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Inchaustegui ML, Ruiz K, Gonzalez MR, Pretell-Mazzini J. Surgical Management of Metastatic Pathologic Subtrochanteric Fractures: Treatment Modalities and Associated Outcomes. JBJS Rev 2023; 11:01874474-202305000-00002. [PMID: 37141383 DOI: 10.2106/jbjs.rvw.22.00232] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Subtrochanteric pathological fractures (PFs) occur in approximately one-third of femur bone metastases. We seek to analyze surgical treatment strategies for subtrochanteric metastatic PFs and their revision rates. METHODS A systematic review was performed using the PubMed and Ovid databases. Reoperations as a result of complications were analyzed according to initial treatment modality, primary tumor site, and type of revision procedure. RESULTS We identified a total of 544 patients, 405 with PFs and 139 with impending fractures. The study population's mean age was 65.85 years with a male/female ratio of 0.9. Patients with subtrochanteric PFs who underwent an intramedullary nail (IMN) procedure (75%) presented a noninfectious revision rate of 7.2%. Patients treated with prosthesis reconstruction (21%) presented a noninfectious revision rate of 8.9% for standard endoprostheses and 2.5% for tumoral endoprostheses (p < 0.001). Revision rates because of infection were 2.2% for standard and 7.5% for tumoral endoprostheses. There were no infections within the IMN and plate/screws group (p = 0.407). Breast was the most common primary tumor site (41%) and had the highest revision rate (14.81%). Prosthetic reconstructions were the most common type of revision procedure. CONCLUSION No consensus exists regarding the optimal surgical approach in patients with subtrochanteric PFs. IMN is a simpler, less invasive procedure, ideal for patients with a shorter survival. Tumoral prostheses may be better suited for patients with longer life expectancies. Treatment should be tailored considering revision rates, patient's life expectancy, and surgeon's expertise. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Kim Ruiz
- Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marcos R Gonzalez
- Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pretell-Mazzini
- Division of Orthopedic Oncology, Miami Cancer Institute, Baptist Health System South Florida, Plantation, Florida
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Li C, Wu Q, Chang D, Liang H, Ding X, Lao C, Huang Z. State-of-the-art of minimally invasive treatments of bone metastases. J Bone Oncol 2022; 34:100425. [PMID: 35391944 PMCID: PMC8980625 DOI: 10.1016/j.jbo.2022.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 10/29/2022] Open
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Abstract
As an extension of percutaneous vertebroplasty (PVP), percutaneous osteoplasty (POP) refers broadly to percutaneous bone cement injected into various parts of the body and narrowly to cement injected into extraspinal bone lesions. POP mainly includes such surgeries as percutaneous sacroplasty, percutaneous acetabuloplasty, percutaneous femoral osteoplasty, and percutaneous iliac osteoplasty (Figure 1). Currently, POP is a positive and an effective treatment for extraspinal bone lesions in that it can rapidly relieve pain, effectively prevent pathological fractures, and partially inactivate tumors, with few complications. The aim of this review is to detail the POP techniques and report their safety and efficacy in the treatment of extraspinal metastases.
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Affiliation(s)
- Qinghua Tian
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Yongde Cheng
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Chungen Wu
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
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Kelekis A, Cornelis FH, Tutton S, Filippiadis D. Metastatic Osseous Pain Control: Bone Ablation and Cementoplasty. Semin Intervent Radiol 2017; 34:328-336. [PMID: 29249856 PMCID: PMC5730439 DOI: 10.1055/s-0037-1608747] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-guided treatments appear as an interesting alternative for localized metastatic lesions of the peripheral skeleton.
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Affiliation(s)
- Alexis Kelekis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
| | - Francois H. Cornelis
- Department of Radiology, Université Pierre et Marie Curie, Sorbonne Université, Tenon Hospital, Paris, France
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Department of Radiology and Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dimitrios Filippiadis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
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5
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Cornelis FH, Deschamps F. Augmented osteoplasty for proximal femur consolidation in cancer patients: Biomechanical considerations and techniques. Diagn Interv Imaging 2017; 98:645-650. [PMID: 28757428 DOI: 10.1016/j.diii.2017.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
Abstract
According to the literature, prophylactic consolidation of lytic metastasis located in the proximal femur is recommended when the Mirels' score is above 8. Osteoplasty alone provides inadequate consolidation but various devices have been used in association for better consolidation. The aim of this review is to detail the augmented osteoplasty techniques published in the literature and to report their safeties and their efficacies to prevent pathological fracture of the proximal femur. A Pubmed research found 5 studies that evaluated augmented osteoplasty of the proximal femur in cancer patients. All devices demonstrate adequate safety and low rate of secondary pathological fractures.
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Affiliation(s)
- F H Cornelis
- Department of Radiology, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - F Deschamps
- Department of Interventional Radiology, Gustave-Roussy cancer center, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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6
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Cornelis FH, Petitpierre F, Fabre T, Gille O, Amoretti N, Hauger O. Percutaneous low-pressure bone stenting to control cement deposition in extensive lytic lesions. Eur Radiol 2017; 27:3942-3946. [PMID: 28124748 DOI: 10.1007/s00330-016-4703-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/21/2016] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate low-pressure bone stenting combined with cementoplasty in extensive lytic lesions. METHODS A single-centre study involving four consecutive patients (four women) with extensive lytic tumours was performed. The average age was 65 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under fluoroscopy guidance. Follow-up was assessed using the visual analogue scale (VAS). RESULTS Under general (n = 2) or local (n = 2) anaesthesia, five 11-gauge bone biopsy needles were advanced in four lesions. Five auto-expandable uncovered stents (10-14 mm diameter and 40-60 mm long) were inserted. In all cases, bone cement was successfully placed into the tumours. The volume of cement that was injected through the cannulas into the stents was 5-10 mL. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 after the procedure for all patients (p < 0.05). No complications occurred during the follow-up (8-19 months). CONCLUSION This study suggests that cementoplasty combined with low-pressure bone stenting could allow effective bone stabilization resulting in pain relief. KEY POINTS • Low-pressure bone stenting is possible. • This technique improves cement injection control. • The procedure allows effective bone stabilization resulting in pain relief.
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Affiliation(s)
- Francois H Cornelis
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France.
- Department of Radiology, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
| | - Francois Petitpierre
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Thierry Fabre
- Department of Surgery, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Olivier Gille
- Department of Surgery, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Nicolas Amoretti
- Department of Radiology, Hôpital Archet 2, CHU Nice, 151 route Saint Antoine de Ginestiere, 06202, Nice, France
| | - Olivier Hauger
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France
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Mavrovi E, Pialat JB, Beji H, Kalenderian AC, Vaz G, Richioud B. Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur. Diagn Interv Imaging 2017; 98:483-489. [PMID: 28126418 DOI: 10.1016/j.diii.2016.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/28/2016] [Accepted: 12/31/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur. MATERIALS AND METHODS The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years±13 (SD) (range: 35-82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score≥8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay. RESULTS No patients treated with RPOC had a fracture during a mean follow-up time of 382 days±274 (SD) (range: 11-815 days). RPOC was performed under general (n=10) or locoregional (n=2) anesthesia. The average duration of the procedure was 95min±17 (SD) (range: 73-121min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4days ±3 (SD) (range: 2-10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n=7), VAS score decreased from 6.8±1.2 (SD) (range: 5-9) before treatment, to 2.3±1.1 (SD) (range: 1-4) one month later. CONCLUSION Preventive RPOC for pathological fracture of the proximal femur is a reliable alternative for cancer patients who are not candidates for surgical stabilization. Studies involving more patients are needed to confirm our preliminary experience.
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Affiliation(s)
- E Mavrovi
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France.
| | - J-B Pialat
- Department of Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - H Beji
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - A-C Kalenderian
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - G Vaz
- Department of Oncologic Surgery, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - B Richioud
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
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Comparison of percutaneous long bone cementoplasty with or without embedding a cement-filled catheter for painful long bone metastases with impending fracture. Eur Radiol 2016; 27:120-127. [DOI: 10.1007/s00330-016-4347-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 03/10/2016] [Accepted: 03/24/2016] [Indexed: 11/29/2022]
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Kelekis A, Filippiadis D, Anselmetti G, Brountzos E, Mavrogenis A, Papagelopoulos P, Kelekis N, Martin JB. Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept. Cardiovasc Intervent Radiol 2015; 39:90-6. [PMID: 26048014 DOI: 10.1007/s00270-015-1138-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/01/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up. MATERIALS AND METHODS Percutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25-50 medical grade stainless steel micro-needles (22 G, 2-6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment. RESULTS Clinical evaluation included immediate and delayed follow-up studies of patient's general condition, NVS pain score, and neurological status. Imaging assessed implant's long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2-36 months). Comparing patients' scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed. CONCLUSION Percutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.
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Affiliation(s)
- A Kelekis
- 2nd Radiology Department, University General Hospital "ATTIKON", 1 Rimini Str, 12462, Athens, Greece.
| | - D Filippiadis
- 2nd Radiology Department, University General Hospital "ATTIKON", 1 Rimini Str, 12462, Athens, Greece.
| | - G Anselmetti
- GVM Care and Research Maria Pia Hospital, Strada Comunale di Mongreno 180, 10132, Turin, Italy.
| | - E Brountzos
- 2nd Radiology Department, University General Hospital "ATTIKON", 1 Rimini Str, 12462, Athens, Greece.
| | - A Mavrogenis
- A Orthopedic Clinic, University General Hospital "ATTIKON", Athens, Greece.
| | - P Papagelopoulos
- A Orthopedic Clinic, University General Hospital "ATTIKON", Athens, Greece.
| | - N Kelekis
- 2nd Radiology Department, University General Hospital "ATTIKON", 1 Rimini Str, 12462, Athens, Greece.
| | - J-B Martin
- Centre Imaginerie Rive Droite & Gauche, Geneva, Switzerland.
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Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur. Cardiovasc Intervent Radiol 2015; 39:81-9. [PMID: 26044668 DOI: 10.1007/s00270-015-1133-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur. METHODS A total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15-45 ml cement was injected into the femur lesion. RESULTS The overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05). CONCLUSION PCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.
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Kelekis A, Filippiadis DK, Kelekis NL, Martin JB. Percutaneous Augmented Osteoplasty of the Humeral Bone Using a Combination of MicroNeedles Mesh and Cement. J Vasc Interv Radiol 2015; 26:595-7. [DOI: 10.1016/j.jvir.2014.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 10/23/2022] Open
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Feasibility of Percutaneous Cementoplasty Combined with Interventional Internal Fixation for Impending Pathologic Fracture of the Proximal Femur. J Vasc Interv Radiol 2014; 25:1112-7. [DOI: 10.1016/j.jvir.2014.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/14/2014] [Accepted: 03/14/2014] [Indexed: 01/30/2023] Open
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Quinn RH, Randall RL, Benevenia J, Berven SH, Raskin KA. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners. J Bone Joint Surg Am 2013; 95:1887-95. [PMID: 24288805 DOI: 10.2106/00004623-201310160-00011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Iannessi A, Amoretti N, Marcy PY, Sedat J. Percutaneous cementoplasty for the treatment of extraspinal painful bone lesion, a prospective study. Diagn Interv Imaging 2012; 93:859-70. [DOI: 10.1016/j.diii.2012.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Deschamps F, Farouil G, Hakime A, Barah A, Guiu B, Teriitehau C, Auperin A, deBaere T. Cementoplasty of Metastases of the Proximal Femur: Is It a Safe Palliative Option? J Vasc Interv Radiol 2012; 23:1311-6. [DOI: 10.1016/j.jvir.2012.06.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/01/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022] Open
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Abstract
Cementoplasty is a palliative treatment for bone metastases. It can be performed alone or in addition to other treatments, such as radiotherapy, radiofrequency ablation or cryotherapy. It is usually performed to reduce pain where the metastases involve the spine and pelvis. It can also be used to stabilise bones in the event of lytic metastases with a risk of fracture. Unlike ablation techniques, it should not be considered a cancer treatment.
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Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 2011; 35:1428-32. [PMID: 22203060 DOI: 10.1007/s00270-011-0330-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/20/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. METHODS We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score ≥8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. RESULTS The mean Mirels' score was 9.8 ± 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 ± 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 ± 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days. CONCLUSIONS POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.
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