1
|
Kobayashi H, Ito N, Nakai Y, Katoh H, Okajima K, Zhang L, Tsuda Y, Tanaka S. Patterns of symptoms and insufficiency fractures in patients with tumour-induced osteomalacia. Bone Joint J 2023; 105-B:568-574. [PMID: 37121579 DOI: 10.1302/0301-620x.105b5.bjj-2022-1206.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The aim of this study was to report the patterns of symptoms and insufficiency fractures in patients with tumour-induced osteomalacia (TIO) to allow the early diagnosis of this rare condition. The study included 33 patients with TIO who were treated between January 2000 and June 2022. The causative tumour was detected in all patients. We investigated the symptoms and evaluated the radiological patterns of insufficiency fractures of the rib, spine, and limbs. The mean age of the patients was 57 years (24 to 87), and the mean duration of pain from onset to time of presentation was 3.9 years (0.75 to 23). The primary symptoms were low back pain (ten patients), chest wall pain (eight patients), and hip pain (eight patients). There were symptoms at more sites at the time of presentation compared with that at the time of the onset of symptoms. Bone scans showed the uptake of tracer in the rib (100%), thoracic and lumbar vertebrae (83%), proximal femur (62%), distal femur (66%), and proximal tibia (72%). Plain radiographs or MRI scans identified femoral neck fractures in 14 patients, subchondral insufficiency fractures of the femoral head and knee in ten and six patients, respectively, distal femoral fractures in nine patients, and proximal tibial fractures in 12 patients. Thoracic or lumbar vertebral fractures were identified in 23 of 29 patients (79.3%) when using any imaging study, and a biconcave deformity was the most common type of fracture. Insufficiency fractures in patients with TIO caused spinal pain, chest wall pain, and periarticular pain in the lower limbs. Vertebral fractures tended to be biconcave deformities, and periarticular fractures of the hips and knees included subchondral insufficiency fractures and epiphyseal or metaphyseal fractures. In patients with a tumour, the presence of one or more of these symptoms and an insufficiency fracture should suggest the diagnosis of TIO.
Collapse
Affiliation(s)
- Hiroshi Kobayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuaki Ito
- Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yudai Nakai
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hajime Katoh
- Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Koichi Okajima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Liuzhe Zhang
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yusuke Tsuda
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
2
|
Lotan R, Hershkovich O, Bronstein Y, Finkelstein J. ‘XX’–Sacroplasty: A Novel Technique for Management of “H-Type” Sacral Insufficiency Fractures. Geriatr Orthop Surg Rehabil 2022; 13:21514593211049671. [PMID: 35140999 PMCID: PMC8819822 DOI: 10.1177/21514593211049671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Examine the feasibility, safety, and results of a novel sacral percutaneous injection
technique (“XX”) addressing both the vertical and horizontal aspects of sacral
insufficiency fractures (SIF). Methods Prospective cohort study. Eight consecutive SIF patients with immobility and pain
investigated using CT and nuclear imaging confirmed “H"-type fracture. Demographics,
pain level, and ambulation status were recorded. The long-term quality of life was
evaluated using the ODI questionnaire and pain VAS scores. Sacroplasty procedures in
prone positioning using fluoroscopy were used to insert 2 bone trochars through the S1
pedicles and 2 trochars through the sacral ale aiming toward the SIJ, thus forming 2 “X”
trochar formations. Balloon kyphoplasty was done through the trocars, and PMM was
injected. Postoperative ambulation and VAS were recorded. Results Average age was 81.5 years (±3.4 years). The time from presenting symptoms to hospital
admission was 2 days to 4 months. All patients were significantly limited with
ambulation. None had a neurologic compromise. Sacroplasty was performed with 2 cases
that required additional lumbar kyphoplasty. The mean operative time was 54 min (±14).
The average exposure was 19 mGy (±12 mGy). Two patients had cement leaks. CT and X-rays
revealed good cement filling of the fractures sacral alae and body of S1. The average
postoperative hospitalization was 10 days. All patients reported postoperatively pain
relief immediately and were able to walk better. Follow-up time was 17 ± 12 months.
Follow-up VAS was 2.7 (±2) and ODI was 57.3% (±21%). Conclusion “XX” technique showed good outcomes for patients with higher complexity SIF, using the
same principles as for lumbar VPL/KPL, and was found to be safe and effective.
Collapse
Affiliation(s)
- Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel. Aviv University, Tel. Aviv, Israel
| | - Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel. Aviv University, Tel. Aviv, Israel
| | - Yigal Bronstein
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel. Aviv University, Tel. Aviv, Israel
| | - Joel Finkelstein
- Department of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
3
|
Klimko A, Brandt A, Cirstoiu C, Iacobescu G. Unilateral Atraumatic Femoral Neck Fracture in the Peripartum Period: Case Report and Literature Review. Cureus 2021; 13:e19524. [PMID: 34934546 PMCID: PMC8668042 DOI: 10.7759/cureus.19524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/11/2022] Open
Abstract
Transient osteoporosis of the hip (TOH) refers to a temporary, focal reduction in bone mineral density that selectively affects bones in weight-bearing joints of young pregnant females. Due to inherent difficulties in diagnosing this pathology, it is difficult to estimate the incidence and it is conceivable that TOH is vastly underreported. In a rare subset of patients, TOH may progress to pathological fractures. We report a case of a 38-year-old pregnant woman who developed an atraumatic, displaced femoral neck fracture during her last trimester. Diagnosis and adequate management of TOH represents a clinical challenge as symptoms that precede the fracture are often non-specific, while the timing of the surgical treatment (i.e. before or after delivery) is debatable.
Collapse
|
4
|
Stress and Insufficiency Fractures. Clin Rev Bone Miner Metab 2017. [DOI: 10.1007/s12018-017-9239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
Affiliation(s)
- M H A Noureldine
- 1 Department of Neurosurgery, Lebanese American University Medical Center, Beirut, Lebanon
| | - I Uthman
- 2 Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
6
|
Poonuru S, Findling JW, Shaker JL. Lower extremity insufficiency fractures: an underappreciated manifestation of endogenous Cushing's syndrome. Osteoporos Int 2016; 27:3645-3649. [PMID: 27525744 DOI: 10.1007/s00198-016-3712-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/19/2016] [Indexed: 01/13/2023]
Abstract
This report describes the presence of lower extremity insufficiency fractures in 10 women prior to the clinical and biochemical diagnosis of endogenous Cushing's syndrome (CS). Osteoporosis is a well-recognized complication of overt CS resulting in a high rate of vertebral and other fractures. After institutional review board (IRB) approval, we did a retrospective chart review of patients with lower extremity (LE) insufficiency fractures (IF) and CS. This chart review found 10 women in whom LE-IF preceded the diagnosis of endogenous CS. Low bone density was found in all but one patient. The CS was considered to be mild (or subclinical) in five patients. LE-IF should be considered part of the skeletal spectrum of CS. Physicians caring for patients with LE-IF should have a low threshold for the consideration of CS even in patients without overt physical evidence of cortisol excess.
Collapse
Affiliation(s)
- S Poonuru
- Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - J W Findling
- Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - J L Shaker
- Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
7
|
Noureldine MHA, Khamashta MA, Merashli M, Sabbouh T, Hughes GRV, Uthman I. Musculoskeletal manifestations of the antiphospholipid syndrome. Lupus 2016; 25:451-62. [DOI: 10.1177/0961203316636467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/01/2016] [Indexed: 11/17/2022]
Abstract
The scope of clinical and laboratory manifestations of the antiphospholipid syndrome (APS) has increased dramatically since its discovery in 1983, where any organ system can be involved. Musculoskeletal complications are consistently reported in APS patients, not only causing morbidity and mortality, but also affecting their quality of life. We reviewed all English papers on APS involvement in the musculoskeletal system using Google Scholar and Pubmed; all reports are summarized in a table in this review. The spectrum of manifestations includes arthralgia/arthritis, avascular necrosis of bone, bone marrow necrosis, complex regional pain syndrome type-1, muscle infarction, non-traumatic fractures, and osteoporosis. Some of these manifestations were reported in good quality studies, some of which showed an association between aPL-positivity and the occurrence of these manifestations, while others were merely described in case reports.
Collapse
Affiliation(s)
- M H A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - M A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College University, London, UK
| | - M Merashli
- Division of Rheumatology, The Royal London Hospital, London, UK
| | - T Sabbouh
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - G R V Hughes
- London Lupus Center, London Bridge Hospital, London, UK
| | - I Uthman
- Division of Rheumatology, American University of Beirut, Beirut, Lebanon
| |
Collapse
|