Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur.

PURPOSE: To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur. MATERIALS AND METHODS: The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years±13 (SD) (range: 35-82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score≥8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay. RESULTS: No patients treated with RPOC had a fracture during a mean follow-up time of 382 days±274 (SD) (range: 11-815 days). RPOC was performed under general (n=10) or locoregional (n=2) anesthesia. The average duration of the procedure was 95min±17 (SD) (range: 73-121min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4days ±3 (SD) (range: 2-10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n=7), VAS score decreased from 6.8±1.2 (SD) (range: 5-9) before treatment, to 2.3±1.1 (SD) (range: 1-4) one month later. CONCLUSION: Preventive RPOC for pathological fracture of the proximal femur is a reliable alternative for cancer patients who are not candidates for surgical stabilization. Studies involving more patients are needed to confirm our preliminary experience.

[Preoperative portal vein embolization with Amplatzer(®) vascular plugs (AVP): a review of 17 cases]. / Embolisation portale préopératoire par Amplatzer(®) Vascular Plugs (AVP) : 17 patients.

The purpose was to determine the efficacy and technical particularities related to the use of Amplatzer(®) Vascular Plugs (AVP) for preoperative portal vein embolization. Between 2005 and 2009, a total of 48 type I AVP were embolized into the portal venous system of 17 patients (51-83 years) prior to extended hepatic resection where the residual liver volume (RLV) was deemed sufficient (RLV < 35-40% in patients with underlying hepatocellular disease, < 25-30% in patients with normal liver). AVP were used alone in seven patients and combined to other embolization agents in 10 patients (coils: n=5, microparticles: n=1, resorbable gel foam: n=4). The procedure was technically successful in 100% of cases with immediate success rate of 94.1% (imcomplete embolization of a segmental branch of segment VIII). The procedure was well tolerated clinically in 94.1% of cases, and in 100% of cases based on laboratory values. The rate of recanalization on follow-up CT at 5 weeks (2-22) was 11.7%. The rate of complications, major (left portal vein thrombosis following right portal vein embolization) and minor (one case of portovenous fistula), was 11.7%. The rate of RLV growth was from +13 to +285 cm(3) (mean at +122 cm(3)), or +4.98 to +78.51% (mean at +33.3%) (hepatocellular carcinoma: mean of +30.7%, metastases: mean of +19.7%). The rate of surgical candicacy was 94.1% (two patients were excluded: insufficient growth of RLV, development of peritoneal carcinomatosis). AVP appear to be reliable and effective for the preoperative embolization of the portal vein, with low morbidity and sufficient growth of RLV.