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Management of Long Bones Metastatic Disease: Concepts That We All Know but Not Always Remember.

Bones are the third most common site of metastatic disease. Treatment is rarely curative; rather, it seeks to control disease progression and palliate symptoms. Imaging evaluation of a patient with symptoms of metastatic bone disease should begin with plain X-rays. Further imaging consists of a combination of (PET)-CT scan and bone scintigraphy. We recommend performing a biopsy after imaging workup has been conducted. Metastatic bone disease is managed with a combination of systemic treatment, radiotherapy (RT), and surgery. External beam RT (EBRT) is used for pain control and postoperatively

Principles of Management of Extremity Skeletal Metastasis.

Understanding the epidemiology of extremity skeletal metastasis and the factors deciding the treatment decision-making are essential in developing a diagnostic and treatment strategy. This leads to optimum care and reduces disease-related burden. With the evolution of medical, radiation therapy, and surgical methods, cancer care has improved the quality of life for patients with improved survival and functional status in patients with skeletal metastasis. Based on the currently available literature, we have described a step-wise evaluation and management strategy of metastatic extremity bone d

Prediction of survival after surgical management of femoral metastatic bone disease - A comparison of prognostic models.

BackgroundOperative fixation for femoral metastatic bone disease is based on the principles of reducing pain and restoring function. Recent literature has proposed a number of prognostic models for appendicular metastatic bone disease. The aim of this study was to compare the accuracy of proposed soring systems in the setting of femoral metastatic bone disease in order to provide surgeons with information to determine the most appropriate scoring system in this setting.MethodsA retrospective cohort analysis of patients who underwent surgical management of femoral metastatic bone disease at a s

Разрывы Фемура в травматизме Спинала Корда.

У лиц, получивших травму спинного мозга (КВП), происходит быстрая и глубокая потеря костей ниже уровня повреждения, предвосхищая их хрупкими трещинами. Ввиду их частотности и клинического воздействия бедренная хрупкость у пациентов СКИ требует особого внимания. Цель этого обзора литературы состоит в обобщении текущих данных об эпидемиологии, патофизиологии, диагностике, управлении и предотвращении бедренной хрупкости у пациентов СКИ. Был проведен всеобъемлющий поиск литературы в базах данных анализа медицинской литературы и системы ретровиваля в онлайновом режиме (MedLINE) и сводного индекса м

Evaluation of Intramedullary Methods with Polymethylmethacrylate for Fixation of Bone Lesions of the Extremities.

Objective  To evaluate the better potential and functional results in pain control in the treatment of pathological fractures and prophylactic fixation with an intramedullary nail associated with polymethylmethacrylate, compared with the utilization of an intramedullary nail in long bone tumor lesions. Methods  From January 2012 to September 2017, 38 patients with 42 pathological lesions (fractures or impending fractures according to the Mirels criteria) were treated surgically. Sixteen patients allocated to the control group underwent a locked intramedullary nail fixation, and 22 patients wit

[Avascular Necrosis of Femoral Head and Coxarthrosis Progression after Acetabular Fractures].

PURPOSE OF THE STUDY Non-operative and operative treatment of acetabular fractures is associated with a risk of development of posttraumatic avascular necrosis of femoral head or with the development of posttraumatic coxarthrosis. The purpose of the study was to identify the occurrence of these two complications in patients in our group and to determine the risk factors for the development of these complications. MATERIAL AND METHODS The retrospective study was conducted in two Level I trauma centres in the period from 2009 to 2014. The group included patients with an acetabular fracture. The

The Advantages of Radiofrequency Echographic MultiSpectrometry in the Evaluation of Bone Mineral Density in a Population with Osteoarthritis at the Lumbar Spine.

BACKGROUND: Osteoarthritis (OA) in the lumbar spine can potentially lead to an overestimation of bone mineral density (BMD), and this can be a challenge in accurately diagnosing conditions like osteoporosis, where precise measurement of BMD is crucial. Radiofrequency Echographic Multi Spectrometry (REMS) is being recognized as an innovative diagnostic tool for assessing bone status. The purpose of this study was to evaluate whether the use of REMS may enhance the identification of osteoporosis in patients with osteoarthritis. METHODS: A cohort of 500 patients (mean age: 63.9 ± 11.2 years) dia

Proximal femoral multiple myeloma pathological fractures, impending and actual fractures - a patient survival study.

INTRODUCTION: The femur is a common site for Multiple Myeloma (MM) involvement. This study explores the impact of preventive surgery for anticipated femoral pathological fractures (IFF), based on Mirels classification, versus treatment of pathological femur fracture (PFF) on MM patient mortality and morbidity. METHODS: Retrospective cohort of 33 patients undergoing surgery due to femoral MM involvement (2004-2015), 18 patients with PFF, 15 patients with IFF, followed up until deceased or to July 2016. Demographic data, oncological, pathological, radiation, surgical reports, outpatient clinica

Hairy cell leukemia with isolated bone lesions.

Key clinical message18F-FDG PET/CT has clinical relevance in HCL at diagnosis and for the follow-up of patients treated, especially in case of atypical presentations such as bone involvements (which are probably underestimated) and poor bone marrow infiltration.AbstractBone lesions are rarely reported in Hairy Cell Leukemia (HCL). We report two BRAFV600E mutated HCL patients presented bone lesions at foreground, poor bone marrow involvement, and the important role 18F-FDG PET/CT played in their management. We discuss the crucial role that 18F-FDG PET/CT could play in HCL routine practice.

Management of skeletal metastases: An orthopaedic surgeon's guide.

Skeletal metastasis is a common cause of severe morbidity, reduction in quality of life (QOL) and often early mortality. Its prevalence is rising due to a higher rate of diagnosis, better systemic treatment, longer lives with the disease and higher disease burden rate. As people with cancer live longer and with rising sensitivity of body imaging and surveillance, the incidence of pathological fracture, metastatic epidural cord compression is rising and constitutes a challenge for the orthopedic surgeon to maintain their QOL. Metastatic disease is no longer a death sentence condemning patients

Treatment of metastatic lesions localized in the acetabulum.

BackgroundMetastatic lesions localized in the periacetabular area cause troublesome pain and reduced mobility of the patients. Radiotherapy effectively decreases pain, yet it does not restore the ability to load the joint. Surgical treatment involving resection of metastatic lesions and joint reconstruction using bone grafts is burdened with a high rate of complications. Modular tumor prostheses are being increasingly used. In some cases, it is possible to strengthen the acetabular roof with bone cement using vertebroplasty kits. The aim of the study was to demonstrate various methods of treat

Multifocal intraosseous hemangioma: A case report.

RationaleMultifocal intraosseous hemangioma, which affects multiple body parts, is rare. The selection of appropriate lesion sites for biopsy and effective treatment in multifocal intraosseous hemangioma is challenging. Here, we report a case of multifocal intraosseous hemangioma.Patient concernsA 49-year-old woman was admitted to our department with a chief complaint of aggravated lumber pain for 10 days.DiagnosesRadiographic imaging revealed lesions involving the bilateral ribs, lumbar vertebrae, ilium, pubis, and proximal femur. Open biopsy in the ilium established the pathological diagnosi

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

Rethinking Femoral Head Biopsies in Geriatric Hip Fractures: Financial Burden vs Clinical Outcomes.

INTRODUCTION: Femoral head specimens are often sent for histopathology after geriatric femoral neck fractures in patients with past history of malignancies. However, the cost-effectiveness of this practice is unclear and the clinical impact and effect on patient management has yet to be ascertained. METHODS: This is a retrospective review of all femoral head histopathology specimens registered in our center from 2003 to 2023. Patients <65 years of age were excluded from the study. Patient demographics were analyzed. Clinical notes and radiographic information were retrieved for all cases with

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

Longitudinal survival trends of patients with cancer with surgically managed appendicular metastatic bone disease: systematic review.

BackgroundAdvances in systemic cancer therapies have improved survival for patients with metastatic carcinoma; however, it is unknown whether these advances have translated to improved survival for patients with appendicular metastatic bone disease (A-MBD) after orthopedic interventions. We conducted a study to evaluate the trend in overall survival for patients who underwent orthopedic surgery for A-MBD between 1968 and 2018.MethodsA systematic search of Embase and Medline to identify studies published since 1968 evaluating patients treated with orthopedic surgery for A-MBD was conducted for

Fracture Risk of Long Bone Metastases: A Review of Current and New Decision-Making Tools for Prophylactic Surgery.

Long bone pathological fractures very much reflect bone metastases morbidity in many types of cancer. Bearing in mind that they not only compromise patient function but also survival, identifying impending fractures before the actual event is one of the main concerns for tumor boards. Indeed, timely prophylactic surgery has been demonstrated to increase patient quality of life as well as survival. However, early surgery for long bone metastases remains controversial as the current fracture risk assessment tools lack accuracy. This review first focuses on the gold standard Mirels rating system.

Use of oral bisphosphonates in primary prevention of fractures in postmenopausal women: a population-based cohort study.

OBJECTIVE: To compare incidence of first osteoporotic fracture in two cohorts of postmenopausal women, one treated with bisphosphonates and the other only with calcium and vitamin D. DESIGN: Retrospective population cohort study with paired matching based on data from electronic health records. SETTING: Women aged 60 years and older in 2005, from 21 primary care centers in a healthcare region of Spain. PARTICIPANTS: Two groups of women aged 60 years and older (n = 1208), prescribed either calcium and vitamin D (CalVitD) or bisphosphonates (BIPHOS) with or without calcium and vitamin D, were

Clinical approaches to osteoporosis in patients with chronic kidney disease: A comprehensive review.

Chronic kidney disease (CKD) induces secondary osteoporosis, characterized by an imbalance between bone formation and resorption due to kidney dysfunction; the result is a reduction in both bone mineral density and quality. This condition is compounded by disruption of bone metabolic turnover, abnormalities in bone microstructure and collagen cross-linking, and compromised bone quality, all of which contribute to increased bone fragility. Reduced kidney function is complicated by secondary hyperparathyroidism, which exacerbates bone fragility. Managing osteoporosis in patients with CKD is chal

Существуют ли преимущества полной гип-артопластики с двухмобильными кубками по сравнению с биполярной гемиартропластикой для феморальной шеи в гериатрическом населении? Систематический обзор и метаанализ сравнительных исследований.

Справочная информация/цели: Оптимальный подход к бедренным переломам шеи (ФЗ) у престарелых остается неясным. Была использована внутренняя фиксация, биполярная гемиартропластика (BH), стандартная общая тазобедренная артропластика (THA) или чашка с двойной мобильностью (DM-THA), каждая из которых имеет различные преимущества и недостатки. В рамках этого систематического обзора и метаанализа были проведены сравнительные исследования по БХ и ДМ-ТХА среди лиц пожилого возраста в целях выявления различий в результатах, включая функциональное восстановление, показатели результатов, сообщаемые пациен

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… Bipolar versus Monopolar Hemiarthroplasty for Displaced Femur Neck Fractures: A Meta-Analysis Study Eur. J. Orthop. Surg. Traumatol. 2020 30 401 410 10.1007/s00590-019-02600-6 31773262 7. Imam M.A. Shehata M. Abdallah A.R. Ahmed H. Kader N. Ernstbrunner L. Narvani A.A. Kambouroglou G. Mcnamara I. …