Percutaneous Nailing and Cementoplasty for Palliative Management of Supra-Acetabular Iliac Wing Metastases: A Case Report.

CASE: A 48-year-old woman was unable to walk due to an extensive osteolytic supra-acetabular iliac wing metastatic lymphoma involving the arcuate line. A minimally invasive technique that combined percutaneous nailing of the iliac bone with a customized nail and cementoplasty (intraosseous injection of polymethylmethacrylate) was performed. At the 1-year follow-up, she was able to walk without crutches, and computed tomography (CT) showed a stable iliac bone fixation. CONCLUSION: Osteolytic metastasis is a common cause of bone weakening, especially in load-bearing areas. With osteolytic metastases involving the acetabulum, intraosseous injection of bone cement into the weakened acetabulum may reduce pain and prevent fracture. Nailing combined with cementoplasty may be proposed for extensive destruction of the iliac bone involving the arcuate line to relieve pain and allow for resumed walking.

Meta-Analysis of a Complex Network of Non-Pharmacological Interventions: The Example of Femoral Neck Fracture.

BACKGROUND: Surgical interventions raise specific methodological issues in network meta-analysis (NMA). They are usually multi-component interventions resulting in complex networks of randomized controlled trials (RCTs), with multiple groups and sparse connections. PURPOSE: To illustrate the applicability of the NMA in a complex network of surgical interventions and to prioritize the available interventions according to a clinically relevant outcome. METHODS: We considered RCTs of treatments for femoral neck fracture in adults. We searched CENTRAL, MEDLINE, EMBASE and ClinicalTrials.gov up to November 2015. Two reviewers independently selected trials, extracted data and used the Cochrane Collaboration's tool for assessing the risk of bias. A group of orthopedic surgeons grouped similar but not identical interventions under the same node. We synthesized the network using a Bayesian network meta-analysis model. We derived posterior odds ratios (ORs) and 95% credible intervals (95% CrIs) for all possible pairwise comparisons. The primary outcome was all-cause revision surgery. RESULTS: Data from 27 trials were combined, for 4,186 participants (72% women, mean age 80 years, 95% displaced fractures). The median follow-up was 2 years. With hemiarthroplasty (HA) and total hip arthroplasty (THA) as a comparison, risk of surgical revision was significantly higher with the treatments unthreaded cervical osteosynthesis (OR 8.0 [95% CrI 3.6-15.5] and 5.9 [2.4-12.0], respectively), screw (9.4 [6.0-16.5] and 6.7 [3.9-13.6]) and plate (12.5 [5.8-23.8] and 7.8 [3.8-19.4]). CONCLUSIONS: In older women with displaced femoral neck fractures, arthroplasty (HA and THA) is the most effective treatment in terms of risk of revision surgery. SYSTEMATIC REVIEW REGISTRATION: PROSPERO no. CRD42013004218. LEVEL OF EVIDENCE: Network Meta-Analysis, Level 1.