Aims. Anchorage of pedicle screw rod instrumentation in the elderly spine with poor bone quality remains challenging. Our study aims to evaluate how the screw bone anchorage is affected by screw design, bone quality, loading conditions, and cementing techniques. Methods. Micro-finite element (µFE) models were created from micro-CT (μCT) scans of vertebrae implanted with two types of pedicle screws (L: Ennovate and R: S. 4. ). Simulations were conducted for a 10 mm radius region of interest (ROI) around each screw and for a full vertebra (FV) where different cementing scenarios were simulated around the screw tips. Stiffness was calculated in pull-out and anterior bending loads. Results. Experimental pull-out strengths were excellently correlated to the µFE pull-out stiffness of the ROI (R. 2. > 0.87) and FV (R. 2. > 0.84) models. No significant difference due to screw design was observed.
Aims. Loosening of pedicle screws is a major complication of posterior
spinal stabilisation, especially in the osteoporotic spine. Our
aim was to evaluate the effect of
Introduction. The main symptoms in multiple myeloma are the result of skeletal destruction mainly the vertebral column. The current treatments for multiple myeloma include radiotherapy and chemotherapy but unfortunately it is still incurable. However, the symptoms and quality of life of these patients can be improved by
Hip fractures constitute the most debilitating complication of osteoporosis with a steadily increasing incidence in an aging population. Intramedullary nailing of osteoporotic proximal femoral fractures can be challenging because of poor implant anchorage in the femoral head. Recently,
Aims. Fixation of osteoporotic proximal humerus fractures remains challenging even with state-of-the-art locking plates. Despite the demonstrated biomechanical benefit of screw tip augmentation with bone cement, the clinical findings have remained unclear, potentially as the optimal augmentation combinations are unknown. The aim of this study was to systematically evaluate the biomechanical benefits of the augmentation options in a humeral locking plate using finite element analysis (FEA). Methods. A total of 64
We have developed a hollow perforated cannulated screw. One or more of these was implanted percutaneously in 11 patients with an osteolytic metastasis in the femoral neck and multiple metastases elsewhere. They were supplemented by one or two additional standard 6.5 mm cannulated screws in nine patients. Polymethylmethacrylate bone cement was injected through the screw into the neck of the femur using small syringes, as in vertebroplasty. The mean amount of cement injected was 23.2 ml (17 to 30). Radiotherapy was started on the fourth post-operative day and chemotherapy, on average, was resumed a day later. Good structural stability and satisfactory relief from pain were achieved in all the patients. This technique may be useful in the palliation of metastases in the femoral neck.
Pedicle screw pullout or loosening is increased in the osteoporotic spine. Recent studies showed a significant increase of pullout forces especially for PMMA-augmentation. With application of conventional viscosity PMMA the risk of cement extravasation is associated. This risk can be reduced by using radiofrequency-responsive, ultrahigh viscosity bone cement. 11 fresh-frozen lumbar vertebral bodies (VB) from 5 cadavers were collected and freed from soft-tissue and ligaments. By DEXA scan (Siemens QDR 2000) 8 VB were identified as severely osteoporotic (BMD 0.8 g/cm3), 3 VB were above this level. Two screws (6×45 mm, WSI-Expertise Inject, Peter Brehm, Weisendorf, Germany) were placed in the pedicles. Through the right screw 3ml of radiofrequency-responsive bone cement (StabiliT® ER2 Bone Cement, DFine, Germany) were injected via hydraulic cement delivery system (StabiliT® Vertebral Augmentation System, DFine, Germany). As control group, left pedicle screws remained uncemented. After potting the whole VB in technical PMMA (Technovit 4004, Heraeus Kulzer, Germany) axial pullout test was performed by a material testing device (Zwick-Roell, Zmart-Pro, Ulm, Germany).Introduction
Method
Posterior internal fixation systems undergo internal constraints resulting in high load bearing requirement for the pedicular screw/bone interface. Only few studies deal with the impact of the vertebral augmentation on the migration of pedicular screws. In this study, the impact of the pedicular screw augmentation has been investigated under physiological load for osteoporotic vertebras. The data have been proceeded to reduce the influence of vertebral geometry, which generally leads to results devoid of statistical meaning In 8 osteoporotic vertebrae, two screws have been inserted in each vertebra: a non-augmented on one side and an augmented one on the contralateral side. Compression tests have been performed (two consecutive 50 cycles load steps -100N and 200N-) to observe the displacement of the screw’s head. Two different setups have been employed: a free connection (FC) and a blocked connection (BC). A load step is successful if the migration between two consecutive cycles tends to zero. To reduce the impact of the vertebras’ geometry, the screws’ migration have been compared contra-laterally using the migration ratio (MR). MR of vertebrae is defined as the division of the augmented screw’s migration with the non-augmented screw’s migration. All the augmented screws survived both test setups whereas the non-augmented failed the 200N FC load step. Significant differences are observable only for the highest successful load steps for each test setup: T-tests (P=0.039 and P=0.007 respectively) put into evidence that the results are statistically smaller than one. It is observable as well, that the BC induced fewer loads into the vertebrae: even non-augmented screw can withstand 200N load step. As expected, augmentation of pedicular perforated screws increases their stability in osteoporotic vertebras undergoing large physiological load. This could be explained by the fact that the presence of PMMA increases the load transfer interface improving screw/PMMA complex bearing capacity. Smaller loads induce only small differences that are not significant.
Over 85% of patients with multiple myeloma (MM) have bone disease, mostly affecting thoraco-lumbar vertebrae. Vertebral fractures can lead to pain and large spinal deformities requiring application of vertebroplasty (PVP). PVP could be enhanced by use of Coblation technique to remove lesions from compromised MM vertebrae prior to cement injection (C-PVP). 28 cadaveric MM vertebrae, were initially fractured (IF) up to 75% of its original height on a testing machine, with rate of 1mm/min. Loading point was located at 25% of AP-diameter, from anterior. Two augmentation procedure groups were investigated: PVP and C-PVP. All vertebrae were augmented with 15% of PMMA cement. At the end of each injection the perceived injection force (PIF) was graded on a 5-point scale (1 very easy to 5 almost impossible). Augmented MM vertebrae were re-fractured, following the same protocol as for IF. Failure load (FL) was defined as 0.1% offset evaluated from load displacement curves.INTRODUCTION
METHODS
The purpose of this study was to determine the effect of cement mixing time on fixation augmentation in both healthy and simulated osteoporotic canine bone. In a canine diaphyseal model, screw insertion into liquid cement achieves greater bending stiffness and resists a greater load to failure than cement inserted as a paste. Bone cement in its liquid state may provide increased structural support in the setting of an osteoporotic fracture, possibly due to increased interdigitation of the cement with the screw threads and bone. An inconsistency exists among orthopaedic surgeons with regards to the appropriate mixing time for bone cement to achieve optimal results. The purpose of this study was to determine the effect of cement mixing time on fixation augmentation in both healthy and simulated osteoporotic canine bone. In a canine diaphyseal fracture model, screw insertion into liquid cement achieves greater bending stiffness and resists a greater load to failure than insertion into cement with the consistency of a paste. Bone cement in its liquid state may provide increased structural support in the setting of an osteoporotic fracture, possibly due to increased interdigitation of the cement with the screw threads and bone. Baseline stiffness for fourteen pairs of cadaveric canine femora was determined. A transverse diaphyseal osteotomy was created and fixed using an eight-hole DC plate and 3.5 mm screws. A 1cm gap was created at the osteotomy site simulating loss of bone. In the left femora, cement was mixed for one minute (liquid) prior to injection into pre-drilled holes; in the right femora, cement was mixed for five minutes prior to injection (thick paste). In each mixing time group, seven specimens were treated with a plate and properly sized pre-drilled and tapped holes (2.5mm), and seven received over-drilled holes (3.2 mm) to simulate osteoporotic bone. Four-point bending stiffness was determined for each plated construct, and normalized to baseline stiffness. Specimens were then loaded to failure. Within the properly sized holes, there were no statistically significant differences (SSD) in bending stiffness with or without a gap. The liquid cement had a force to failure 77% greater than that of cement as a paste (p<
0.05). Within the over-sized holes, there was no SSD between liquid and paste without a gap. With a gap, liquid cement demonstrated an increased bending stiffness of 24 % (p<
0.05) and force to failure was 92% higher (p<
0.05).
Within the over-sized holes simulating osteoporotic bone, there was no difference between liquid and paste without a gap. With a gap, liquid cement demonstrated an increased bending stiffness of 24% (p<
0.05) and force to failure was 92% higher (p<
0.05). Bone cement in its liquid state may provide increased structural support in the setting of an osteoporotic fracture, possibly due to increased interdigitation of the cement with the screw threads and bone.
The augmentation of fixation with bone cement
is increasingly being used in the treatment of severe osteoporotic fractures.
We investigated the influence of bone quality on the mechanics of
augmentation of plate fixation in a distal femoral fracture model
(AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral
models were randomly assigned to either an augmented or a non-augmented
group. Fixation was performed using a locking compression plate.
In the augmented group additionally 1 ml of bone cement was injected
into the screw hole before insertion of the screw. Biomechanical
testing was performed in axial sinusoidal loading. Augmentation significantly
reduced the cut-out distance in the osteoporotic models by about
67% (non-augmented mean 0.30 mm ( Cite this article:
Aims. Proximal humeral fractures are the third most common fracture among the elderly. Complications associated with fixation include screw perforation, varus collapse, and avascular necrosis of the humeral head. To address these challenges, various augmentation techniques to increase medial column support have been developed. There are currently no recent studies that definitively establish the superiority of augmented fixation over non-augmented implants in the surgical treatment of proximal humeral fractures. The aim of this systematic review and meta-analysis was to compare the outcomes of patients who underwent locking-plate fixation with
Aims. The purpose of the study was to investigate whether closed intramedullary
(IM) nailing with percutaneous
Introduction and Objective. Trochanteric fractures are associated with increasing incidence and represent serious adverse effect of osteoporosis. Their cephalomedullary nailing in poor bone stock can be challenging and associated with insufficient implant fixation in the femoral head. Despite ongoing implant improvements, the rate of mechanical complications in the treatment of unstable trochanteric fractures is high. Recently, two novel concepts for nailing with use of a helical blade – with or without bone
Introduction. Spine is a common site for haematological malignancies. Multiple myeloma affects the spine in 70% of cases. New guidelines were published in 2015 to help manage spinal haematological malignancies. Despite neural compression or spinal instability, instrumentation of the spine should be avoided. Surgery carries significant risks of wound complications and more importantly delaying the definitive chemotherapy and radiotherapy.
Femoroplasty is the process of injecting cement (cement augmentation) into the proximal femur to prevent osteoporotic hip fractures. Femoroplasty increases the strength and energy to failure of the femur and can be performed in a minimally-invasively manner with lower hospitalization costs and reduced recovery. Our hypothesis was that efficient
Introduction. In complex primary and revision total knee replacement (TKR) the operating surgeon may encounter proximal tibial bone defects. The correct management of such defects is fundamental to both the initial stability and long-term survival of the prosthesis. Cement or metal augments have been used to address some such type II unconstrained defects [1]. Aim. The aim of this finite element (FE) study was to analyse the comparative behaviour of cement and metal based augments and quantify the stresses within these different augments and underlying cancellous bone. Materials and methods. A three-dimensional FE model was constructed from a computer tomography (CT) scan of the proximal tibia using SIMPLEWARE v3.2 image processing software. The tibial component of a TKR was implanted with either a block or wedge-shaped augment made of either metal or cement. The model was axially loaded with a force of 3600N and testing was conducted with both evenly and eccentrically distributed loads. Results. Upon loading the FE model, the von-Mises stresses in the cancellous bone underneath the augments were found to be higher with
Intramedullary nails (IMNs) are the current gold standard for treatment of long bone diaphyseal and selected metaphyseal fractures. Their design has undergone many revisions to improve fixation techniques, conform to the bone shape with appropriate anatomic fit, reduce operative time and radiation exposure, and extend the indication of the same implant for treatment of different fracture types with minimal soft tissue irritation. The IMNs are made or either titanium alloy or stainless steel and work as load-sharing internal splints along the long bone, usually accommodating locking elements – screws and blades, often featuring angular stability and offering different configurations for multiplanar fixation – to secure secondary fracture healing with callus formation in a relative-stability environment. Bone
Intramedullary nailed high proximal tibial fractures rely on the proximal screw-bone interface to provide stability, which can be insufficient in low-density bones. This study investigated the biomechanics of proximal screw
Objectives.
Aim. The aim of this FE study was to analyse the comparative behaviour of cement and metal based augments in TKR and quantify the stresses within these different augments and underlying cancellous bone. Materials and methods. A three-dimensional FE model was constructed from a CT scan of the proximal tibia using SIMPLEWARE v3.2 image processing software. The tibial component of a TKR was implanted with either a block or wedge-shaped augment made of either metal or cement. The model was axially loaded with a force of 3600N and testing was conducted with both evenly and eccentrically distributed loads. Results. Upon loading the FE model, the von-Mises stresses in the cancellous bone underneath the augments was higher with
Purpose: The objectives of this study were to determine the effect of posterior instrumentation extension and/or
Interbody fusion aims to treat painful disc disease by demobilising the spinal segment through the use of an interbody fusion device (IFD). Diminished contact area at the endplate interface raises the risk of device subsidence, particularly in osteoporosis patients. The aim of the study was to ascertain whether vertebral body (VB)
Aims. The aim of this study was to compare the peak pull-out force
(PPF) of pedicle-lengthening screws (PLS) and traditional pedicle
screws (TPS) using instant and cyclic fatigue testing. Materials and Methods. A total of 60 lumbar vertebrae were divided into six groups:
PLS submitted to instant pull-out and fatigue-resistance testing
(groups A1 and A2, respectively), TPS submitted to instant pull-out
and fatigue-resistance testing (groups B1 and B2, respectively)
and PLS augmented with 2 ml polymethylmethacrylate, submitted to
instant pull-out and fatigue-resistance testing (groups C1 and C2,
respectively). The PPF and normalized PPF (PPFn) for bone mineral density
(BMD) were compared within and between all groups. Results. In all groups, BMD was significantly correlated with PPF (r =
0.83, p < 0.001). The PPFn in A1 was significantly less than
in B1 (p = 0.006) and C1 (p = 0.002). The PPFn of A2 was significantly
less than in B2 (p < 0.001) and C2 (p < 0.001). The PPFn in
A1, B1, and C1 was significantly greater than in A2 (p = 0.002),
B2 (p = 0.027), and C2 (p = 0.003). There were no significant differences
in PPFn between B1 and C1, or between B2 and C2. Conclusion. Pedicle lengthening screws with
Aims. Plating displaced proximal humeral fractures is associated with a high rate of screw perforation. Dynamization of the proximal screws might prevent these complications. The aim of this study was to develop and evaluate a new gliding screw concept for plating proximal humeral fractures biomechanically. Methods. Eight pairs of three-part humeral fractures were randomly assigned for pairwise instrumentation using either a prototype gliding plate or a standard PHILOS plate, and four pairs were fixed using the gliding plate with bone
The February 2014 Oncology Roundup. 360 . looks at: suspicious lesions; limb salvage in pelvic sarcomas; does infection affect oncological survival?; cancer patient pathways; radiological arthritis with
To evaluate our results of treatment of kyphosis following osteoporotic fractures of the last 3 years. 28 women with a mean age of 63,2 years were treated for a painful kyphotic deformity of a mean Cobb angle 76,1°. They all had posterior fusion with pedicular screws and rods enhanced with autologous bone graft as well as allografts.
To investigate and compare the biomechanical characteristics of Bipedicular versus Unipedicular Vertebroplasty in cadaveric vertebra. Cadaveric single level vertebra were used to evaluate Bipedicular versus Unipedicular Vertebroplasty as an intervention for vertebral compression fractures. Cadaveric vertebra were assigned to two arms: Arm A simulated a wedge fracture followed by bipedicular
The radiological and biomechanical assessment using cement augmented cannulated pedicle screw (Biomet. ®. , Omega 21. ®. ) and the correlation of the cement volume to the pullout strength needed for each screw. Cadaveric vertebrae of different lumbar levels were used. Through cannulated pedicle screw a definite volume of cement was applicated. The bone volume occupied by cement was assessed by means of segmentation after Computer Tomography. Biomechanical Pullout tests and statistical correlation analysis were then performed. The maximum pullout strength was 1361 N and the minimum pullout strength was 172 N (SD 331 N). The maximum cement volume was 5,29 cm3 and the minimum 1,02 cm3 (SD 1,159). The maximum cement diameter was 26,6 cm and the minimum cement diameter was 20,7 cm (SD 1,744). There is statistically significant correlation between the pullout strength and the injected cement volume (p<
0,05). The cannulated pedicle screw was used for a better fixation in the vertebral body. The
In severe destructive spinal infections, with neurological deficit, progressive deformity or uncontrolled sepsis, the mainstay of treatment is surgical debridement with anterior and posterior stabilisation. We retrospectively reviewed 14 patients (11 Male 3 female) with a mean age of 63 (range 38 to 85) who underwent anterior only surgery consisting of an expandable vertebral body cage and a ventrolateral locking plate (Synthes). Organisms included Tuberculosis (7), Staphylococcus (5), E-Coli (1) and Pseudomonas (1). Radiological and functional outcomes were assessed upto 18 months post surgery. Cobb angles were used to measure angular deformity. Good early results in terms of safety, resolution of pain, control of deformity and improvement of neurological deficits was observed. Average blood loss was 633mls (range 300mls to 1500mls) with a mean deformity correction of 23 degrees. Post operative radiological assessment showed the cages to be relatively stable in the under 80 yrs groups (mean loss of correction 15 %). In elderly patients (>
80 yrs) there was significant subsidence leading to a loss of correction (mean 52%) which required stabilisation using vertebral body
We studied the biomechanical behaviour of three sliding fixation devices for trochanteric femoral fractures. These were a titanium alloy sideplate and lag screw, a titanium alloy sideplate and dome plunger with
Numerous studies have examined the biomechanical properties of the vertebral body following PMMA
The August 2024 Shoulder & Elbow Roundup360 looks at: Comparing augmented and nonaugmented locking-plate fixation for proximal humeral fractures in the elderly; Elevated five-year mortality following shoulder arthroplasty for fracture; Total intravenous anaesthesia with propofol reduces discharge times compared with inhaled general anaesthesia in shoulder arthroscopy: a randomized controlled trial; The influence of obesity on outcomes following arthroscopic rotator cuff repair; Humeral component version has no effect on outcomes following reverse total shoulder arthroplasty: a prospective, double-blinded, randomized controlled trial; What is a meaningful improvement after total shoulder arthroplasty by implant type, preoperative diagnosis, and sex?; The safety of corticosteroid injection prior to shoulder arthroplasty: a systematic review; Mortality and subsequent fractures of patients with olecranon fractures compared to other upper limb osteoporotic fractures.
Giant cell tumours (GCTs) of the proximal femur are rare, and there is no consensus about the best method of filling the defect left by curettage. In this study, we compared the outcome of using a fibular strut allograft and bone cement to reconstruct the bone defect after extended curettage of a GCT of the proximal femur. In a retrospective study, we reviewed 26 patients with a GCT of the proximal femur in whom the bone defect had been filled with either a fibular strut allograft (n = 12) or bone cement (n = 14). Their demographic details and oncological and nononcological complications were retrieved from their medical records. Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) score.Aims
Methods
The orthopaedic surgeon is often consulted to manage pathologic fractures due to metastatic disease, even though he or she may not be an orthopaedic oncologist. A good understanding of the principles of management of metastatic disease is therefore important. The skeleton remains a common site for metastasis, and certain cancers have a predilection for bone, namely, tumors of the breast, prostate, lung, thyroid, and kidney. Myeloma and lymphoma also often involve bone. The proximal femur and pelvis are most commonly affected, so we will focus on those anatomic sites. The patient may present with pain and impending fracture, or with actual fracture. Careful preoperative medical optimization is recommended. If the lesion is solitary, or the primary is unknown, the diagnosis must be made by a full workup and biopsy before definitive treatment is planned. For patients with known metastasis (the most common situation), the options for treatment of pathologic lesions of the proximal femur generally center on internal fixation versus prosthetic replacement. Patients with breast or prostate metastasis can live for several years after pathologic fracture, so constructs must be relatively durable. If fixation is chosen, it must be stable enough to allow full weight bearing, since the overwhelming majority of pathologic fractures will never heal. In general, long constructs are chosen to protect the entire length of the bone. Nails should protect the femoral neck as well, so cephalomedullary devices are typically chosen. Megaprostheses can be useful in situations where bony destruction precludes stable internal fixation. Postoperative radiation is recommended after wound healing. Acetabular involvement typically requires reinforcement rings or
The aim of this study was to describe the management and associated outcomes of patients sustaining a femoral hip periprosthetic fracture (PPF) in the UK population. This was a multicentre retrospective cohort study including adult patients who presented to 27 NHS hospitals with 539 new PPFs between 1 January 2018 and 31 December 2018. Data collected included: management strategy (operative and nonoperative), length of stay, discharge destination, and details of post-treatment outcomes (reoperation, readmission, and 30-day and 12-month mortality). Descriptive analysis by fracture type was performed, and predictors of PPF management and outcomes were assessed using mixed-effects logistic regression.Aims
Methods
The August 2023 Knee Roundup360 looks at: Curettage and cementation of giant cell tumour of bone: is arthritis a given?; Anterior knee pain following total knee arthroplasty: does the patellar cement-bone interface affect postoperative anterior knee pain?; Nickel allergy and total knee arthroplasty; The use of artificial intelligence for the prediction of periprosthetic joint infection following aseptic revision total knee arthroplasty; Ambulatory unicompartmental knee arthroplasty: development of a patient selection tool using machine learning; Femoral asymmetry: a missing piece in knee alignment; Needle arthroscopy – a benefit to patients in the outpatient setting; Can lateral unicompartmental knees be done in a day-case setting?
To explore the clinical efficacy of using two different types of articulating spacers in two-stage revision for chronic knee periprosthetic joint infection (kPJI). A retrospective cohort study of 50 chronic kPJI patients treated with two types of articulating spacers between January 2014 and March 2022 was conducted. The clinical outcomes and functional status of the different articulating spacers were compared. Overall, 17 patients were treated with prosthetic spacers (prosthetic group (PG)), and 33 patients were treated with cement spacers (cement group (CG)). The CG had a longer mean follow-up period (46.67 months (SD 26.61)) than the PG (24.82 months (SD 16.46); p = 0.001).Aims
Methods
Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the “after weightbearing” images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft.Aims
Methods
Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed.Aims
Methods
Introduction: Despite the lack of good clinical evidence post operative radiotherapy is standard practice following non radical surgical treatment of skeletal metastases in long bones There is little in the literature about the size of radiation field and whether the whole bone, the nail or just the area of the metastatic deposit should be covered. Methods: We present two cases where the metastases were treated by intramedullary nailing and were subsequently irradiated. In each case the tip of the intramedullary nail was outside the radiotherapy field. Results: Subsequent second metastasis formation occurred at the tip of the nail compounded by pathological fracture. Salvage surgery was achieved in one case with a total femoral replacement and in the other by bi-columnar plating of the humerus with
Introduction: Spine fractures are common manifestation of osteoporosis. After an acute osteoporotic vertebral compression fracture pain persisting even after 3 months and clinical tenderness should raise the suspicion of pseudarthrosis. Pseudarthrosis is not a rare complication of a benign osteoporotic vertebral collapse occurs in about 10% of cases after an acute collapse. Treatment plan needs to be individualized.
Introduction: Percutaneous kyphoplasty is a minimally invasive, radiologically guided procedure in which bone cement is injected into structurally weakened or destructed vertebrae. In addition to treating osteoporotic vertebral fractures, this technique gains popularity to relieve pain by stabilizing vertebrae compromised by, for example, metastases, aggressive hemangiomas or multiple myeloma that are at risk of pathologic fracture. Materials and Methods: Retrospective study including 44 patients (67 fractures) who undergone percutaneous kyphoplasty from one or several tumoral fractures of the spine between January 2006 and February 2009. 77% were female. The mean age was 67. VAS scale and Karnofsky index were both measured pre and postoperatively. The most frequent lesion found was metastases from a primary tumor followed by myeloma. Results: All patients were seated 24 hours after surgery. Partial or complete pain relief was obtained in 91% of patients (40/44); significant results were also obtained with regard to improvement in functional mobility and reduction of analgesic use. The mean value of the visual analogue scale (VAS) was 5.9 preoperatively, and significantly decreased to 3.3 one day after kyphoplasty. We reported 4 new vertebral fractures and no cases of cement extrusion during the follow-up. We didn’t report any case of neurological dysfunction after surgery. Discussion: Most cases in our study show a significant improvement in pain and functionality with no associated complications. Kyphoplasty
Objective: In 1989 Mirels published a scoring system for identifying impending pathological fractures in long bones. However, the spine is the most common site of skeletal metastases. A MR-based scoring system is proposed to quantify the risk of sustaining a pathological fracture through a metastatic lesion in a vertebral body. Methods: A retrospective analysis of 101 vertebral body metastatic lesions was carried out. The metastases were identified through the onco-radiology database. Only lesions with a MR scan and subsequent imaging within 24-months of the index scan were included. Variables potentially predictive of impending fracture were analysed for significance. The significant variables were then statistically weighted. The original MR scans were scored, and the subsequent imaging was used to identify which lesions fractured. The scores were compared between the fracture and non-fracture group. Analysis was carried out for each predictive variable to establish whether they were individually as good as the scoring system alone in predicting fracture. Intra and inter-observer variability was assessed using kappa statistics. Results: Twenty-one of the 101 lesions fractured within 24 months. A mean score of 0.65 was identified in the non-fracture group, whilst the fracture group had a mean score of 6.52 (p<
0.0001). The percentage risk of a lesion sustaining a pathological fracture was calculated for any given score. As the score increased above 4, so did the percentage risk of fracture (sensitivity 85.7%, specificity 97.5%). Very good intra and inter-observer agreement was present, showing the scoring system to be reliably reproducible. Conclusions: The authors propose that all painful vertebral body metastatic lesions be evaluated by MR scanning. Lesions with a score of 3 or less can be left untreated. Lesions with scores of 4 or higher are at risk of fracture and should be considered for prophylactic
Acute osteoporotic vertebral compression fractures (VCFs) are frequently misdiagnosed as there is often no history of preceding trauma. VCFs not only cause back pain, but can also result in a loss of function, spinal deformity and increased mortality.
The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications with this procedure have been reported. This study reports on the results of using a new humeral nail for the treatment of pathological fracture or impending fracture of the humerus. Twenty nine patients had 31 Austofix humeral nails, 25 for pathological fracture and 6 for impending fracture. Twenty-four nails were inserted anterograde and 7 retrograde.
Endoprosthetic replacement is often the preferred treatment for neoplastic lesions as internal fixation has been shown to have a high failure rate. Due to anatomical location, disease factors and patient factors internal fixation may be the treatment of choice. No reports exist in the literature regarding the use of locking plates in the management of neoplastic long bone lesions. Data was collected prospectively on the first 10 patients who underwent locking plate fixation of neoplastic long bone lesions. Data was collected on the nature of the lesion, surgery performed, complications and outcome. The patients mean age was 56.6 (15–88). Six lesions were metastatic, one haematological (myeloma) and 3 were primary bone lesions (lymphoma, Giant cell tumour, simple bone cyst). In nine cases a fracture through the lesion had occurred. Anatomical locations of the lesions were; proximal humerus (four), proximal tibia (three), distal femur (two) and distal tibia (one).