Free Vascularized Fibular Graft for Femoral Head Collapse Combined with Ununited Pathologic Intertrochanteric Fracture / 대한정형외과학회잡지

Surgery for pathologic hip fracture poses significant challenges regarding the fixation of fracture and management of the original tumor lesion. An extensive destruction of the femoral neck and intertrochanteric region by benign or malignant lesions complicated by a pathological fracture generally necessitates total hip arthroplasty; however, in adolescents and young adults, preservation of the hip is preferable. We present a 14-year-old female patient, who sustained a pathological intertrochanteric fracture through a pre-existing aneurysmal bone cyst. Several operative interventions with internal fixation and bone graft were unsuccessful, and combined nonunion and progression of osteolysis around the compression hip screw eventually caused femoral head collapse, mimicking osteonecrosis. Hip preservation and resolution of the original tumor were achieved by free vascularized fibular graft.

The Use of Locking Compression Plate for Stabilization of Existing and Impending Pathologic Fractures at Long Bones with Metastatic Cancer / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the results and the advantages of the operative treatment of metastatic pathologic fractures in long bones using locking compression plates. MATERIALS AND METHODS: Twenty-five patients (28 cases) who underwent open reduction and internal fixation with a locking compression plate with or without cement augmentation for pathologic fractures in long bones resulting from metastatic cancer between 2004 and 2013 were reviewed retrospectively. Mean age at the time of surgery was 62.8 years. Pathologic fractures occurred in 11 cases in the humerus, 11 cases in the femur, and 6 cases in the tibia. Functional analysis of Musculoskeletal Tumor Society (MSTS) scores, functional restoration condition of patients with upper extremity involvements, and interval to wheelchair ambulation in patients with lower extremity involvements was performed. Pain relief (visual analogue scale, VAS) and operation time, postoperative satisfaction with individuals, and complications were evaluated. RESULTS: Mean operation time was 81.3 minutes and mean MSTS scores were 19.8. Mean time from operation to wheelchair ambulation was 3.3 days. Mean VAS improved from 8.1 preoperatively to 2.9 at 1 week postoperatively. Most patients reported that they were more than 'satisfied' One transient radial nerve palsy and one late complication of screw breakage and reduction loss had occurred at postoperative 3 months. CONCLUSION: Internal fixation with a locking compression plate in metastatic pathologic fractures can be an effective treatment option in the meta or diaphyseal area of long bones.

The prognostic value of pathologic fractures in patients with high-grade classic osteosarcoma

Pathologic fracture in osteosarcoma has traditionally been associated with a poor prognosis and is an immediate indication for amputation of the affected extremity. This concept has been questioned and remains an area of debate, especially because advances in osteosarcoma treatment have today resulted in better survival and limb salvage rates. It is the objectives of this paper to analyze the survival and limb salvage rate of osteosarcoma patients presenting with pathologic fractures and compare these with the population of osteosarcoma patients without pathologic fractures. Over a 15-year period (1993-2008), these were 84 patients presenting with non-metastatic high-grade classic osteosarcoma of the extremities (Enneking Stage IIB) who received complete treatment from the University of the Philippines-Musculoskeletal Tumor (UP-MuST) Unit and who had a follow up of at least 2 years. Ten of these 84 patients had pathologic fractures prior to surgery. Their overall survival was 50%, similar to the 50.38% overall survival of the entire group of 84 osteosarcoma patients. Limb salvage rate was 60%, similar to the 59% rate of patients without pathologic fractures. This study shows that contrary to traditional teaching, overall survival for this subset of osteosarcoma patients with pathologic fractures is acceptable at 50% and is equal to that of the entire group of osteosarcoma patients. At the same time, successful limb salvage surgery is possible despite the presence of a pathologic fracture, especially in patients with good response to chemotherapy.

Neurofibromatosis, Pathological Fracture and Hypervitaminosis-D.

Pathologic fractures in children may be due to various causes. Rarely, it may be the presenting symptom of neurofibromatosis. A misdiagnosis of Rickets and Vitamin D supplementation in such a case may wreak havoc in the form of iatrogenic hypervitaminosis D. We report one such case.

Compromiso esquelético en el hiperparatiroidismo primario / Bone involvement in primary hyperparathyroidism

La enfermedad ósea sintomática es infrecuente en el hiperparatiroidismo primario (HPTP), y cuando se presenta puede transcurrir mucho tiempo antes del diagnóstico. Con el objetivo de revisar y actualizar conceptos acerca del compromiso esquelético en el HPTP buscamos en nuestros archivos casos de pacientes en quienes las manifestaciones iniciales o principales de la enfermedad hubieran sido las alteraciones óseas. MATERIALES Y MÉTODOS: revisamos los archivos de la Sección de Ortopedia y del Departamento de Patología de la Facultad de Medicina, Universidad de Antioquia (2000-2006) en busca de casos de hiperparatiroidismo con presentación clínica inicial o principal en los huesos. De cada caso resumimos los hallazgos clínicos, paraclínicos y de seguimiento más relevantes. Basados en estos casos hicimos una revisión del tema. RESULTADOS: encontramos tres casos que cumplían estas características. En los tres la atención inicial fue motivada por una fractura; sin embargo, los tres habían tenido síntomas sistémicos inespecíficos de varios meses o años de evolución. Otras alteraciones óseas detectadas fueron: lesiones osteoblásticas múltiples, desviación de la columna, deformidades en los dedos, osteopenia, dolores óseos y tumor pardo. Los síntomas extraesqueléticos incluían alteraciones gastrointestinales, neurológicas, adinamia y disminución de peso. En los tres casos se detectó adenoma paratiroideo. CONCLUSIONES: aunque infrecuentes, las alteraciones esqueléticas en el HPTP comprometen múltiples huesos y suelen asociarse con síntomas extraesqueléticos inespecíficos. Si se tiene en mente esta enfermedad, se debe medir el calcio sérico como prueba inicial que ayudará al diagnóstico.

Symptomatic bone disease is not usual in primary hyperparathyroidism (PHPT). Increased awareness of the various manifestations of the disease may lead to earlier diagnosis before devastating and irreparable effects have occurred. Our aim was to review skeletal manifestations of PHPT as an important presentation of the disease. MATERIAL AND METHODS: We reviewed archives at our institution (2000-2006) searching for cases of PHPT with bone disease being the initial or main clinical manifestation. Clinical and laboratory data, radiological features and outcome were registered. Based on this information, we carried out a review. RESULTS: We found three cases with these inclusion criteria. In all of them, the initial bone manifestation was a fracture; however, every one had suffered from unspecific systemic manifestations for several months or years. Other bone alterations were: multiple osteoblastic lesions, spine deviation, finger deformity, bone pain, decreased bone mineral density, and brown tumor. Extra-skeletal manifestations in our cases included: gastrointestinal alterations, neurological symptoms, weight loss and depressed mood. In all cases a parathyroid adenoma was detected. CONCLUSIONS: Although infrequent, bone disease in PHPT involves multiple sites and usually is associated with unspecific extra-skeletal manifestations that permit to suspect the diagnosis. Serum calcium determination may lead to the correct diagnosis.

Internal fixation with locked plate and bone cement in treatment of long bone pathologic fractures due to metastatic carcinoma / 中国矫形外科杂志

[Objective] To investigate internal fixation with locked plate and bone cement in treatment of long bone pathologic fractures due to metastatic carcinoma. [Methods]From February 2005 to February 2008, 15 patients suffering from pathologic fractures caused by metastatic lesions of the humerus(3 cases), ulna(2 cases), radius(1 cases), femur(5 cases) and tibia(4 cases) have been surgically treated with internal fixation with locked plate and bone cement.[Results]All patients were followed up after operation for ranging from 24~46 months. Pain relief was achieved in 14 patients(93.3%). Thirteen(86.7%) patients got excellent Enneking scores at 2 weeks postoperatively. The quality of life had significant difference betwen before and after operation (P

A Clinical Study on Pathologic Fractures of Long Bones / 대한정형외과학회잡지

Pathologic fracture is a bresk of bony continuity within an abnormal bone. The abnormslity ma be due to systemic skeletal disease, infection, primary benign and malignant tumor, or metastati carcinoms. Among these, metastatic carcinoma to bone is most common cause of pathologic fractur excluding those due to osteoporosis. When considering the msnagement, pathologic fractures due to systemic skeletal disease usually heal with conservative treatment, while others often require operative treatment. We have experienced 20 cases of pathologic fracture in long bones for 8 years from 19 to 1987. The results were as follows ; 1. The average sge was somewhat different according to underlying diseases Malignant tumorous lesion; 53 years Benign tumorous lesion ; 17 years Chronic osteomyelitis, 42 years 2. The most common cause was malignant tumorous lesion, 8 cases(40%). 3. The most frequent site was femur, 17 cases(85%). 4. Surgical treatment was done in 17 cases(85%), and conservative treatment was done in 3 cas(1sw). 5. In 3 cases of pathologic fractures due to metaststic tumor, the pain was markedly relieved and essy nursing care was possible immediately after operation.

A Clinical Study on Pathologic Fractures / 대한정형외과학회잡지

A pathologic fracture is a fracture of a bone with preexisting structural weakness. When considering the local treatment of pathologic fractures, those resulting from disorders which cause a generalized weakness of the whole or part of the skeleton can be largely treated conservatively. And those because of localized bone destruction or weakness often require operative treatment. For ten years from 1973 to 1983, we observed and analysed 26 cases of pathologic fractures, excluding those due to osteoporosis. The results were as follows: 1. The age distribution showed an even pattern, and the male to female ratio was 58% (15 Males): 42% (11 Females). 2. The underlying etiologies were infection in 6 cases (23%), disturbance in skeletal development in 7 cases (27%), benign tumorous lesion in 10 cases (38%) and malignant tumorous lesion in 3 cases (12%). 3. The most common site was femur, 54% (14 cases). 4. Previous treatment was carried on 38% (10 cases). 5. Of the 26 cases, conservative treatment was done in 4 cases (15%) and surgical treatment was done in 22 cases (85%).