Insufficiency fracture associated with oncogenic osteomalacia

Preoperative evaluation and orthopedic surgical strategies for tumor-induced osteomalacia

Tumor-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is very rare, with about 1000 reported cases globally. Removing most TIO culprit tumors requires the evaluation and intervention of orthopedic doctors. However, orthopedic doctors often have a poor understanding of the optical treatment of TIO due to its rarity. In addition, most TIO patients lack specific clinical manifestations. Also, the clinical localization and qualitative diagnosis of TIO are difficult and thus can easily be misdiagnosed and mistreated. Furthermore, the true incidence rate of TIO may be underestimated. Although many breakthroughs have been made in exploring the pathogenesis, clinical diagnosis, and treatment of TIO, rational and standardized orthopedic surgical treatment experience summary and sorting for TIO patients are lacking. In this article, the recent experience and progress in the field of orthopedic surgical treatment for TIO globally have been summarized, providing a theoretical basis and new clinical practice guidance for the rational treatment of TIO patients.

Perioperative management of patients with severe hypophosphataemia secondary to oncogenic osteomalacia: Our experience and review of literature

Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumours. It is characterised by phosphaturia, hypophosphataemia, decreased serum Vitamin D3 levels and severe osteomalacia. OOM-inducing tumours are usually benign, arising either from bone or soft tissue, with extremities and craniofacial region being the most common sites. Surgical resection of the tumour remains the mainstay of treatment. Challenges to an anaesthesiologist arise when such patients are planned for surgical resection of the underlying tumour. All the perioperative dilemmas are directly related to the severe hypophosphataemia. We describe three such cases of OOM and their perioperative management.

Rehabilitation of a Patient Receiving a Large-Resection Hip Prosthesis Because of a Phosphaturic Mesenchymal Tumor

Tumor-induced osteomalacia is an osteomalacic syndrome caused by a mesenchymal origin's tumor. The diagnostic procedure takes time and extensive investigations because of the characteristics of these tumors usually small dimensioned, slowly growing, non-invasive and therefore hard to locate. The differential diagnosis is determined by a bone biopsy. Tumor's surgical removal is the treatment of choice that leads up to a complete regression of the oncogenic malacic syndrome. In the clinical course of these patients we can often see multiple episodes of pathological fractures, peri-prosthesis fractures or prosthesis mobilizations, due to the malacic picture: surgical procedures are often widely demolitive and requires mega-prosthetic implant. The rehabilitative procedure used to take care of these patients, is described in the following case report and based on the collaboration between surgical and rehabilitative teams. Rehabilitative pathway after hip mega-prosthesis does not find references in medical literature: the outcomes analyzed in this case report demonstrate the efficacy of the rehabilitative procedure applied.