33 pacientes, como média de idade de 71 anos, sendo 11 pacientes com mais de um nível operado. Do total, 13 pacientes apresentavam fraturas tumorais e 20 possuíam fraturas por insuficiência. Observou-se extravasamento do PMMA em 31 vértebras, mais frequentemente para Plexo Venoso Vertebral Externo (23), Corpo Discal (9), Recesso Epidural Anterior (4) Vasos Pulmonares (4), Plexo Venoso Vertebral Interno (3), Cava Inferior (2), Plano Adiposo (2) e Veia Ázigos (1). Nenhum paciente apresentou complicações clínicas. Ainda, o EVA pré-operatório médio foi 8 e o pós-operatório de 3, enquanto o ODI pré-operatório médio foi de 56 e o pós-operatório de 30. Conclusão: O extravasamento de PMMA foi frequente em diversos locais e níveis, sem nenhuma complicação clínica. A VP mostrou-se eficaz na melhora de dor e função. Nível III; Estudo Longitudinal Coorte Retrospectivo.

RESUMEN Objetivo: Evaluar los resultados de la vertebroplastia percutánea (PV) en fracturas por fragilidad de columna (osteoporosis/tumor), analizando posibles complicaciones. Método: Se evaluaron 33 pacientes con fractura de columna (FXV) por osteoporosis o tumor, entre enero y noviembre de 2021, que fueron sometidos a PV. Se realizó examen físico junto con obtención de antecedentes y factores de riesgo de fragilidad ósea/tumor, además de evaluación radiológica de columna para verificar FXV. Para la clasificación postoperatoria se utilizó el método semicuantitativo de Genant, además de utilizar la escala EVA y un cuestionario de discapacidad (ODI). El control tomográfico fue evaluado por un radiólogo para cuantificar el llenado vertebral y la extravasación, determinando dónde se producían. Resultados: Se operaron 46 vértebras de 33 pacientes, con una edad promedio de 71 años, 11 pacientes con más de un nivel de cirugía. Del total, 13 pacientes presentaron fracturas tumorales y 20 fracturas por insuficiencia. Se observó extravasación de PMMA en 31 vértebras, con mayor frecuencia en el Plexo Venoso Vertebral Externo (23), Cuerpo Discal (9), Receso Epidural Anterior (4), Vasos Pulmonares (4), Plexo Venoso Vertebral Interno (3), Cava Inferior (2), Plano Adiposo (2) y Vena Azygos (1). Ningún paciente presentó complicaciones clínicas. Además, la EVA preoperatoria media fue de 8 y la postoperatoria de 3, mientras que la ODI preoperatoria media fue de 56 y la postoperatoria de 30. Conclusión: La extravasación de PMMA fue frecuente en varias localizaciones y niveles, sin complicaciones clínicas. VP demostró ser eficaz para mejorar el dolor y la función. Nivel III; Estudio de cohorte retrospectivo longitudinal.

Tumores que producen metástasis óseas / Tumors that cause bone metastases

Resumen: Introducción: Una metástasis es la capacidad celular tumoral para migrar del tumor primario e implantarse en tejidos de un órgano a distancia por vía hematógena, linfática o contigüidad. Las principales causas de metástasis óseas son: cáncer de mama, próstata y pulmón. Habitualmente se da en pacientes mayores de 50 años. Existe predilección por metastatizar al esqueleto axial. Objetivo: Determinar la frecuencia de los tumores que producen metástasis óseas en nuestra institución. Material y métodos: Estudio observacional, transversal, descriptivo, para análisis retrospectivo de los casos con diagnóstico de metástasis ósea. Resultados: Ciento noventa y tres casos; 121 mujeres y 72 hombres con rango de edad de 42 a 84 años. Los cánceres asociados a metástasis ósea fueron cáncer de mama, pulmón, próstata, cervicouterino y renal; en menor proporción otros como colon, tiroides, hígado y piel. Los huesos más afectados fueron esqueleto axial: columna lumbar y dorsal; en esqueleto apendicular el fémur en la región diafisaria y en el húmero el tercio proximal. En la actualidad, no se ha logrado mejorar la efectividad de estrategias de detección oportuna, por lo que los cuadros de dolor óseo deben iniciar con un protocolo de sospecha tumoral. Conclusiones: Más de 80% de los pacientes acudieron por fractura. Todos tenían historial de dolor mayor a 12 meses sin protocolo de estudio previo.

Abstract: Introduction: A metastasis is the tumor cell capacity to migrate from the primary tumor and implant itself in tissues of an organ at a distance by hematogenous, lymphatic or contiguity. The main causes of bone metastases are: breast, prostate and lung cancer. It usually occurs in patients over 50 years of age. There is a predilection for metastasizing to the axial skeleton. Objective: To determine the frequency of tumors that produce bone metastases in our institution. Material and methods: Observational, cross-sectional, descriptive study, for retrospective analysis of the cases of patients diagnosed with bone metastases. Results: 193 cases; 121 women and 72 men with an age range of 42 to 84 years. Cancers associated with bone metastases were breast, lung, prostate, cervical and renal cancers; to a lesser extent other such as colon, thyroid, liver and skin. The most affected bones were axial skeleton: lumbar and dorsal spine, and in appendicular skeleton the femur in the diaphysiary region and in the humerus the proximal third. At present it has not been possible to improve the effectiveness of timely detection strategies, so bone pain should begin with a protocol of tumor suspicion. Conclusions: More than 80% of the patients came for fracture. All patients had a history of pain greater than 12 months with no prior study protocol.

Enfermedad de Chester Erdheim costal: reporte de caso y revisión de la literatura / Chester Erdheim costal disease: case report and literature review

Introducción. La enfermedad de Erdheim Chester es un trastorno infrecuente, de etiología no clara y edad de presentación variable, que se caracteriza por la proliferación anormal de histiocitos no Langerhans. Puede presentarse de forma asintomática, con manifestaciones locales o como complicaciones sistémicas. El diagnóstico se basa en las condiciones clínicas del paciente, estudios imagenológicos y el estudio anatomopatológico, mediante el cual se confirma la enfermedad. Caso clínico. Paciente masculino con una lesión lítica en el séptimo arco costal, inicialmente asintomático y posteriormente con dolor torácico persistente. Se realizó resección y reconstrucción de la pared torácica, con resolución de la sintomatología y adecuada evolución posoperatoria. El resultado de la patología confirmó el diagnóstico de enfermedad de Erdheim Chester. Discusión. Se presenta el caso de un paciente con compromiso costal y fractura patológica como localización y manifestación inusual de la enfermedad de Erdheim Chester, tratado quirúrgicamente de forma adecuada, y sin aparición de recidiva. Debido a la diversidad de síntomas que pueden presentar y a la afectación de múltiples órganos, además de los estudios imagenológicos, la clínica debe orientar los exámenes complementarios, como electro o ecocardiograma, resonancia nuclear magnética, o angioTAC. En los pacientes asintomáticos se ha recomendado un manejo expectante y en los sintomáticos el tratamiento médico con glucocorticoides, inhibidores de BRAF e interferón alfa. El papel de la cirugía no ha sido estudiado a profundidad

Introduction. Erdheim Chester disease is a rare disorder of unclear etiology and variable age of presentation, characterized by abnormal proliferation of non-Langerhans histiocytes. It can present asymptomatic, with local manifestations or as systemic complications. The diagnosis is based on the clinical conditions of the patient, imaging studies, and the pathological study, through which the disease is confirmed.Clinical case. A male patient with a lytic lesion in the seventh costal arch, initially asymptomatic and later with persistent chest pain, underwent resection and reconstruction of the chest wall, with resolution of the symptoms and adequate postoperative evolution. The pathology report confirmed the diagnosis of Erdheim Chester's disease.Discussion. The case of a patient with rib involvement and pathological fracture is presented as an unusual location and manifestation of Erdheim Chester's disease, treated surgically appropriately, and without recurrence. Due to the diversity of symptoms that they can present and the involvement of multiple organs, in addition to imaging studies, the clinic should direct complementary tests such as electrocardiogram or echocardiogram, magnetic resonance imaging, or CT angiography. Expectant management has been recommended in asymptomatic patients, and medical treatment with glucocorticoids, BRAF inhibitors, and interferon alfa in symptomatic patients. The role of surgery has not been studied in depth

Result analysis of percutaneous core needle biopsy for bone tumors in upper limbs with pathological fracture / 中国骨伤

OBJECTIVE@#To analyze the results of percutaneous core needle biopsy for bone tumors in upper limbs with pathologic fracture and to find the possible factors that could impact the results.@*METHODS@#The including criteria for this study was the patients who had received percutaneous core needle biopsy and definitive surgery, whose tumor was located at upper limb with pathologic fracture. From January 2015 to December 2019, seventy-seven patients were enrolled. There were 55 males and 22 females. The median age was 27 years old (range:5 to 88 years old). The tumor located at humerus in 67 cases, radius in 8 cases and ulna in 2 cases. If the pathologic diagnosis of core needle biopsy was the same with the definitive surgery, it was defined as "correct". If the pathologic diagnosis of biopsy for benign or malignant was right but the exact diagnostic name was not the same with definitive surgery, it was defined as "supportive". If the pathologic diagnosis of biopsy for benign or malignant was not correct, it was defined as "wrong". We retrospectively analyzed the accuracy and impact factors for core needle biopsy.@*RESULTS@#The result was "correct" in 63 cases(81.8%), "supportive" in 14 cases(18.2%), and "wrong" in 0 cases. We analyzed the gender, age, location, fracture displacement, the destroyed type for bone tumor, soft tissue mass, fluid area in the tumor as the factors. The results showed the rate for "correct" was significantly higher when the tumor had soft tissue mass (@*CONCLUSION@#The accuracy of percutaneous core needle biopsy for upper limb bone tumor with pathologic is high and acceptable. The biopsy chosen the soft tissue mass area can increase the accuracy.

Quiste óseo solitario. Presentación de un caso / Solitary bone cyst. Presentation of a case / Cisto ósseo solitário. Apresentação de um caso

RESUMEN Introducción: el quiste óseo solitario (QOS) ha sido reconocido durante muchos años como una lesión benigna; es una cavidad llena de líquido claro. Caso clínico: paciente masculino de 12 años de edad, refiere que hace 2 años sufrió una caída de sus pies provocándole un trauma leve a nivel del humero derecho, fue atendido de urgencia en cuerpo de guardia diagnosticándole una fractura patológica de humero derecho por un quiste óseo solitario. El mismo fue tratado conservadoramente con férula de yeso en U y posterior de humero y Velpeaux de yeso durante 2 meses. Al cabo de 1 año el paciente viene porque presenta ligero dolor y aumento de volumen en la región antero-externa de humero derecho sin cambio de coloración. Examen Físico: Ligero dolor a la palpación, aumento de volumen y limitación a los movimientos de la abducción y flexo extensión del brazo derecho. Discusión: se indicó radiografía que mostro: Lesión metafisaria bien delimitada, radio lúcida, con la cortical adelgazada, atravesado por tabiques. Conclusiones: se diagnosticó un quiste óseo solitario. El tratamiento quirúrgico realizado fue raspado y relleno con Hidroxiapatita.

ABSTRACT Introduction: the Solitary Bone Cyst (QOS) has been recognized for many years as a benign injury; it's a cavity full of clear liquid. Clinical case: 12-year-old male patient, who says that two years ago he suffered a fall from his feet causing him a mild trauma at the level of the right humerus, was seen urgently in the guard corps diagnosing a pathological fracture of right humerus by a solitary bone cyst. It was treated conservatively with U-gypsum splint and later humerus and plaster Velpeaux for 2 months. After 1 year the patient comes because he has slight pain and increased volume in the antero-external region of right humerus without color change. Physical Examination: Slight pain to palpation, increased volume and limitation to the movements of abduction and flexo extension of the right arm. Discussion: x-ray was indicated to show: Well-delimited metaphysarian lesion, lucid radius, with the cortical thinned, crossed by septums. Conclusions: a solitary bone cyst was diagnosed. The surgical treatment performed was scraping and filling with Hydroxyapatite.

RESUMO Introdução: o cisto ósseo solitário (CEC) é reconhecido há muitos anos como uma lesão benigna; é uma cavidade cheia de um líquido claro. Caso clínico: paciente do sexo masculino, 12 anos, relata que há dois anos sofreu uma queda de pé causando leve trauma no úmero direito, foi atendido com urgência na guarita com diagnóstico de fratura patológica do úmero direito devido a um cisto osso solitário. Foi tratado conservadoramente com tala de gesso em forma de U e úmero posterior com gesso Velpeaux por 2 meses. Após 1 ano o paciente chega porque apresenta dor discreta e aumento de volume na região ântero-externa do úmero direito sem descoloração. Exame Físico: Dor leve à palpação, aumento de volume e limitação dos movimentos de abdução e flexoextensão do braço direito. Discussão: foi indicada radiografia que evidenciou: Lesão metafisária bem definida, rádio lúcido, com córtex adelgaçado, cruzado por septos. Conclusões: foi diagnosticado um cisto ósseo solitário. O tratamento cirúrgico realizado foi raspagem e obturação com Hidroxiapatita.

Pathological fracture of subtrochanter femur, soft tissue infection along the fracture site, shaft femur bone cortex thickening and blastic lession on contralateral shaft femur due to renal osteodystrophy on the end stage renal disease patient: a case report

Renal osteodystrophy (ROD) is a skeletal complication resulting from pathologic alterations in calcium, phosphate, and bone metabolism. The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported. In this case presents a pathological fracture on a routinely hemodialyzed woman. She complained pain on her left subtrochanteric area after low energy trauma accident. A thickening of the shaft femoral bone cortex was also found, reflecting the osteosclerosis event due to imbalance of proliferation and differentiation of osteoblast with increase bone formation. She also had a blastic lesion on her contralateral shaft femoral during the bone survey, but this finding remains asymptomatic. Decreased osteoclastic activity may contribute to cortical thickening, resulting in overall bone mass increase, which may lead to decreased elasticity of the bone or impaired repair capabilities, therefore increasing the risk of fracture. The blastic lesion that occurred on contralateral side may indicated effect of ROD or primary bone lesion. Careful assessment and holistic management of patients with kidney disease is necessary to achieve optimal outcome. The prevention of falls is also an important strategy to prevent pathological fractures. End stage renal disease (ESRD) have reduced bone mineral density, a risk factor for fracture incidence. Careful anamnesis and clinical examination are needed for diagnosis and management.

Erdheim-Chester disease with multisystemic involvement: a diagnostic challenge

Erdheim–Chester disease (ECD) is a rare, non-inherited, non- Langerhans form of histiocytosis of unknown origin, first described in 1930. This entity is defined by a mononuclear infiltrate consisting of lipid laden, foamy histiocytes that stain positively for CD68. Individuals affected by this disease are typically adults between their 4th and 6th decades of life. The multi systemic form of ECD is associated with significant morbidity, which may arise due to histiocytic infiltration of critical organ systems. Among the more common sites of involvement are the skeleton, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum) and skin. The most common presenting symptom of ECD is bone pain. Bilateral symmetric increased tracer uptake on 99mTc bone scintigraphy affecting the periarticular regions of the long bones is highly suggestive of ECD. However, definite diagnosis of ECD is established only once CD68(+), CD1a(−) histiocytes are identified within a biopsy specimen with aid of clinical and radiological data. Here we present a rare case of Erdheim-Chester disease in a 46 year male patient based on clinical data, radiological data, histopathological and immunohistochemistry findings.

Tratamiento quirúrgico de la espondilitis tuberculosa (enfermedad de Pott). Reporte de un caso y revisión de la literatura / Surgical treatment of tuberculous spondylitis (Pott's disease). Case report and literature review

RESUMEN La espondilitis tuberculosa (enfermedad de Pott) representa del 1-5% de los casos de tuberculosis. Se presenta un caso clínico de una paciente femenina de 14 años de edad con esta patología complicada con fractura de cuerpos vertebrales T4, T7, T8 y T9; a quien se le realizó un abordaje por vía posterior, consistente en laminectomía completa bilateral de T3, T4, T7, T8, T9 preservando las articulaciones facetarias, mas artrodesis instrumentada con ganchos sublaminares en T1-T2, colocación de alambres sublaminares T5 y T6, tornillos transpediculares en T11 y dos barras de titanio. Con excelentes resultados postoperatorios. Además, se discuten las diferentes vías de abordaje quirúrgico de esta patología.

ABSTRACT Tuberculous spondylitis (Pott's disease) represent 1-5% of tuberculosis cases. We present a clinical case of a female patient of 14 years of age with tuberculous spondylitis (Pott's disease) complicated with vertebral body fracture T4, T7, T8 and T9, who underwent a posterior approach, bilateral complete laminectomy of T3, T4, T7, T8, T9 preserving the facet joints, more arthrodesis instrumented with sublaminar hooks in T1-T2 placement of sublaminar wires T5 and T6 placement of transpedicular screws in T11, and two titanium bars. With excellent postoperative results. In addition, the different surgical approaches to this pathology are discussed.

Fractura patológica de cadera en edad pediátrica. Revisión de la angiomatosis quística ósea / Pathological hip fracture of pediatric age. Revision of the cystic angiomatosis of the bone

Resumen: Introducción: La angiomatosis quística ósea es una enfermedad con solamente 200 casos descritos basados en la proliferación no maligna angiomatosa en tejido óseo y vísceras. Se observa más en la pelvis, los huesos largos y la cintura escapular. La evolución clínica varía de formas autolimitantes a osteólisis agresiva masiva (Gorham-Stout). Su diagnóstico es por exclusión, con datos clínico-radiológicos (imágenes líticas) y resultados histopatológicos no específicos. Caso clínico: Nuestro estudio se basa en el caso clínico de un paciente de 14 años diagnosticado con angiomatosis quística ósea, con afección ósea diseminada, que vino a nuestro centro por el dolor y la impotencia funcional en la cadera derecha, diagnosticando una fractura pertrocantérea. Se le hizo una osteosíntesis con tornillo deslizante de la placa VERSA de cuatro agujeros. Se utilizó un injerto alogénico de hueso esponjoso de la cabeza femoral. La evolución fue satisfactoria con ambulación a plena carga por mes sin requerir medicación analgésica y control de rayos X a los ocho meses, los cuales mostraron signos de completa integración del injerto. La escala analgésica del dolor (EVA) mostró una puntuación de 2/10 por mes. Discusión: Hay controversia con respecto al tratamiento de estas fracturas por la osteosíntesis con el injerto del hueso. Nos enfrentamos a un caso sin criterios clínicos serios, pero con múltiples focos de osteólisis. Se decidió no intervenir profilácticamente la cadera contralateral, ya que es asintomática y hay diferentes patrones de evolución descritos en la literatura y los riesgos en la cirugía

Abstract: Introduction: Bone cystic angiomatosis is a disease with only 200 cases described, based on angiomatous nonmalignant proliferation, in bone tissue and viscera. It focuses on pelvis, long bones and scapular waist. Clinical evolution ranges from self-limiting forms to massive aggressive osteolysis (Gorham-Stout).Its diagnosis is of exclusion, with nonspecific clinical, radiological (lytic images) and histopathological findings. Clinical case: Our study is based on the clinical case of a 14-year-old man diagnosed with bone cystic angiomatosis, with disseminated bone involvement, who came to our center for pain and functional impotence in the right hip, diagnosing a pertrochanteric fracture. It was operated by open reduction and osteosynthesis with four-hole VERSA sliding plate screw. An allogeneic graft of cancellous bone was used from femoral head. The evolution was satisfactory, with ambulation at full load per month without requiring analgesic medication and control X-ray at eight months that showed signs of complete integration of the graft. The analgesic pain scale (visual analogue scale) showed a score of 2/10 per month. Discussion: There is controversy regarding the treatment of these fractures by osteosynthesis with bone graft. We are facing a case without serious clinical criteria, but with multiple foci of osteolysis. It was decided not to intervene prophylactically the contraleteral hip, since it is asymptomatic and there are different patterns of evolution described in the literature and risks in surgery.

Palliative Posterior Instrumentation versus Corpectomy with Cage Reconstruction Treatment for Thoracolumbar Pathological Fracture

STUDY DESIGN: Single-center, retrospective cohort study. PURPOSE: We aimed to evaluate and compare the clinical outcomes in patients who underwent palliative posterior instrumentation (PPI) versus those who underwent corpectomy with cage reconstruction (CCR) for thoracolumbar pathological fracture. OVERVIEW OF LITERATURE: The requirement for anterior support after corpectomy has been emphasized in the treatment of pathological fractures of the vertebrae. However, for patients with a relatively short life expectancy, anterior reconstruction may not be required and posterior instrumentation alone may provide adequate stabilization. METHODS: A total of 43 patients with metastases of the thoracolumbar spine underwent surgery in the department of orthopaedic and traumatology of Istanbul University Faculty of Medicine from 2003 to 2016. Surgical outcomes were assessed on the basis of survival status, pre- and postoperative pain, complication rate, and operation time. RESULTS: PPI was performed for 22 patients and CCR was performed for 21 patients. In the PPI group, the follow-up period of the five surviving patients was 32 months. The remaining 17 patients died with a mean survival duration of 12.3 months postoperatively. In the CCR group, the five surviving patients were followed up for an average of 14.1 months. The remaining 16 patients died with a mean survival duration of 18.7 months postoperatively. No statistically significant difference (p=0.812) was noted in the survival duration. The Visual Analog Scale scores of the patients were significantly reduced after both procedures, with no significant difference noted on the basis of the type of surgical intervention (p>0.05). The complication rate in the CCR group (33.3%) was higher compared with that in the PPI group (22.7%); however, this difference was not noted to be statistically significant (p=0.379). The average operation time in the PPI group (149 minutes) was significantly shorter (p=0.04) than that in the CCR group (192 minutes). CONCLUSIONS: The PPI technique can decompress the tumor for functional improvement and can stabilize the spinal structure to provide pain relief.

An Uncommon Case of Bilateral Pathologic Hip Fractures: Antiviral Drug-induced Osteomalacia in a Patient with Hepatitis B / 대한고관절학회지

The long-term use of adefovir and tenofovir–antiviral medications commonly used to treat chronic hepatitis B–can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemic osteomalacia. However, there have been few reports about pathological fractures requiring surgical stabilization in cases of antiviral drug-induced hypophosphatemic osteomalacia. We present the case of a 51-year-old man who sustained bilateral pathological hip fractures associated with antiviral drug-induced hypophosphatemic osteomalacia. To treat a lamivudine-resistant hepatitis-B viral infection, the patient received adefovir for 7 years followed by tenofovir for the subsequent 3 years. He had suffered from polyarthralgia and generalized weakness for 2 years prior to presentation at our clinic. Misdiagnosis and inadequate management of his condition accelerated weakness of the bone matrix and ultimately induced pathological fractures. The patient was managed via cementless total hip arthroplasty on the left hip and internal fixation on the right hip. This case highlights that orthopaedic surgeons should consider the possibility of hypophosphatemic osteomalacia if patients receiving antiviral drugs complain of polyarthralgia and generalized weakness.

Osteomielitis causante de fractura patológica: reporte de un caso / Pathological fracture resulting from osteomyelitis: report of a case

Las fracturas patológicas mandibulares son poco comunes, representanel 1 a 2% de todas las fracturas. Pueden ser defi nidas como fracturasque ocurren en regiones donde el hueso ha sido debilitado bajo un procesopatológico. Los factores de causa más comunes incluyen procesosquirúrgicos tales como extracciones de terceros molares, colocación deimplantes, osteonecrosis relacionada con bifosfonatos, osteorradionecrosisde la mandíbula, osteomielitis, infecciones, tumores o lesionesquísticas. La osteomielitis es una condición infl amatoria del hueso; estapatología es uno de los factores que puede determinar el debilitamientodel hueso mandibular y causar una subsecuente fractura patológica. Laosteomielitis mandibular se puede desarrollar si una infección primaria noes manejada adecuadamente. El tratamiento de las fracturas patológicaspuede representar un reto para el profesional de la salud y difi ere segúnla etiología de la misma. Se presenta un caso de una paciente de 54 añosde edad, con una fractura mandibular patológica causada por osteomielitis,la cual fue tratada con antibioticoterapia e intervención quirúrgica.

Pathological mandibular fractures are rare, accounting for between1 and 2% of all fractures. They can be defi ned as fractures thatoccur in regions where the bone has become weakened as a result of a pathological process. Common causal factors include surgicalprocedures such as third molar removal, implant placement, bisphosphonate-related osteonecrosis, osteoradionecrosis of the jaw,osteomyelitis, infections, tumors, and cystic lesions. Osteomyelitisis an infl ammatory condition of the bone; this pathology is one ofthe factors that may prompt weakening of the mandibular boneand cause subsequent pathological fracture. Osteomyelitis of themandible may develop if a primary infection is not properly treated.Treatment of pathological mandibular fractures can be challengingand varies according to their etiology. This article looks at the caseof a 54-year-old woman with a pathological mandibular fracture caused by osteomyelitis, which was treated by means of antibioticotherapy and surgical intervention.

The Clinical Characteristics of Giant Cell Tumor of Bone with Aneurysmal Bone Cyst / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the difference in clinical features, process, and prognosis depending on the presence of secondary aneurysmal bone cysts (ABCs) in patients with giant cell tumors. MATERIALS AND METHODS: A total of 33 patients who underwent surgery for giant cell bone tumors between March 2009 and April 2013 were selected. Data on clinical features were obtained from medical records and pathological and radiological review, including age, sex, location, and size of the tumor, and Campanacci grade, as well as whether there was any pathological fracture, local recurrence, distant metastasis, or malignant transformation. The Student t-test and Fisher exact test were used for comparison of the differences in clinical features by the presence or absence of ABCs. RESULTS: Local recurrence occurred in 6 of the 33 cases, 3 each were in the groups with and without ABCs; however, the difference was not statistically significant. In total, nine cases had pathological fractures, seven were in the group with ABC and two were in the group without ABC (p=0.013). No statistically significant differences in age, sex, location and size of the tumor, or Campanacci grade were observed between the groups with and without ABCs. CONCLUSION: There was no difference in the frequency of local recurrence between the groups with and without ABCs. However, pathological fracture occurred more frequently in the group with ABCs compared to the group without ABCs.

Minimally Invasive Spinal Stabilization Using Fluoroscopic-Guided Percutaneous Screws as a Form of Palliative Surgery in Patients with Spinal Metastasis

STUDY DESIGN: Prospective cohort study. PURPOSE: To report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression. OVERVIEW OF LITERATURE: The advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis. METHODS: Between 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival. RESULTS: The mean Tomita score was 6.3+/-2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3+/-0.5 hours for MISt alone and 3.4+/-1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4+/-0.2 L and 1.7+/-0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9+/-1.4 that was significantly decreased to 2.5+/-1.2 postoperatively (p=0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4+/-1.8 days. The mean overall survival time was 11.3 months (range, 2-51 months). Those with a Tomita score or =8 with a mean survival of 14.1+/-12.5 months and 6.8+/-4.9 months, respectively (p=0.019). There were no surgical complications, except one case of implant failure. CONCLUSIONS: MISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications.

Surgical Treatment of Pathological Fractures Occurring at the Proximal Femur

PURPOSE: To analyze the results of surgical treatment for pathological fractures at the proximal femur. MATERIALS AND METHODS: Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. RESULTS: The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. CONCLUSION: Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.

Surgical Treatment of Pathological Fractures Occurring at the Proximal Femur

PURPOSE: To analyze the results of surgical treatment for pathological fractures at the proximal femur. MATERIALS AND METHODS: Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. RESULTS: The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. CONCLUSION: Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.

Percutaneous internal fixation combined with osteoplasty for the treatment of metastasis of proximal femur：preliminary experience in six cases / 介入放射学杂志

Objective To discuss the feasibility and clinical application of percutaneous internal fixation (PIF) combined with pecutaneous osteoplasty (POP) for the treatment of metastasis of proximal femur with impending pathological fracture. Methods Six consecutive patients with metastases of the proximal femur, who could not be able to tolerate conventional surgery, underwent PIF together with POP. The results were analyzed. Results The procedure was successfully accomplished in all six patients. Neither pulmonary embolism nor death occurred in all patients during and after the operation. No fracture at operated area was observed during follow-up period. Conclusion For stabilization of proximal femoral metastatic lesion with impending pathological fracture, percutaneous internal fixation combined with pecutaneous osteoplasty is a safe and effective technique.

Skeletal Manifestations of Hydatid Disease in Serbia: Demographic Distribution, Site Involvement, Radiological Findings, and Complications

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9+/-18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.