Orthopaedic Web Links

Surgical management of metastatic disease of the proximal femur

Hattori et al — 2009-09-12 23:33:51 GMT

Purpose. To review the surgical treatment for metastatic disease of the proximal femur. Methods. Records of 8 patients who underwent endoprosthetic replacement with tumour resection (group 1) and 8 others who underwent intramedullary nailing without tumour resection (group 2) were reviewed. Treatments were based on the disease progression and patient�s condition. Results. In groups 1 and 2, the respective mean survival periods were 16 and 4 months. All patients in group 1 regained preoperative mobility, but only one patient in group 2 was able to walk with crutches. Conclusion. This was a retrospective, rather than comparative study of endoprothetic replacement and intramedullary nailing for metastatic disease of the proximal femur. Both procedures are considered palliative, and not curative. The longer survival period in group 1 was mainly due to selection of patients with better preoperative medical status.
H Hattori, J Mibe, H Matsuoka, S Nagai, K Yamamoto Journal of Orthopaedic Surgery 2007;15(3):295-8

Pathologic Fracture Femur Gentili

Not Available — 2009-09-12 23:33:51 GMT

Pathologic fractures result from an underlying abnormality of the bone, usually either a primary bone lesion such as a tumor, or metastatic disease. However, pathologic fractures may result from metabolic conditions as well. A fracture results when normal stress is placed onto abnormal bone.
Radiology site

Pathologic fractures of the Femur

Ditell & Rapp — 2009-09-12 23:33:51 GMT

Book chapter in the Double Dynamic Martin Screw eds Dittel & Rapp

Evaluation of the Risk of Pathologic Fractures Secondary to Metastatic Bone Disease

Not Available — 2009-09-12 23:33:51 GMT

Pathologic fractures create a serious morbidity in patients with metastatic bone disease. Orthopedic surgeons who treat patients with metastatic skeletal lesions should focus on proactive treatments designed to prevent pathologic fractures before they occur. Prevention of pathologic fractures result in better patient outcome, lower cost, and less difficult operative procedures. For this reason, it is critical to identify both patients and skeletal lesions that are at increased risk of pathologic fracture. The goal of this review is to establish a systematic screening tool and treatment algorithm that orthopedic surgeons can easily apply to their patients in order to optimize the management of metastatic skeletal disease.
Oct 4 , 2001 HD BoneTumor.org

Pathologic Hip Fractures A Class of Their Own

Mary I. O�Connor, MD — 2009-09-12 23:33:51 GMT

The hip is a common site for metastatic disease. In 2005, approximately 650,000 patients in the United States will be newly diagnosed with cancers that commonly metastasize to bone; these cancers include breast, lung, renal, thyroid, and prostate.1 Bone metastases eventually will develop in many of these patients. Moreover, patients may present to the orthopedic surgeon with musculoskeletal symptoms secondary to bone metastases and no prior diagnosis of cancer.
This article highlights the detection and evaluation of metastatic disease, discusses when referral to an orthopedic oncologist is appropriate, and provides guidelines for the surgical treatment of metastatic disease about the hip.
Mary I. O�Connor, MD ORTHOPEDICS 2006; 29:789

Soft tissue balance and recovery of proprioception after total knee replacement

Not Available — 2009-09-12 23:33:51 GMT

Decreasing proprioception of the knee is multifactorial and is a function of age and degenerative joint disease. Soft-tissue release during total knee replacement may have an influence. We have quantified soft-tissue imbalance at the time of knee replacement and attempted to eliminate it at full extension, using established methods. We studied the influence of residual soft-tissue imbalance on postoperative proprioception, assessing this in 38 patients before total knee replacement and at three and six months postoperatively. We found that proprioception improved in varus knees at three and six months after soft-tissue balancing procedures. Knees balanced in full extension and in flexion (< �2�) showed a significant improvement in proprioception (p < 0.0005) whereas those which were not balanced in flexion but fully balanced in extension had no significant improvement. We conclude that soft-tissue balance in both flexion and extension is important to allow satisfactory postoperative proprioception of the knee.
S. F. ATTFIELD, T. J. WILTON, D. J. PRATT, A. SAMBATAKAKIS J Bone Joint Surg [Br] 1996;78-B:540-5

Pathologic Humerus Fracture

Gobezie et al — 2009-09-12 23:33:51 GMT

Historically, pathologic humerus fractures have been treated non-operatively with casts, splints, or braces in conjunction with radiotherapy. However, the functional outcome for these patients was poor, as use of the arm was extremely limited. As a result, surgical techniques for fracture stabilization have been employed using endoprostheses, polymethylmethacrylate (PMMA), and modern methods of fracture management. The success in functional improvement and pain relief has led to the much broader use of operative treatment in patients with metastatic disease.
Reuben Gobezie MD, Brent A. Ponce MD, John Ready MD The Orthopaedic Journal at Harvard Medical School

Pathologic fracture of proximal femur

Not Available — 2009-09-12 23:33:51 GMT

Case discussion presented by William Craig
50 y o female with breast cancer who had pathologic fracture of proximal femur. Originally fixed with PFN which has broken. Patient is a Jehovah's witness and will not take transfusions. Hgb is 8. She needs chemo for mets which are in her bladder/pelvis. How would you fix it and what would you use for bone graft?

Compound Osteosynthesis for Osteolyses and Pathological Fractures of the Proximal Femur

Kinkel et al — 2009-09-12 23:33:51 GMT

Due to improved oncological therapeutic procedures with longer survival times, the stabilization of osteolyses and pathological fractures is gaining importance. The proximal femur is often affected by metastases. As femoral stability can be compromised by such bone lesions, stabilization as a palliative measure is indicated to restore function and relieve pain. Besides intramedullary osteosynthesis and endoprosthetic reconstruction, compound osteosynthesis is an alternative method for stabilization of the proximal femur.
A technically demanding alternative method for the treatment of large osteolytic lesions of the proximal femur is plate compound osteosynthesis. With this technique, stabilization is achieved by implanting a condylar plate after removal of tumor tissue through a cortical window and filling the defect with bone cement (single-plate compound osteosyntheses). In addition, an intramedullary plate can be introduced that provides a medial load transfer and supports the condylar plate blade (double-plate compound osteosyntheses)
Stefan Kinkel, MD; Jens Stecher, MD; Tobias Gotterbarm, MD; Thomas Bruckner, PhD; Ulrich Holz, MD, PhD ORTHOPEDICS 2009; 32:403

Pathological fractures of the proximal femur with impending shaft fractures treated by THR and cemented intramedullary nailing

Voggenbreiter et al — 2009-09-12 23:33:51 GMT

We have used total hip replacement combined with cemented intramedullary nailing to treat a selected group of nine patients with pathological fractures of the proximal femur and impending fractures of the shaft due to metastases. One patient died from cardiopulmonary failure on the third postoperative day, but the others were able to walk within the first week after operation. Complications included one recurrent dislocation of the THR and one fracture of an osteolytic lesion of the femoral shaft during nail insertion. Both were managed successfully. The hybrid osteosynthesis which we describe is an alternative to the use of tumour or long-stem prostheses; it has the advantage of preserving bone stock and muscle attachments.
GREGOR VOGGENREITER, STEFAN ASSENMACHER, WILHELM KLAES, KLAUS-PETER SCHMIT-NEUERBURG J Bone Joint Surg [Br] 1996;78-B:400-3.