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Zhang Y, Guo Y, Li Z, Wang B, Li Z. 3D-printed Multifunctional Guide Plate for Fenestration and Screws Drill in Proximal Femoral Benign Tumor. Orthop Surg 2024; 16:1487-1492. [PMID: 38726583 PMCID: PMC11144502 DOI: 10.1111/os.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 06/04/2024] Open
Abstract
The accurate fenestration, screw implantation and assisting stabilizing-plate placement in surgery of benign tumors in the proximal femur needs be defined easily. The aim of this study was to investigate the value of 3D printed multifunctional guides plate (3D-MGP) based on computer aided design. Between January 2020 and June 2022, 17 patients (nine females and eight males) with benign proximal femoral tumor had lesion curettage and allograft combined with internal plate fixation using 3D-MGP. In this study, the patients had CT scans and a technician reconstructed the 3D images of tumor and the femur, a doctor designed the location and margin of the fenestration and screws, and integrated different functions into MGP for benign proximal femoral lesions, which assisted in precise localization, fenestration and screw drilling. Musculoskeletal Tumor Society (MSTS) scoring was used to evaluate lower extremity function. Bone healing and the screws location was assessed with the radiographs. All patients underwent successful surgery with complete resection of the tumor and internal fixation with using the 3D-MGP. The mean follow-up was 16.4 months. The operative time was 126.47 ± 18.44 min, intraoperative bleeding was 198.23 ± 67.94 mL, intraoperative fluoroscopy was 6.47 ± 0.62, postoperative drainage was 223.82 ± 119.51 mL, and MSTS score was 27.29 ± 1.31 points. There were no unplanned fenestration and improper screw fixation. The 3D-MGP enabled personalized and accurate location of tumor, fenestration, screw placement and assisted stabilizing-plate placement for the treatment of benign tumor of the proximal femur. This technique has the potential to shorten operative times, decrease intraoperative bleeding, and reduce radiation exposure to patients.
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Affiliation(s)
- Yuxuan Zhang
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Yi Guo
- Montefiore Medical CenterAlbert Einstein School of MedicineNew YorkNew YorkUSA
| | - Zonghao Li
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Bing Wang
- School of Mechanical EngineeringShandong UniversityJinanChina
| | - Zhenfeng Li
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
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Elçi S, Özkul E, Alemdar C, Atiç R, Akar MS. How successful is synthetic graft treatment for children with pathological hip fractures? Hip Int 2024; 34:390-395. [PMID: 38146063 DOI: 10.1177/11207000231212423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
PURPOSE To determine whether synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children. METHODS Paediatric patients treated for pathological fractures of the proximal femur between 2013 and 2020 were evaluated retrospectively. 17 patients with a mean age of 10.7 years (range 6-16 years) were assessed. The definitive histopathological diagnoses were SBC (simple bone cyst) (12) and ABC (aneurysmal bone cyst) (5). The median duration of follow-up was 37 months (range 12-70 months). RESULTS All patients returned to their normal daily routine within 3-8 months following surgery. The mean post-op recovery time was 3.2 months (range 3-6 months). Graft was incorporated at approximately 12 months. No significant radiographic healing was observed in 2 patients. In the remaining 15 patients, the mean duration of healing was 14 months (range 8-24 months). CONCLUSION Synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children.
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Affiliation(s)
- Serhat Elçi
- Department of Orthopaedics and Traumatology, Sultan Private Hospital, Diyarbakır, Turkey
| | - Emin Özkul
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Celil Alemdar
- Department of Orthopaedics and Traumatology, Medipol University Medical Faculty, Istanbul, Turkey
| | - Ramazan Atiç
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Mehmet Sait Akar
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, Diyarbakir, Turkey
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Jiang X. Application of the Locking Compression Pediatric Hip Plate™ in children with proximal femoral tumors. J Orthop Surg Res 2022; 17:536. [PMID: 36503578 PMCID: PMC9743614 DOI: 10.1186/s13018-022-03433-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pediatric proximal femoral tumors often present with accumulative and severe bone destruction and are often complicated by pathological fractures and malunion. Such tumors are treated clinically by lesion scraping and graft reconstruction with autologous iliac bone alone or in combination with artificial bone. This study aimed to determine the efficacy of the Locking Compression Pediatric Hip Plate™ in treating pediatric proximal femoral tumors. METHODS From 2012-2017, the Locking Compression Pediatric Hip Plate™ was applied for internal fixation in 28 children in the Department of Pediatric Surgery. The complications were pathological fractures in 19 patients and multiple lesions in 5 patients. Tumors were removed by tumor curettage and reconstruction with autogenous iliac bone or artificial bone graft. The Locking Compression Pediatric Hip Plate™ was then applied. Postoperative pathological examination confirmed the diagnosis. RESULTS The cohort comprised 20 males and 8 females (mean age 7.8 ± 2.9 years). The mean follow-up duration was 26.1 ± 8.1 months (range 18-48 months). Post-treatment radiography showed that the lesions and local pathological fractures were healed in 3.2 ± 0.4 months (range 3-4 months), with no complications. Four patients continued to receive antineoplastic therapy postoperatively. Four patients experienced recurrence in situ, while another four developed distant metastases. The radiographic and joint function findings indicated that the affected limbs had excellent function. The mean Enneking score was 28.7 ± 1.0 points (range 27-30 points). CONCLUSIONS Internal fixation with the Locking Compression Pediatric Hip Plate™ in children achieves good therapeutic effects. Moreover, the Locking Compression Pediatric Hip Plate™ resolves the shortcomings of external fixation by traditional plaster casts and internal fixation by Kirschner wires and elastic intramedullary screws.
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Affiliation(s)
- Xin Jiang
- grid.13291.380000 0001 0807 1581Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
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Park CW, Oh SJ, Kim KS, Jang MC, Kim IS, Lee YK, Chung MJ, Cho BH, Seo SW. Artificial intelligence-based classification of bone tumors in the proximal femur on plain radiographs: System development and validation. PLoS One 2022; 17:e0264140. [PMID: 35202410 PMCID: PMC8870496 DOI: 10.1371/journal.pone.0264140] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/03/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose
Early detection and classification of bone tumors in the proximal femur is crucial for their successful treatment. This study aimed to develop an artificial intelligence (AI) model to classify bone tumors in the proximal femur on plain radiographs.
Methods
Standard anteroposterior hip radiographs were obtained from a single tertiary referral center. A total of 538 femoral images were set for the AI model training, including 94 with malignant, 120 with benign, and 324 without tumors. The image data were pre-processed to be optimized for training of the deep learning model. The state-of-the-art convolutional neural network (CNN) algorithms were applied to pre-processed images to perform three-label classification (benign, malignant, or no tumor) on each femur. The performance of the CNN model was verified using fivefold cross-validation and was compared against that of four human doctors.
Results
The area under the receiver operating characteristic (AUROC) of the best performing CNN model for the three-label classification was 0.953 (95% confidence interval, 0.926–0.980). The diagnostic accuracy of the model (0.853) was significantly higher than that of the four doctors (0.794) (P = 0.001) and also that of each doctor individually (0.811, 0.796, 0.757, and 0.814, respectively) (P<0.05). The mean sensitivity, specificity, precision, and F1 score of the CNN models were 0.822, 0.912, 0.829, and 0.822, respectively, whereas the mean values of four doctors were 0.751, 0.889, 0.762, and 0.797, respectively.
Conclusions
The AI-based model demonstrated high performance in classifying the presence of bone tumors in the proximal femur on plain radiographs. Our findings suggest that AI-based technology can potentially reduce the misdiagnosis of doctors who are not specialists in musculoskeletal oncology.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong-Je Oh
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyung-Su Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
| | - Min-Chang Jang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Keun Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Baek Hwan Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
- * E-mail: (SWS); (BHC)
| | - Sung-Wook Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (SWS); (BHC)
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Maes DJA, Kaneuchi Y, Abudu A, Stevenson JD. Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:559-566. [PMID: 34047855 DOI: 10.1007/s00590-021-03015-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG). METHODS Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17 years (range, 3 to 37 years) with a median follow-up of 39.5 months (IQR 46.7 months). Patients were grouped according to their age at diagnosis (< 16 years versus ≥ 16 years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups. RESULTS The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12 weeks (IQR 0 weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2 years and 88% at 5 years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2 years and 85% at 5 years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups. CONCLUSION The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.
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Affiliation(s)
- Danielle J A Maes
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Yoichi Kaneuchi
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Department of Orthopaedic Surgery, Fukushima Medical, University School of Medicine, Fukushima, 960-1295, Japan
| | - Adesegun Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Aston University Medical School, Aston University, Birmingham, UK
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Which one of the benign tumors and tumor-like lesions located in long bones needs prophylactic fixation during surgery? Jt Dis Relat Surg 2021; 32:210-217. [PMID: 33463439 PMCID: PMC8073453 DOI: 10.5606/ehc.2020.75064] [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] [Received: 04/01/2020] [Accepted: 06/13/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives
This study aims to define the simultaneous prophylactic fixation indications of benign tumors and tumor-like lesions located in long bones that were treated by curettage and grafting/cementing. Patients and methods
Fifty-six patients (33 males, 23 females; mean age 30.9±15.9; range, 15 to 65 years) who were treated by curettage and grafting or cementation for their benign tumors or tumor-like lesions in long bones between January 2013 and June 2016 were retrospectively analyzed. Age, sex, anamnesis and physical examination findings, histopathologic diagnosis, lesion localization, pre- and postoperative imaging results and follow-up data were all analyzed. The patients were divided into two groups as those with and without postoperative fracture. Results
The most common localization was femur (38%). The mean tumor diameter was 6.8±2.2 (range, 2.6 to 12.6) cm and volume was 58.3±45.0 (range, 6 to 177) cm3. Postoperative fracture occurred in 14 patients. The lesion diameter and volume of the patients in postoperative fracture group were significantly higher compared to group without postoperative fracture (p=0.034 and p=0.004, respectively). A volume value greater than 67 cm3 and ages over 35 years were found to be associated with a higher rate of fracture for all lesions. Conclusion
In the postoperative period, patients with benign tumors or tumor-like lesions of long bones had a higher fracture risk if the volume value was greater than 67 cm3 and the age was over 35 years. Prophylactic fixation may be suggested for these patients.
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Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Araki Y, Alkhooly AZA, Abd-Elfattah AS, Fouly EH, Elsaid ANS, Tsuchiya H. Surgical treatment of chondroblastoma using extended intralesional curettage with phenol as a local adjuvant. J Orthop Surg (Hong Kong) 2020; 27:2309499019861031. [PMID: 31315494 DOI: 10.1177/2309499019861031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study is to report the clinical and radiological outcomes following surgical treatment of chondroblastoma by means of an extended intralesional curettage using high-speed burr, with phenol as a local adjuvant which is followed by the implantation of synthetic bone graft, aiming to lower the recurrence rate of this tumor. PATIENTS AND METHODS This retrospective study included 20 patients with chondroblastoma lesions during the period between 2000 and 2015. RESULTS Fifteen males and five females were followed up for a mean of 63.35 (26-144) months with average age at the time of presentation was 20.8 (range: 12-32) years. Nineteen patients (95%) were complaining of pain at the time of presentation, and the lesion was discovered accidently in one patient. The mean operative time was 138.5 min (75-250). At the most recent follow-up, all patients had regained full physical function without pain at the operation site. CONCLUSION The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling.
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Affiliation(s)
- Karem M Zekry
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.,2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | - Norio Yamamoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Katsuhiro Hayashi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiko Takeuchi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshihiro Araki
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ali Zein Aa Alkhooly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Ezzat H Fouly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Hiroyuki Tsuchiya
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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