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.

Screw-Home Movement of the Tibiofemoral Joint during Normal Gait: Three-Dimensional Analysis

BACKGROUND: The purpose of this study was to evaluate the screw-home movement at the tibiofemoral joint during normal gait by utilizing the 3-dimensional motion capture technique. METHODS: Fifteen young males and fifteen young females (total 60 knee joints) who had no history of musculoskeletal disease or a particular gait problem were included in this study. Two more markers were attached to the subject in addition to the Helen-Hayes marker set. Thus, two virtual planes, femoral coronal plane (P(f)) and tibial coronal plane (P(t)), were created by Skeletal Builder software. This study measured the 3-dimensional knee joint movement in the sagittal, coronal, and transverse planes of these two virtual planes (P(f) and P(t)) during normal gait. RESULTS: With respect to kinematics and kinetics, both males and females showed normal adult gait patterns, and the mean difference in the temporal gait parameters was not statistically significant (p > 0.05). In the transverse plane, the screw-home movement occurred as expected during the pre-swing phase and the late-swing phase at an angle of about 17degrees. However, the tibia rotated externally with respect to the femur, rather than internally, while the knee joint started to flex during the loading response (paradoxical screw-home movement), and the angle was 6degrees. CONCLUSIONS: Paradoxical screw-home movement may be an important mechanism that provides stability to the knee joint during the remaining stance phase. Obtaining the kinematic values of the knee joint during gait can be useful in diagnosing and treating the pathological knee joints.

Risk Factors and Postoperative Prognostic Factors of Spontaneous Spinal Epidural Hematoma

STUDY DESIGN: Retrospective study. OBJECTIVES: To explore the risk factors and the factors associated with the neurological improvement after operation in the spontaneous spinal epidural hematoma. SUMMARY OF LITERATURE REVIEW: The cause of the spontaneous spinal epidural hematoma is unknown. The objective risk and prognostic factors are still controversial. MATERIALS AND METHODS: From January 2006 to December 2014, a total of 12 patients with spontaneous epidural hematoma were evaluated. The risk and prognostic factors analyzed were sex, age, underlying diseases, medications, neurologic status, level and extent of hematoma, cord edema, and interval from onset to surgery. We analyzed the correlation between each factor and neurologic recovery. The neurologic status was analyzed using the American Spinal Injury Association impairment scale (AIS) at the first and the last neurologic examination. RESULTS: The average age of the patients was 68.6 years. Seven patients were treated with anticoagulation therapy, and two were advised to switch to a healthier diet. The initial neurologic status of the patients was AIS A in 2 cases, B in 5 cases, C in 4 cases, D in 1 case, and in two patients, cord edema was revealed on magnetic resonance imaging (MRI). The interval of time from onset to surgery was less than 24 hours in 6 cases, 24-48 hours in 4 cases, and more than 48 hours in 2 cases. CONCLUSIONS: The prognostic factors associated with spontaneous spinal epidural hematoma were found to be initial neurologic status, cord edema on MRI, and interval from onset to surgery. We found no correlation between anticoagulation therapy or healthy diet and spontaneous spinal epidural hematoma, but anticoagulation therapy cannot be excluded as a risk factor.