ABSTRACT
A case of antegrade nailing of the humeral shaft in a polytrauma patient was complicated by heterotopic ossification of the lateral deltoid muscle and severe loss of shoulder motion. The patient did not respond to physiotherapy alone and was successfully managed by excision of the heterotopic bone and adjunctive radiation therapy.
Subject(s)
Fracture Fixation, Intramedullary/adverse effects , Humeral Fractures/surgery , Multiple Trauma/surgery , Ossification, Heterotopic/etiology , Accidents, Aviation , Adult , Bone Nails , Follow-Up Studies , Fracture Fixation, Intramedullary/methods , Fracture Healing/physiology , Humans , Humeral Fractures/diagnostic imaging , Male , Multiple Trauma/diagnostic imaging , Multiple Trauma/rehabilitation , Muscle, Skeletal/pathology , Ossification, Heterotopic/diagnostic imaging , Radiography , Range of Motion, Articular , Shoulder JointABSTRACT
Osteoradionecrosis occurs in approximately 10% to 15% of patients following radiation therapy for head and neck cancer. In these patients, it is most commonly reported in sites involving the mandible, but it has also been reported in the maxilla, sphenoid, and temporal bones. The majority of these cases are related to some type of trauma such as dental extraction or intraoral biopsies. However, approximately 40% of these entities occur spontaneously and are felt to be secondary to cell kill in intermediate tissues such as bone and periosteum. Our literature review yielded no previously reported cases of osteoradionecrosis involving the anterior cranium. The following two cases present patients who experienced osteoradionecrosis of their frontal bone flaps following subcranial approaches for tumor resection. Both patients suffered from carcinomas involving the ethmoid sinuses; one tumor was a moderately well-differentiated squamous cell carcinoma, the other a mucinous adenocarcinoma. One patient's radiation therapy consisted of external beam photons; the other patient received external beam neutrons. Treatment for these patients, as well as possible causative factors regarding their osteoradionecrosis, are discussed.
ABSTRACT
Ninety-seven patients who underwent radiation treatment for metastatic carcinomas and sarcomas were evaluated to define prognostic factors that may reliably help determine survival and probability of completing a course of palliative radiation therapy. Actuarial and logistic models were used for analysis. Predictor variables included age; sex; symptoms; primary site of disease; pathologic diagnosis; prior metastatic disease, treatment, and response; solitary versus multiple metastatic sites; location of metastasis; status of primary lesion; interval between initial diagnosis and treatment for metastatic disease; and Karnofsky performance score (KPS). The interval between primary diagnosis and metastatic treatment, and KPS, were significant variables for 22 patients (23%) who failed to complete their planned radiation treatment. KPS was consistently significant for probability of survival at 2-, 4-, 8-, and 16-month intervals. At 8 months and 16 months, site of primary disease was significant, and at 16 months, solitary site of metastasis was also significant. Conventional factors, especially KPS, are useful in predicting the likelihood of completing radiation therapy and of subsequent survival for patients undergoing palliative treatment.
