1
|
Lozano-Calderon SA, Rijs Z, Groot OQ, Su MW, Werenski JO, Merchan N, Yeung CM, Sodhi A, Berner E, Oliveira V, Bianchi G, Staals E, Lana D, Donati D, Segal O, Marone S, Piana R, Meo SD, Pellegrino P, Ratto N, Zoccali C, Scorianz M, Tomai C, Scoccianti G, Campanacci DA, Andreani L, Franco SD, Boffano M, Pensado MP, Ruiz IB, Moreno EH, Ortiz-Cruz EJ, van de Sande M. Outcomes of Long Bones Treated With Carbon-Fiber Nails for Oncologic Indications: International Multi-institutional Study. J Am Acad Orthop Surg 2024; 32:e134-e145. [PMID: 37824083 DOI: 10.5435/jaaos-d-22-01159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/27/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Intramedullary nail fixation is commonly used for prophylactic stabilization of impending and fixation of complete pathological fractures of the long bones. However, metallic artifacts complicate imaging evaluation for bone healing or tumor progression and postoperative radiation planning. Carbon-fiber implants have gained popularity as an alternative, given their radiolucency and superior axial bending. This study evaluates incidences of mechanical and nonmechanical complications. METHODS Adult patients (age 18 years and older) treated with carbon-fiber nails for impending/complete pathological long bone fractures secondary to metastases from 2013 to 2020 were analyzed for incidences and risk factors of mechanical and nonmechanical complications. Mechanical complications included aseptic screw loosening and structural failures of host bone and carbon-fiber implants. Deep infection and tumor progression were considered nonmechanical. Other complications/adverse events were also reported. RESULTS A total of 239 patients were included; 47% were male, and 53% were female, with a median age of 68 (IQR, 59 to 75) years. Most common secondary metastases were related to breast cancer (19%), lung cancer (19%), multiple myeloma (18%), and sarcoma (13%). In total, 17 of 30 patients with metastatic sarcoma received palliative intramedullary nail fixation for impending/complete pathological fractures, and 13 of 30 received prophylactic nail stabilization of bone radiated preoperatively to manage juxta-osseous soft-tissue sarcomas, where partial resection of the periosteum or bone was necessary for negative margin resection. 33 (14%) patients had complications. Mechanical failures included 4 (1.7%) structural host bone failures, 7 (2.9%) implant structural failures, and 1 (0.4%) aseptic loosening of distal locking screws. Nonmechanical failures included 8 (3.3%) peri-implant infections and 15 (6.3%) tumor progressions with implant contamination. The 90-day and 1-year mortalities were 28% (61/239) and 53% (53/102), respectively. The literature reported comparable failure and mortality rates with conventional titanium treatment. CONCLUSIONS Carbon-fiber implants might be an alternative for treating impending and sustained pathological fractures secondary to metastatic bone disease. The seemingly comparable complication profile warrants further cohort studies comparing carbon-fiber and titanium nail complications.
Collapse
Affiliation(s)
- Santiago A Lozano-Calderon
- From the Massachusetts General Hospital-Harvard Medical School, Boston, MA (Lozano-Calderon, Groot, Werenski, Merchan, Yeung, Sodhi, and Berner), Leiden University Medical Center Leiden, The Netherlands (Rijs, Su, and van de Sande), Centro Hospitalar Universitário do Porto, Oporto University Hospital Center, Porto, Portugal (Oliveria), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (Bianchi, Staals, and Donati), Ospedale Maggiore Trauma Center, Bologna, Italy (Lana), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Segal), Centro Traumatologico Ortopedico, Turin, Italy (Marone, Piana, Meo, Pellegrino, and Ratto), Department of General Surgery, Plastic Surgery, and Orthopaedics, Policlinico Umberto I Hospital-Sapienza, Orthopaedic and Traumatology Unit, University of Rome, Rome, Italy (Zoccali). Orthopaedic Oncology Unit, Careggi University Hospital, Florence, Italy (Tomai, Scoccianti, and Campanacci), University Hospital of Pisa, Pisa, Italy (Andreani and Franco), Hospital Universitario La Paz, Madrid, Spain (Pensado, Ruiz, Moreno, and Ortiz-Cruz), Regina Margherita Children's Hospital Torino, TO, Italy (Boffano)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Pala E, Procura A, Trovarelli G, Berizzi A, Ruggieri P. Intramedullary nailing for impending or pathologic fracture of the long bone: titanium vs carbon fiber peek nailing. EFORT Open Rev 2022; 7:611-617. [PMID: 35924657 PMCID: PMC9458939 DOI: 10.1530/eor-22-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Methods Results Conclusions
Collapse
Affiliation(s)
- Elisa Pala
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Alberto Procura
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Giulia Trovarelli
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Antonio Berizzi
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Krumme JW, MacConnell AE, Adams BW, Jelinek JJ, Henshaw RM. Radiolucent Implants for Fixation of Impending and Pathologic Fractures. Orthopedics 2022; 45:e115-e121. [PMID: 35201938 DOI: 10.3928/01477447-20220217-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radiolucent implants offer theoretical advantages of increased ability to evaluate the fracture site for healing and recurrence and potentially less effect on radiation treatment, avoiding scatter. Their clinical utility and outcomes have yet to be proven in a well-designed randomized trial or large cohort study, although studies based on other indications have shown relative safety and they are approved by the US Food and Drug Administration for treatment of pathologic fractures. Further research is necessary to better understand when and how these implants should be implemented in practice. [Orthopedics. 2022;45(3):e115-e121.].
Collapse
|
4
|
Sabharwal S, Alcorn SR, Morris CD. Treatment of Radiation-Associated Fractures: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202108000-00007. [PMID: 34415860 DOI: 10.2106/jbjs.rvw.20.00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Fractures that result from radiation-induced bone damage are a recognized adverse effect of radiation therapy (RT). » The mechanisms of damage from RT are thought to be related to impaired vascularity, aberrations in osteoclast and osteoblast-mediated bone turnover, and compromise of cortical and trabecular microarchitecture. » Treatment of radiation-associated fractures is challenging, with rates of delayed union and nonunion of >50%. » Fracture management strategies, each with its own profile of risks and benefits, include prophylactic intramedullary nailing of long bones, open reduction and internal fixation with adjunctive iliac crest or vascularized fibular grafting, and endoprosthetic reconstruction.
Collapse
Affiliation(s)
- Samir Sabharwal
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara R Alcorn
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carol D Morris
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
5
|
Borzunov DY, Kolchin SN, Malkova TA. Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved. World J Orthop 2020; 11:304-318. [PMID: 32572367 PMCID: PMC7298454 DOI: 10.5312/wjo.v11.i6.304] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use. AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes. METHODS Three databases (PubMed, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period (2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results, complications and described large patient samples (not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded. RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen. Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously (bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion. CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.
Collapse
Affiliation(s)
- Dmitry Y Borzunov
- Department of Traumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia
| | - Sergei N Kolchin
- Orthopaedic Department 4, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
| | - Tatiana A Malkova
- Department for Medical Information and Analysis, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
| |
Collapse
|