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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.
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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)
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Cazzato RL, Garnon J, Dalili D, Autrusseau PA, Auloge P, De Marini P, Buy X, Palussiere J, Gangi A. Percutaneous Osteoplasty in long bones: current status and assessment of outcomes. Tech Vasc Interv Radiol 2022; 25:100803. [DOI: 10.1016/j.tvir.2022.100803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sebghati J, Khalili P, Tsagkozis P. Surgical treatment of metastatic bone disease of the distal extremities. World J Orthop 2021; 12:743-750. [PMID: 34754830 PMCID: PMC8554352 DOI: 10.5312/wjo.v12.i10.743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/16/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Metastatic bone disease of the distal extremities, also known as acrometastasis, is very rare. Thus, there is very limited information regarding the clinical manifestations and methods of surgical treatment. The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival. As metastatic bone disease is generally uncurable, the goal of surgical treatment is to provide the patient with good function with as few complications as possible. In this article, we discuss the clinical manifestation of acrometastases, the methods of surgical intervention, and the expected clinical outcome. Non-surgically managed pathological fractures generally remain ununited; therefore, conservative treatment is reserved for patients with poor general condition or dismal prognosis. The current evidence suggests that in lesions of the lower arm and leg, osteosynthesis (plate and screw fixation or intramedullary nail) is the most common method of reconstruction, whereas local excision or amputation are more commonly used in cases of more distal lesions (such as ankle, foot and hand). Following surgery most patients receive adjuvant radiotherapy, even though its role is poorly documented. Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome. Further studies are needed in order to provide stronger clinical evidence and improve decision-making, in an effort to optimize the patients’ quality of life and avoid the need for revision surgery.
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Affiliation(s)
| | - Pendar Khalili
- Department of Orthopedics, Central Hospital in Karlstad, Karlstad 65230, Sweden
| | - Panagiotis Tsagkozis
- Department of Orthopedic Surgery, Karolinska University hospital, Solna 17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna 17176, Sweden
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Metastatic Lesion of the Tibia from Renal Cell Carcinoma. Case Rep Oncol Med 2021; 2021:2428820. [PMID: 34373797 PMCID: PMC8349284 DOI: 10.1155/2021/2428820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Renal cell carcinoma is responsible for 3% of all cancers, with the highest incidence occurring in Western countries. Additionally, in patients with osseous metastasis, only 3% occur within the tibia. Rarely, a patient presents with a primary complaint of lower limb pain in advanced metastatic renal cell carcinoma. Case Presentation. The patient arrived at the emergency department with a primary complaint of left ankle pain. Ankle X-rays demonstrated a lytic lesion involving the medial malleolus with possible metastatic disease. CT scan confirmed a tumor within the right kidney. The patient was treated with a laparoscopic radical nephrectomy with histopathologic confirmation of clear cell renal cell carcinoma. Biopsy was then performed of the tibial lesion, confirming metastatic clear cell renal cell carcinoma. The tibial lesion was treated with local radiotherapy, and because of the progression of the tibia lesion, a decision was made to amputate the leg. Additionally, the patient was enrolled to sunitinib treatment and was disease free at one year of follow-up. 13 months after diagnosis of cancer, she was suffering a major stroke of the brain that caused her to die. Conclusion The treatment of patients with osseous metastases of renal cell cancer depends on the number of metastases, location of metastases, and overall health of the patient. We performed an overview of available literature and provided a summary regarding the use of cytoreductive nephrectomy, local therapy, target therapy, and bone-targeting agents in the treatment of metastatic renal cell cancer.
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Başdelioğlu K, Civi G. Case Report of a Posterior Malleolus Metastasis: A Very Rare Metastasis Localization. J Am Podiatr Med Assoc 2021; 111:464166. [PMID: 33872359 DOI: 10.7547/20-142] [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
Metastasis of the distal tibia is quite rare. In this article, we present the case of a 58-year-old woman with distal tibial metastasis located in the posterior malleous caused by breast cancer. She had left ankle pain and nonweightbearing status that had been ongoing for 2 months and showed progression. The patient's Mirels score was 10. Limb salvage surgery was performed by removing the metastatic lesion by posterior ankle incision followed by applying a double plate from the posterior and the medial side of the distal tibia, and the defect was reconstructed with methylmethacrylate. Consequently, good stability was achieved. Radiotherapy consisting of 10 fractions (2000 cGy total) was applied to the distal tibia at postoperative week 3. There were no complications after surgery. No recurrence was observed at the 18-month follow-up of the patient. The Musculoskeletal Tumor Society Score at the 18-month control of the patient was 86%. Use of curettage of the metastatic mass, double-plate application, and defect reconstruction with methylmethacrylate is an effective method for distal tibia metastases located in the posterior malleolus.
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Bonnevialle P, Sailhan F. Spinal and peripheral bone metastases: Time to structure medico-surgical management! Orthop Traumatol Surg Res 2020; 106:995-996. [PMID: 32891548 DOI: 10.1016/j.otsr.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Paul Bonnevialle
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hôpital P.P. Riquet, Place Baylac, 31052 Toulouse Cedex, France.
| | - Frédéric Sailhan
- Service d'Orthopédie, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Meynard P, Seguineau A, Laumonerie P, Fabre T, Foltran D, Niglis L, Descamps J, Bouthors C, Lebaron M, Szymanski C, Sailhan F, Bonnevialle P. Surgical management of proximal femoral metastasis: Fixation or hip replacement? A 309 case series. Orthop Traumatol Surg Res 2020; 106:1013-1023. [PMID: 32778439 DOI: 10.1016/j.otsr.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The proximal femur is the most frequent operative site for metastasis, but there is no consensus between internal fixation and hip replacement. The present multicenter retrospective observational study sought: (1) to compare early clinical results between internal fixation and hip replacement for proximal femoral metastasis (PFM), and (2) to assess events affecting survival. HYPOTHESIS The study hypothesis was that internal fixation and hip replacement give comparable clinical results, operative site complications rates and survival. MATERIAL AND METHODS The series comprised 309 cases, 10 of which were bilateral, in 182 females and 117 males, with a mean age of 67.2±11.5 years and 62.5±13.2 years, respectively. Primaries were mainly breast (118; 38.2%), lung (85; 25.5%) or kidney (40; 12.9%). PFM was revelatory in 114 cases (36.9%). There was visceral involvement in 142 patients (46%), multiple peripheral bone involvement in 212 (68.6%), and spinal involvement in 134 (43.4%). There were 124 pathologic fractures (40%), 51 of which were revelatory. Metastases were cervicocephalic in 135 cases (43.7%), metaphyseal in 166 (53.7%) and both in 8 (2.6%). PFM was osteolytic in 90% of cases, managed by hip replacement in 161 cases and internal fixation in 148 (12 screwed plates, 136 nails). Seventy-seven patients had postoperative radiation therapy. RESULTS After hip replacement (n=144), walking was normal in 35 cases (24.3%), impaired but unassisted in 53 (36.8%), with 1 forearm crutch in 24 (16.6%), 2 crutches or a frame in 26 (18%), and impossible in 6 (4.1%). After nailing (n=125), results were respectively 38 (30.4%), 47 (37.6%), 15 (12%), 18 (14.4) and 7 (5.6%). Recovery of normal walking capacity did not significantly differ according to technique (p=0.162); nor did pain or function. Recovery of normal walking capacity was better after preventive surgery (p<0.001). Perioperative complications comprised: 10 cases of severe blood loss, 7 pulmonary embolisms, 6 digestive hemorrhages, and 5 lung infections. Secondarily, there were 11 infections (7 after hip replacement, 2 after nailing, 2 after plate fixation), 7 progressive osteolyses and 5 fractures. Complications rates were significantly higher with plate fixation, with no difference between nailing and hip replacement. Survival did not significantly differ between hip replacement (12 months [95% CI: 7-19]), nailing (7 months [95% CI: 6-11]) and plate fixation (16 months [95% CI: 6-not calculable]). CONCLUSIONS Clinical results and survival were comparable between hip replacement and nailing, confirming the study hypothesis, in agreement with the literature. Each technique has its indications. Patients with severely impaired walking capacity benefited greatly from surgery. The importance of preventive surgery was highlighted. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Pierre Meynard
- Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France.
| | - Arthur Seguineau
- Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Pierre Laumonerie
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse cedex, France
| | - Thierry Fabre
- Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Deborah Foltran
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse cedex, France
| | - Lucas Niglis
- Service d'orthopédie traumatologie, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - Jules Descamps
- Service d'orthopédie, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique et traumatologie et du Rachis, hôpital Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marie Lebaron
- Service de chirurgie orthopédique et traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - Christophe Szymanski
- Service de chirurgie orthopédique et traumatologie, hôpital Salengro, avenue du Professeur-Emile-Laine, 59037 Lille, France
| | - Fréderic Sailhan
- Service d'orthopédie, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse cedex, France
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- Société française de chirurgie orthopédique et traumatologique (SoFCOT), 56, rue Boissonade, 75014 Paris, France
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