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Multicenter study on atypical femoral fractures in patients with bone metastases taking bone- modifying agents.

Bone-modifying agents (BMAs), with bone-resorptive inhibitory effects, such as zoledronic acid and denosumab, are widely used at higher doses for bone-related events caused by bone metastasis of malignant tumors. These drugs have been suggested to be associated with atypical femoral fractures (AFFs), and the relationship between BMAs and AFFs has attracted attention. To investigate the clinical features including bone union time of AFFs in patients administered BMA for bone metastasis, we conducted a retrospective multicenter study. Thirty AFFs from 19 patients were enrolled in this study. Thi

Combined Microwave Ablation and Osteosynthesis for Long Bone Metastases.

Background and Objectives: The purpose of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) in combination with open surgery nail positioning for the treatment of fractures or impending fractures of long bone metastases. Material and Methods: Eleven patients (four men, seven women) with painful bone metastases of the humerus, femur or tibia with non-displaced fractures (one case) or impending fractures (10 cases) underwent open MWA in combination with osteosynthesis by locked nail positioning. Pain intensity was measured using a VAS score before and af

Percutaneous-Reinforced Osteoplasty: A Review of Emerging Treatment Strategies for Bone Interventions.

Percutaneous-reinforced osteoplasty is currently being investigated as a possible therapeutic procedure for fracture stabilization in high-risk patients, primarily in patients with bone metastases or osteoporosis. For these patients, a percutaneous approach, if structurally sound, can provide a viable method for treating bone fractures without the physiologic stress of anesthesia and open surgery. However, the low strength of fixation is a common limitation that requires further refinement in scaffold design and selection of materials, and may potentially benefit from tissue-engineering-based

Non-union after bisphosphonate-associated atypical femoral fractures: a review of the current literature.

BACKGROUND: This article explores the mechanism of action of atypical femoral fractures (AFF), specifically focussing on osteoporosis, management challenges, and the implications for clinical practice. Non-union of AFF can result in severe pain, deformity and restricted mobility-all of which will have a detrimental impact on the patients' quality of life. PURPOSE: This review consolidates the current literature regarding non-union after bisphosphonate-associated atypical femoral fractures, providing a revision tool for higher examinations. METHOD/FINDINGS: An extensive search strategy was co

Gluteus Minimus Indentation Is Associated With Acetabular Undercoverage and Increased Femoral Torsion in Patients With Nontraumatic Hip Pain.

BACKGROUND: Although the hip is generally considered a stable joint, certain morphological configurations-such as acetabular dysplasia or abnormal femoral torsion-can predispose it to instability. Gluteus minimus indentation, a lateral femoral head morphologic finding, has been described in patients with cerebral palsy and severe dysplasia; however, whether it occurs in other instability-related hip morphologies and whether it has clinical relevance remains unclear. QUESTIONS/PURPOSES: (1) Did a higher percentage of patients with hip dysplasia (defined as a lateral center-edge angle [LCEA] <

Scintigraphic characteristics of non-ossifying fibroma in military recruits undergoing bone scintigraphy for suspected stress fractures and lower limb pains.

INTRODUCTION: Non-ossifying fibroma (NOF) is the most common fibrous bone lesion in children and young adults. This benign lesion is not a true neoplasm but is considered a developmental defect. Clinically, the lesion is asymptomatic and has a predilection for the long bones, particularly the femur and the tibia. NOF that ossify can show increased uptake on bone scintigraphy. Although the radiographic and histopathological findings of NOF have been well described, the scintigraphic findings of the abnormality have only been incidentally mentioned in the literature. AIM: To document the scinti

[Three-dimensional geometry of the proximal humerus and rotator cuff attachment and its utilization in shoulder arthroplasty].

PURPOSE OF THE STUDY: The aim of the study was to provide a method of measurement and data collection, based on morphologic analysis of the proximal humerus, that would facilitate precise placement of the humeral stem and would be easy to apply in clinical medicine in patients requiring shoulder arthroplasty. MATERIAL: Three groups of materials were used. Materials for the first and second groups were provided by the Department of Anatomy, First Faculty of Medicine, Charles University. The first group included 10 specimens (five left and five right humeral bones) obtained at routine anatomica

Paradoxical Stress Fracture in a Patient With Multiple Myeloma and Bisphosphonate Use.

Multiple myeloma (MM) is a plasma cell disorder with related organ dysfunction, including hypercalcemia, renal insufficiency, anemia, and bone disease. Osteolytic bone lesions that result in pain and pathologic fractures are a major source of morbidity and the use of bisphosphonates is generally safe and effective treatment in reducing myeloma-related skeletal fractures and associated morbidity. We present a 73-year-old African American woman with MM in remission and on intravenous (IV) bisphosphonate therapy in the past five years who reported gradually worsening bilateral thigh pain of six m

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… Bilateral hip X-rays showed bilateral incomplete insufficiency stress fractures along the lateral aspect of both proximal femoral diaphyses (Figures 1 - 3 ). … Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. Shane E, Burr D, Abrahamsen B, et al. J Bone Miner Res. 2014;29:1–23. doi: 10.1002/jbmr.1998. 17. …

Acute Correction of Multiplanar Proximal Tibial Deformity Utilizing Fixator-Assisted Intramedullary Nailing.

UNLABELLED: Proximal tibial deformities, particularly varus deformities, are relatively common in adolescents and young adults. The etiology of these deformities is often untreated or undercorrected infantile and adolescent Blount disease. Other less common etiologies include metabolic bone disease-associated deformities, posttraumatic and iatrogenic growth disturbance, and deformity related to surgical treatment or radiation for tumors1-3. We apply the principles of fixator-assisted acute deformity correction, mostly described for use at the distal aspect of the femur, as well as the principl

Geriatric chronic recurrent multifocal osteomyelitis (CRMO) mimicking multifocal multiple myeloma: a first in an octogenarian.

Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder characterized by non-bacterial osteomyelitis causing recurrent multifocal bone lesions, is a well-known, yet uncommon pediatric condition that rarely affects adults; to date, it has never been diagnosed over the age of 75. The following report will discuss the first octogenarian diagnosed with CRMO and therefore represents an exceptionally rare presentation of a rare disease. An 83-year-old woman presented with progressive right shoulder, forearm, and hip pain, with associated weight loss and global weakness,

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… CRMO is characterized by recurrent bone pain due to inflammation of the metaphyses and diaphyses of long bones and typically occurs in the lower limbs and pelvis [ 2 , 3 ]. Patients with CRMO often have comorbid autoimmune diseases and a family history of autoimmunity [ 4 ]. … Coronal computed tomography (CT) ( C ) and axial CT ( D ) similarly showing lateral proximal diaphyseal cortical destruction with adjacent exuberant lateral cortical periosteal reaction and osseous proliferation (see arrows) Fig. 3 4/2021 — AP ( A ) and lateral ( B ) right hip radiographs demonstrating …

Treating pathological metastatic fractures of the humerus by compound osteosynthesis: a retrospective cohort study.

BACKGROUND: The number of malignant tumors is increasing as are bone metastases, such as those in the humerus. Arm function is important for an independent everyday life. In this study, compound osteosynthesis of metastatic fractures of the humerus is examined for its suitability in light of the competing risk of death. METHODS: This retrospective monocentric study includes a cohort of tumor patients who underwent primary compound osteosynthesis for pathological humeral fractures. The main endpoint was the continued existence of compound osteosynthesis using competing risk analysis to contras

Stress Fracture of the Femoral Shaft in Paget's Disease of Bone: A Case Report.

Paget's disease of bone (PDB) is a progressive bone disorder characterized by increased osteoclast-mediated bone resorption and abnormal bone formation. Incomplete atypical femoral fracture, appearing radiographically as a stress fracture at the lateral aspect of the femur, is an uncommon low-trauma fracture frequently seen in association with long-term bisphosphonate therapy. We describe the case of a 61-year-old female patient with PDB who developed a stress fracture at the lateral femoral cortex after 5 doses of intravenous bisphosphonate. The conservative treatment plan included discontinu

MiR-328-5p/BCL7A axis is involved in fracture healing by modulating osteoblast function.

BackgroundDelayed fracture healing severely impacts patients' quality of life and imposes economic burdens.ObjectiveThis study aimed to investigate the role of miR-328-5p in fracture healing and its underlying molecular mechanisms, providing novel insights for the management of delayed fracture healing.MethodsSerum miR-328-5p levels were measured by RT-qPCR in 125 tibial fracture patients. The diagnostic potential of miR-328-5p for delayed healing was assessed through ROC curve analysis. Osteogenic differentiation of hFOB 1.19 cells was induced using osteogenic medium followed by evaluation of

Cemented long versus standard femoral stem in proximal femoral metastasis: a noninferiority single-blinded quasi-randomized clinical trial.

BACKGROUND AND PURPOSE: Proximal femur is a common site for metastasis, it has a significant impact on patient's quality of life, and traditional treatment aims at protecting as much as possible from the femur. However, recent studies have demonstrated increased rate of complications and questioned the need for long stem in this high-risk group. Our purpose is to determine whether standard-length femoral stem is noninferior to long femoral stem in the treatment of proximal femoral metastasis. PATIENTS AND METHODS: Between 2019 and 2021, we prospectively included 24 patients with proximal femo

The Treatment Gap in Osteoporosis.

Worldwide, there are millions of people who have been diagnosed with osteoporosis, a bone disease that increases the risk of fracture due to low bone mineral density and deterioration of bone architecture. In the US alone, there are approximately ten million men and women diagnosed with osteoporosis and this number is still growing. Diagnosis is made by measuring bone mineral density. Medications used for the treatment of osteoporosis are bisphosphonates, denosumab, raloxifene, and teriparatide. Recently, romosozumab has been added as well. In recent years, a number of advances have been made

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus.

BACKGROUND: Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes. METHODS: We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes. RESU

Is Proximal Femur Reconstruction With a Vascularized Fibula and Allograft Successful at Reconstructing a Tumor Resection in Children 6 Years of Age or Younger?

BACKGROUND: Treating bone sarcomas in young children, particularly in the proximal femur, is challenging because of the need to preserve growth potential, maintain joint function, and conserve bone for future revisions. In 1997, we introduced a new technique combining a vascularized fibula that preserved the proximal epiphysis to substitute for the femoral head and physis with a massive bone allograft aimed at providing a supportive scaffold for the autograft during growth. This approach initially showed promising results in both anatomic and functional restoration, but because it was a comple

What Is the Probability of Radial Nerve Recovery After Surgical Repair of Humerus Fractures Accounting for Time Since Injury?

BACKGROUND: Radial nerve injury after operative treatment of humeral shaft fracture usually improves, but a subgroup of patients does not recover. Understanding the probability of recovery over time is important in deciding on watchful waiting, nerve exploration, or tendon or nerve transfer. Bayesian analysis is helpful in estimating such probabilities. This type of analysis is predicated on estimating the probability that an event will occur and subsequently updating that estimate as new information becomes available-for instance, when nerve recovery does not occur over time. QUESTIONS/PURPO

Can a Novel Scoring System Improve on the Mirels Score in Predicting the Fracture Risk in Patients with Multiple Myeloma?

BACKGROUND: Stratification of the fracture risk is an important treatment component for patients with multiple myeloma, which is associated with up to an 80% risk of pathologic fracture. The Mirels score, which is commonly used to estimate the fracture risk for patients with osseous lesions, was evaluated in a cohort in which fewer than 15% of lesions were caused by multiple myeloma. The behavior of multiple myeloma lesions often differs from that of lesions caused by metastatic disease, and accurate risk stratification is critical for effective care. To our knowledge, the Mirels score has not

A Unique Mode of Failure in the Noncontact Bridging Periprosthetic Plating System.

Although lateral locking plates are often a preferred and successful fixation construct for the treatment of periprosthetic proximal and distal femur fractures, specific complications and modes of failure have been associated and well-described with their use. We present two cases of implant failure in the Non-Contact Bridge Periprosthetic Plating System (Zimmer Biomet) in which a nonlocked screw fretted through the annular seating of the plate. One case demonstrates failure in the setting of a proximal femur periprosthetic fracture, whereas the other demonstrates failure in the setting of a d