ABSTRACT
Vertebral hemangiomas are the most common benign spinal tumors with an incidence range of 10-12%. Approximately 1-2% of the cases develop clinically significant symptoms causing the necessity for treatment. Based on our own results and a review of the literature we discuss the role of radiotherapy in the management of symptomatic vertebral hemangiomas. A total dose of 30.0 Gy given in five weekly fractions of 2.0 Gy has been proven as effective for the primary treatment and postsurgical irradiation for the prevention of a recurrence. In the literature review the results are summarized of 59 reports in the period of 1929-2000 for a total of 327 cases. The analysis of 55 studies reporting results in 210 cases which underwent primary radiotherapy or combinations with other methods of treatment demonstrated that in 54% occurred a complete relief of symptoms (CR), in 32% a partial relief (PR), and 11% were non-responders (NR). The analysis of 21 reports of 63 cases which were treated with radiotherapy as the sole measure of treatment demonstrated that 57% had a complete remission of symptoms (CR), 32% a partial remission (PR), and 11% did not respond to radiotherapy (NR). We conclude that radiation therapy is very effective in the management of symptomatic vertebral hemangiomas. With regard on the delayed effects of the irradiation, cases with an acute compression of the spinal cord should be treated primarily with a surgical procedure and a postsurgical irradiation is recommended to prevent a relapse of symptoms. In order to minimise acute or late toxicity and the risk of radiation-induced neoplasms the total dose should not exceed 30 Gy.
Subject(s)
Hemangioma/radiotherapy , Lumbar Vertebrae , Spinal Neoplasms/radiotherapy , Thoracic Vertebrae , Adult , Age Factors , Aged , Child , Combined Modality Therapy , Diagnosis, Differential , Female , Follow-Up Studies , Hemangioma/complications , Hemangioma/diagnosis , Hemangioma/epidemiology , Hemangioma/surgery , Humans , Laminectomy , Magnetic Resonance Imaging , Male , Middle Aged , Postoperative Care , Radiography, Thoracic , Radiotherapy Dosage , Sex Factors , Spinal Cord Compression/etiology , Spinal Neoplasms/complications , Spinal Neoplasms/diagnosis , Spinal Neoplasms/epidemiology , Spinal Neoplasms/surgery , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
In attempted open reduction and internal fixation of displaced calcaneal fractures, comminution of the sustentacular fragment can pose major problems. Two cases of a form of external fixation are presented. The method takes advantage of the strong superomedial and plantar calcaneonavicular ligaments, which link the sustentaculum to the navicular. Traction along these structures (by pins placed in the first metatarsal) indirectly controls the sustentacular fragment, while countertraction from medially placed pins in the tuberosity allows derotation of the fragment and correct repositioning in relation to the sustentaculum. The essential deformities of a calcaneal fracture are corrected by this technique. In addition, distortion of the middle facet appears to correct as well.
