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Multicenter, retrospective comparison of implant survival, complications and cost between plate and screw and intramedullary nail fixation for metastatic lesions of the diaphyseal humerus.

BACKGROUND: The humerus is a common site of metastatic disease that can be fixated with either plate and screw or intramedullary nail (IMN) constructs. A multicenter retrospective comparison study was undertaken to compare implant survival, complication rate and cost between the two constructs. No prior studies have included a cost comparison. METHODS: Databases of two academic practices were queried retrospectively to identify patients with metastases of the humerus. Inclusion criteria were a lesion in the proximal metaphysis to distal diaphysis and amenable to both implant options with avai

The Prediction of Survival after Surgical Management of Bone Metastases of the Extremities-A Comparison of Prognostic Models.

Individualized survival prognostic models for symptomatic patients with appendicular metastatic bone disease are key to guiding clinical decision-making for the orthopedic surgeon. Several prognostic models have been developed in recent years; however, most orthopedic surgeons have not incorporated these models into routine practice. This is possibly due to uncertainty concerning their accuracy and the lack of comparison publications and recommendations. Our aim was to conduct a review and quality assessment of these models. A computerized literature search in MEDLINE, EMBASE and PubMed up to

Biodegradable tracheal stents: our ten-year experience with adult patients.

BACKGROUND: Biodegradable (BD) stents made from polydioxanone have been used only in human airways. These stents combine the advantages of classical tracheal stents, and fewer side effects are expected due to their biocompatibility and their time-limited presence in airways. However, new clinical consequences have arisen. Here, the authors share their experiences with BD stents for tracheal indications, focusing on their safety and efficacy. METHODS: This was a retrospective review of a collected database of adult patients who underwent implantation of biodegradable tracheal stents between Se

Current Overview of Treatment for Metastatic Bone Disease.

The number of patients with bone metastasis increases as medical management and surgery improve the overall survival of patients with cancer. Bone metastasis can cause skeletal complications, including bone pain, pathological fractures, spinal cord or nerve root compression, and hypercalcemia. Before initiation of treatment for bone metastasis, it is important to exclude primary bone malignancy, which would require a completely different therapeutic approach. It is essential to select surgical methods considering the patient's prognosis, quality of life, postoperative function, and risk of pos

Comparison of treatment options with long intramedullary nail and dynamic hip screws for metastatic subtrochanteric fracture: A cohort study.

BACKGROUND: Pathological subtrochanteric fractures pose challenges due to the high biomechanical demands of this region and the systemic complexity of metastatic disease. At present, the optimal fixation method remains controversial, particularly between intramedullary nailing (IMN) and dynamic hip screw (DHS) fixation. This study compared the mechanical, oncological, and functional outcomes of these two treatment strategies. METHODS: This retrospective study reviewed patients treated for metastatic subtrochanteric fractures at a single tertiary referral center between 2002 and 2018. Demograp

Temporary halo fixation and radiotherapy as alternative to long-construct spondylodesis in patients with multiple unstable cervical metastases.

Background and purposeCurrently no minimally invasive surgical treatment exists to provide immediate stability for unstable cervical/cervicothoracic metastases. Long-construct spondylodesis carries a high complication risk and has severe impact on residual range of motion. This study explores temporary halo fixation and radiotherapy as an alternative to long-construct cervical spondylodesis.Materials and methodsThis retrospective cohort study included twenty patients with multiple unstable cervical metastases treated between 2013-2023. All patients underwent halo fixation for an intended durat

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

Percutaneous endoscopic cecostomy for management of Ogilvie's syndrome: a case series and literature review with an update on current guidelines (with video).

IntroductionPercutaneous endoscopic cecostomy (PEC) is a viable treatment option for patients with persistent or recurrent acute colonic pseudo-obstruction (ACPO; Ogilvie's syndrome). It should be generally considered in patients that are refractory to pharmacologic and endoscopic decompression, especially those not amenable to surgical intervention due to an increased perioperative risk. Physicians are rather unfamiliar with this approach given the limited number of reports in the literature and paucity of guideline resources, although guidelines concerning ACPO and covering the role of endos

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… Iobst , Anirejuoritse Bafor, Danielle Hatfield, Anthony Yassall Nationwide Children’s Hospital, Columbus, OH, USA OP-163 2:37 PM–2:41 PM Evaluation of physical and mental health in adults who underwent limb-lengthening procedures with circular external fixators during childhood or adolescence Alessandro … Hubbard , Alexander Cherkashin, Mikhail Samchukov, David A Podeszwa, John G Birch Scottish Rite for Children, Dallas, TX, USA OP-166 3:01 PM–3:05 PM Chronic knee pain following infrapatellar/suprapatellar magnetic intramedullary lengthening nails versus external fixators in limb length discrepancy …

The Surgical Management of Proximal Femoral Metastases: A Narrative Review.

The proximal femur is a common location for the development of bony metastatic disease. Metastatic bone disease in this location can cause debilitating pain, pathologic fractures, reduced quality of life, anemia or hypercalcemia. A thorough history, physical examination and preoperative investigations are required to ensure accurate diagnosis and prognosis. The goals of surgical management is to provide pain relief and return to function with a construct that provides stability to allow for immediate weightbearing. Current surgical treatment options include intramedullary nailing, hemiarthropl

Palliative care of proximal femur metastatic disease and osteolytic lesions: results following surgical and radiation treatment.

BACKGROUND: Femoral bone metastases (FBM) or lesions (FBL) can lead to loss of mobility and independence due to skeletal-related events (SRE), e.g. pain, deformity and pathological fractures. Aim of this study was to analyze effects of radiotherapy and surgery, different surgical techniques and complications on disease-specific survival (DSS). METHODS: Patients who underwent palliative therapy for FBM or FBL between 2014 and 2020 were retrospectively analyzed. Chi-square test was used to detect intergroup differences. Survival was calculated using Kaplan-Meier method, Cox regression and compa

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

Local surgical complication rates in patients receiving surgery without immediate post-operative radiation therapy for lower extremity bone metastases.

PURPOSE: Pathological metastatic fractures in lower-extremity weight bearing bones often require surgical reconstruction. Post-operative radiation is routinely recommended following surgical reconstruction. This study evaluated the clinical outcomes of patients that undergo surgical fixation of an established or an impending pathologic lower extremity fracture without post-operative radiation. MATERIALS AND METHODS: A retrospective chart review of patients at Sunnybrook Health Sciences Center between 2007 and 2019 was performed. Descriptive statistical analyses were performed. RESULTS: A tot

The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG).

Multiple myeloma (MM) represents approximately 15% of haematological malignancies and most of the patients present with bone involvement. Focal or diffuse spinal osteolysis may result in significant morbidity by causing painful progressive vertebral compression fractures (VCFs) and deformities. Advances in the systemic treatment of myeloma have achieved high response rates and prolonged the survival significantly. Early diagnosis and management of skeletal events contribute to improving the prognosis and quality of life of MM patients. The management of patients with significant pain due to VC

Quantitative preoperative patient assessments are related to survival and procedure outcome for osseous metastases.

AimsOur objective was to determine if preoperative patient-reported assessments are associated with survival after surgery for stabilization of skeletal metastases.Patients and methodsAll patients with metastatic cancer to bone and indications for skeletal stabilization surgery were approached to participate in a prospective cohort study at a tertiary care center from 2012 to 2017. Of the 208 patients who were eligible, 195 (94%) completed the 36-item Short Form Health Survey (SF-36) preoperatively and underwent surgical treatment of skeletal metastases with complete or impending fractures; th

Ablation-First Balloon-Assisted Acetabuloplasty for Painful Acetabular Metastases: Clinical Outcomes and Mechanical Rationale.

PURPOSE: To evaluate the safety, technical feasibility, and clinical outcomes of a strict two-step protocol-CT/fluoroscopic-guided thermal ablation followed by Balloon-Assisted Acetabuloplasty (BAA)-for the treatment of painful acetabular metastases, utilized as an immediate mechanical stabilization bridge prior to radiotherapy. MATERIALS AND METHODS: A retrospective study was conducted on 16 consecutive patients treated for severe mechanical pain (VAS ≥ 6) and impaired mobility due to osteolytic acetabular metastases. The physiological rationale mandated a strict procedural sequence: (1) pre

Morphologic Features of the Contralateral Femur in Patients With Unilateral Slipped Capital Femoral Epiphysis Resembles Mild Slip Deformity: A Matched Cohort Study.

BACKGROUND: Hip osteoarthritis has been reported in the contralateral hip in patients who had been treated for unilateral slipped capital femoral epiphysis (SCFE) during adolescence. Although this might be related to the presence of a mild deformity, the morphologic features of the contralateral hip in unilateral SCFE remains poorly characterized. QUESTIONS/PURPOSES: Do measurements of (1) femoral head-neck concavity (α angle and femoral head-neck offset), (2) epiphyseal extension into the metaphysis (epiphyseal extension ratio and epiphyseal angle), and (3) posterior tilt of the epiphysis (e

[Our experience with revision total knee arthroplasty].

PURPOSE OF THE STUDY: In the period from 1990 and June 2003, 885 total knee replacements were performed at the orthopedic ward of the Ceske Budejovice Hospital. Of these, 19 (2.14 %) patients underwent revision surgery; in addition, 25 patients who had had primary surgery in other hospitals were operated on. Of these 44 patients, 25 were followed up and evaluated. The aim of the study was to evaluate the pre-operative treatment including examination for bacterial infection by cultivation, the selection of an optimal procedure (one- or two-stage operation, surgical approach and implantation tec

[Operative neurosurgery: personal view and historical backgrounds (3). Anterior circulation--pterional approach].

Under the title of anterior circulation aneurysms and the pterional approach, followings are presented and emphasized along with mentioning their historical development in our present performance status. Pterional approach: head positioning with Mayfield-Kees fixation apparatus using one pin around the processus matoideus and the other 2 pins on the contralateral side behind the hair line the head turned 30 degrees and reclined chin-up l5-20 grade. Skin incision beginning just in front of the tragus ending up at the midline hair line in a curvilinear fashion always including the superficial te

Одонтоид реконструировался с стабилизацией затылочного кондила у пациентов с метастатическим участием C2.

Зашифрованное соединение (OCJ) является сложным анатомическим районом, имеющим решающее значение для защиты нижнего ствола мозга, верхнего спинного мозга и нижних черепных нервов. Нестабильность в этой области может привести к таким серьезным последствиям, как хроническая боль, неврологические расстройства или смерть. Для стабилизации OCJ были разработаны различные хирургические методы, в частности с использованием затылочных кондитерских винтов, которые продемонстрировали свои перспективы в обеспечении стабильности и сохранении вращения шеи. Эта статья представляет two - случаи нестабильности