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Garnon J, Autrusseau PA, Caudrelier J, Weiss J, Bertucci G, Koch G, Gangi A, Cazzato RL. Combination of Elastic Nail(s) and Cementoplasty to Treat Pathological Fractures in Long Bones of the Upper Limb. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03844-4. [PMID: 39198277 DOI: 10.1007/s00270-024-03844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE To describe and study retrospectively the combination of elastic nails and cementoplasty to stabilize pathological fractures in the upper limb and present the results on pain and mobility. MATERIALS AND METHODS Between January 2022 and April 2024, six patients with a median age of 65 were treated with elastic nailing and cement injection. Pathological fractures were located in the clavicle (n = 3), humerus (n = 1) and radius (n = 2). Displacement at the fracture site was noted in two cases. RESULTS All nails were inserted successfully. Two nails were used for the humerus (n = 1) and the radius (n = 2), and a single nail was used for the clavicle (n = 3). A median volume of 6.5 cc of PMMA was injected. Median duration of the procedure was 155 min. Median pain score dropped from 8/10 the day before intervention to 3.5/10 at 10 days of follow-up and 3/10 at one-month follow-up. Three patients could move their upper limb without limitation. For the five patients for whom imaging was available, no fracture displacement was recorded at a median last follow-up of 3 months. There was no delayed complication. CONCLUSION The combination of elastic nail and cementoplasty is feasible and allows to reduce pain and restore limb function. It may offer an alternative to patients suffering from pathological fractures in the upper limb and who are not candidates for surgery.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France.
| | - Pierre-Alexis Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Gregory Bertucci
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
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Percutaneous reinforced cementoplasty using spindles as a palliative option for malignant fractures of the humerus. Diagn Interv Imaging 2022; 103:375-377. [DOI: 10.1016/j.diii.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 12/26/2022]
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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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Cazzato RL, Koch G, Buy X, Ramamurthy N, Tsoumakidou G, Caudrelier J, Catena V, Garnon J, Palussiere J, Gangi A. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus. Cardiovasc Intervent Radiol 2016; 39:1455-63. [DOI: 10.1007/s00270-016-1389-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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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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Regarding “Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept”: Reply. Cardiovasc Intervent Radiol 2015; 39:479-80. [DOI: 10.1007/s00270-015-1289-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/06/2015] [Indexed: 10/22/2022]
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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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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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Filippiadis DK, Tutton S, Kelekis A. Percutaneous bone lesion ablation. Radiol Med 2014; 119:462-9. [PMID: 24894924 DOI: 10.1007/s11547-014-0418-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/01/2014] [Indexed: 12/22/2022]
Abstract
Benign tumors and metastatic bone lesions can be treated by ablation techniques performed either alone or in combination with other percutaneous techniques. Ablation techniques include ethanol or acetic acid injection and thermal ablation by means of energy deposition [including laser, radiofrequency, microwave, cryoablation, radiofrequency ionization and magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU)]. Goal definition of the therapy is crucial: ablation techniques can be proposed as curative treatments in benign bone tumors or oligometastatic disease (<3 lesions). Alternatively, these techniques can be proposed as palliative treatments aiming at reduction of pain, local control of the disease and tumor decompression. Depending on the lesion's location ablation can be combined with cementation with or without further metallic augmentation; local tumor control can be enhanced by combining ablation with transarterial bland embolization or chemoembolization. Thermal ablation of bone and soft tissues is characterized by high success and relatively low rates of potential complications, mainly iatrogenic thermal damage of surrounding sensitive structures. Successful thermal ablation requires a sufficient ablation volume and thermal protection of the surrounding vulnerable structures. This article will describe the general principles governing ablation and the mechanism of action for each technique and in addition will review the literature about safety and effectiveness of percutaneous imaging-guided ablation for benign and malignant (primary and metastatic) lesions.
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Affiliation(s)
- Dimitrios K Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens, Greece,
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Filippiadis DK, Tutton S, Mazioti A, Kelekis A. Percutaneous image-guided ablation of bone and soft tissue tumours: a review of available techniques and protective measures. Insights Imaging 2014; 5:339-46. [PMID: 24838839 PMCID: PMC4035489 DOI: 10.1007/s13244-014-0332-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/27/2014] [Accepted: 04/07/2014] [Indexed: 12/20/2022] Open
Abstract
Background Primary or metastatic osseous and soft tissue lesions can be treated by ablation techniques. Methods These techniques are classified into chemical ablation (including ethanol or acetic acid injection) and thermal ablation (including laser, radiofrequency, microwave, cryoablation, radiofrequency ionisation and MR-guided HIFU). Ablation can be performed either alone or in combination with surgical or other percutaneous techniques. Results In most cases, ablation provides curative treatment for benign lesions and malignant lesions up to 3 cm. Furthermore, it can be a palliative treatment providing pain reduction and local control of the disease, diminishing the tumour burden and mass effect on organs. Ablation may result in bone weakening; therefore, whenever stabilisation is undermined, bone augmentation should follow ablation depending on the lesion size and location. Conclusion Thermal ablation of bone and soft tissues demonstrates high success and relatively low complication rates. However, the most common complication is the iatrogenic thermal damage of surrounding sensitive structures. Nervous structures are very sensitive to extremely high and low temperatures with resultant transient or permanent neurological damage. Thermal damage can cause normal bone osteonecrosis in the lesion’s periphery, surrounding muscular atrophy and scarring, and skin burns. Successful thermal ablation requires a sufficient ablation volume and thermal protection of the surrounding vulnerable structures. Teaching points • Percutaneous ablations constitute a safe and efficacious therapy for treatment of osteoid osteoma. • Ablation techniques can treat painful malignant MSK lesions and provide local tumour control. • Thermal ablation of bone and soft tissues demonstrates high success and low complication rates. • Nerves, cartilage and skin are sensitive to extremely high and low temperatures. • Successful thermal ablation occasionally requires thermal protection of the surrounding structures.
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Affiliation(s)
- Dimitrios K Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens, Greece,
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Kelekis A, Filippiadis D, Velonakis G, Malagari A, Alexopoulou E, Brountzos E, Kelekis N. Percutaneous augmented osteoplasty for the treatment of symptomatic fractures in peripheral long bones. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2014.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abdel-Aal AK, Underwood ES, Saddekni S. Use of cryoablation and osteoplasty reinforced with Kirschner wires in the treatment of femoral metastasis. Cardiovasc Intervent Radiol 2012; 35:1211-5. [PMID: 22565529 DOI: 10.1007/s00270-012-0401-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/06/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We report the case of a 43-year-old man with metastatic breast carcinoma to the proximal right femur resulting in severe painful pathological fracture. The patient experienced severe pain despite large doses of analgesia, resulting in impaired functionality and quality of life. The patient had significant comorbidities, making him a high surgical risk. MATERIALS AND METHODS The patient was treated with cryoablation and osteoplasty, followed by a novel technique consisting of osteoplasty reinforced with bone marrow Kirschner wires (K-wires) which will be described in details in this report. RESULTS The patient reported significant pain relief after the procedure, and gained right lower extremity functionality, as compared to total immobility before the procedure. CONCLUSION Our technique offers an alternative feasible treatment for patients at high surgical risk with pathological fractures in weight-bearing bones, in which osteoplasty alone has a high risk of cement leakage, inadequate fracture reduction, and early refracture. To our knowledge, our technique has not been previously described.
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