Treatment guidelines for atypical femoral fractures associated
with bisphosphonates have not been established. We conducted a systematic
review of the treatment of atypical femoral fractures first, to
evaluate the outcomes of surgical fixation of complete atypical fractures
and secondly, to assess whether prophylactic surgery is necessary
for incomplete atypical fractures. Case reports and series were identified from the PubMed database
and were included if they described the treatment of atypical femoral
fractures. In total, 77 publications met our inclusion criteria
and 733 patients with 834 atypical complete or incomplete femoral fractures
were identified.Aims
Materials and Methods
Peri-acetabular tumour resections and their subsequent
reconstruction are among the most challenging procedures in orthopaedic
oncology. Despite the fact that a number of different pelvic endoprostheses
have been introduced, rates of complication remain high and long-term
results are mostly lacking. In this retrospective study, we aimed to evaluate the outcome
of reconstructing a peri-acetabular defect with a pedestal cup endoprosthesis
after a type 2 or type 2/3 internal hemipelvectomy. A total of 19 patients (11M:8F) with a mean age of 48 years (14
to 72) were included, most of whom had been treated for a primary
bone tumour (n = 16) between 2003 and 2009. After a mean follow-up
of 39 months (28 days to 8.7 years) seven patients had died. After
a mean follow-up of 7.9 years (4.3 to 10.5), 12 patients were alive,
of whom 11 were disease-free. Complications occurred in 15 patients.
Three had recurrent dislocations and three experienced aseptic loosening.
There were no mechanical failures. Infection occurred in nine patients,
six of whom required removal of the prosthesis. Two patients underwent
hindquarter amputation for local recurrence. The implant survival rate at five years was 50% for all reasons,
and 61% for non-oncological reasons. The mean Musculoskeletal Tumor
Society score at final follow-up was 49% (13 to 87). Based on these poor results, we advise caution if using the pedestal
cup for reconstruction of a peri-acetabular tumour resection. Cite this article:
The February 2015 Oncology Roundup360 looks at: Achieving global collaboration; A new standard for limb salvage; Inoperable chondrosarcoma and chemotherapy; Soft-tissue sarcoma and adjuvant chemotherapy; Missed diagnoses and malpractice in sarcoma; Radiofrequency and cartilage tumours
The aims of this retrospective study were to report the feasibility
of using 3D-printing technology for patients with a pelvic tumour
who underwent reconstruction. A total of 35 patients underwent resection of a pelvic tumour
and reconstruction using 3D-printed endoprostheses between September
2013 and December 2015. According to Enneking’s classification of
bone defects, there were three Type I lesions, 12 Type II+III lesions,
five Type I+II lesions, two Type I+II+III lesions, ten type I+II+IV
lesions and three type I+II+III+IV lesions. A total of three patients
underwent reconstruction using an iliac prosthesis, 12 using a standard
hemipelvic prosthesis and 20 using a screw-rod connected hemipelvic
prosthesis.Aims
Patients and Methods
Intermittently administered parathyroid hormone (PTH 1-34) has been shown to promote bone formation in both human and animal studies. The hormone and its analogues stimulate both bone formation and resorption, and as such at low doses are now in clinical use for the treatment of severe osteoporosis. By varying the duration of exposure, parathyroid hormone can modulate genes leading to increased bone formation within a so-called ‘anabolic window’. The osteogenic mechanisms involved are multiple, affecting the stimulation of osteoprogenitor cells, osteoblasts, osteocytes and the stem cell niche, and ultimately leading to increased osteoblast activation, reduced osteoblast apoptosis, upregulation of Wnt/β-catenin signalling, increased stem cell mobilisation, and mediation of the RANKL/OPG pathway. Ongoing investigation into their effect on bone formation through ‘coupled’ and ‘uncoupled’ mechanisms further underlines the impact of intermittent PTH on both cortical and cancellous bone. Given the principally catabolic actions of continuous PTH, this article reviews the skeletal actions of intermittent PTH 1-34 and the mechanisms underlying its effect.
The purpose of this retrospective study was to differentiate
between the MRI features of normal post-operative change and those
of residual or recurrent disease after intralesional treatment of
an atypical cartilage tumour (ACT)/grade I chondrosarcoma. We reviewed the case notes, radiology and histology of 75 patients,
who had been treated for an ACT/grade I chondrosarcoma by curettage,
phenolisation and bone allografting between 1994 and 2005. The first
post-operative Gd-enhanced MRI scan was carried out within one year
of surgery. Patients had a minimum of two scans and a mean follow-up
of 72 months (13 to 169). Further surgery was undertaken in cases
of suspected recurrence.Aims
Patients and Methods
Diabetes mellitus is the most common co-morbidity associated
with necrotising fasciitis. This study aims to compare the clinical
presentation, investigations, Laboratory Risk Indicator for Necrotising
Fasciitis (LRINEC) score, microbiology and outcome of management
of this condition in diabetic and non-diabetic patients. The medical records of all patients with surgically proven necrotising
fasciitis treated at our institution between 2005 and 2014 were
reviewed. Diagnosis of necrotising fasciitis was made on findings
of ‘dishwater’ fluid, presence of greyish necrotic deep fascia and
lack of bleeding on muscle dissection found intra-operatively. Information
on patients’ demographics, presenting symptoms, clinical signs,
investigations, treatment and outcome were recorded and analysed.Aims
Patients and Methods
Clinical studies of patients with bone sarcomas have been challenged
by insufficient numbers at individual centres to draw valid conclusions.
Our objective was to assess the feasibility of conducting a definitive
multi-centre randomised controlled trial (RCT) to determine whether
a five-day regimen of post-operative antibiotics, in comparison
to a
24-hour regimen, decreases surgical site infections in patients
undergoing endoprosthetic reconstruction for lower extremity primary
bone tumours. We performed a pilot international multi-centre RCT. We used
central randomisation to conceal treatment allocation and sham antibiotics
to blind participants, surgeons, and data collectors. We determined
feasibility by measuring patient enrolment, completeness of follow-up,
and protocol deviations for the antibiotic regimens. Objective
Methods
Prophylactic antibiotics can decrease the risk
of wound infection and have been routinely employed in orthopaedic surgery
for decades. Despite their widespread use, questions still surround
the selection of antibiotics for prophylaxis, timing and duration
of administration. The health economic costs associated with wound
infections are significant, and the judicious but appropriate use
of antibiotics can reduce this risk. This review examines the evidence behind commonly debated topics
in antibiotic prophylaxis and highlights the uses and advantages
of some commonly used antibiotics. Cite this article:
The June 2014 Oncology Roundup360 looks at: Infection still a problem in endoprosthetic reconstruction; massive allografts not as successful as we perhaps think; curopsy for aneurysmal bone cysts?; lengthening prosthesis: days are numbered; new WHO classification in brief; proximal tumours and fluid levels: bad news; infection is predictable in orthopaedic oncology; psychosocial support key in oncological outcomes.
Vascularised fibular grafts (VFGs ) are a valuable
surgical technique in limb salvage after resection of a tumour.
The primary objective of this multicentre study was to assess the
risk factors for failure and complications for using a VFG after
resection of a tumour. The study involved 74 consecutive patients (45 men and 29 women
with mean age of 23 years (1 to 64) from four tertiary centres for
orthopaedic oncology who underwent reconstruction using a VFG after
resection of a tumour between 1996 and 2011. There were 52 primary
and 22 secondary reconstructions. The mean follow-up was 77 months
(10 to 195). In all, 69 patients (93%) had successful limb salvage; all of
these united and 65 (88%) showed hypertrophy of the graft. The mean
time to union differed between those involving the upper (28 weeks;
12 to 96) and lower limbs (44 weeks; 12 to 250). Fracture occurred
in 11 (15%), and nonunion in 14 (19%) patients. In 35 patients (47%) at least one complication arose, with a
greater proportion in lower limb reconstructions, non-bridging osteosynthesis,
and in children. These complications resulted in revision surgery
in 26 patients (35%). VFG is a successful and durable technique for reconstruction
of a defect in bone after resection of a tumour, but is accompanied
by a significant risk of complications, that often require revision
surgery. Union was not markedly influenced by the need for chemo-
or radiotherapy, but should not be expected during chemotherapy.
Therefore, restricted weight-bearing within this period is advocated. Cite this article:
Resection of malignant bony tumours of the pelvis
creates large bone and soft-tissue defects, and is frequently associated
with complications such as wound dehiscence and deep infection.
We present the results of six patients in whom a rectus abdominis
myocutaneous (RAM) flap was used following resection of a malignant
tumour of the pelvis. Bony reconstruction was performed using a
constrained hip tumour prosthesis in three patients, vascularised
fibular graft in two and frozen autograft in one. At a mean follow-up
of 63 months (16 to 115), no patients had a problem with the wound. Immediate reconstruction using a RAM flap may be used after resection
of a malignant tumour of the pelvis to provide an adequate volume
of tissue to eliminate the dead space, cover the exposed bone or
implants with well-vascularised soft tissue and to reduce the risk
of complications. Cite this article:
There is increasing global awareness of adverse
reactions to metal debris and elevated serum metal ion concentrations
following the use of second generation metal-on-metal total hip
arthroplasties. The high incidence of these complications can be
largely attributed to corrosion at the head-neck interface. Severe
corrosion of the taper is identified most commonly in association
with larger diameter femoral heads. However, there is emerging evidence
of varying levels of corrosion observed in retrieved components
with smaller diameter femoral heads. This same mechanism of galvanic
and mechanically-assisted crevice corrosion has been observed in
metal-on-polyethylene and ceramic components, suggesting an inherent
biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers
clinicians and researchers must understand regarding corrosion of
the taper, and its relevance to current orthopaedic practice. Cite this article:
We chose unstable extra-capsular hip fractures as our study group
because these types of fractures suffer the largest blood loss.
We hypothesised that tranexamic acid (TXA) would reduce total blood
loss (TBL) in extra-capsular fractures of the hip. A single-centre placebo-controlled double-blinded randomised
clinical trial was performed to test the hypothesis on patients
undergoing surgery for extra-capsular hip fractures. For reasons
outside the control of the investigators, the trial was stopped
before reaching the 120 included patients as planned in the protocol. Aims
Patients and Methods
The June 2012 Oncology Roundup360 looks at: avoiding pelvic hemipelvectomy; proximal femoral metastasis; extendible prostheses; rotationplasty; soft-tissue sarcomas; osteosarcoma of the pelvis; recurrent chondrosarcoma ; MRI and the differentiation between benign and malignant lesions; and malignant fibrous histiocytoma.
The October 2015 Oncology Roundup360 looks at: Radiotherapy for the radioresistant; Multiple hereditary exostosis; The total femur as a limb salvage option; Survival prediction in osteosarcoma; What happens when chondrosarcoma recurs?; Thumbs up for vascularised fibular graft; Radiotherapy and survival; Musculoskeletal tumours in pregnancy
