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1.
Medicine (Baltimore) ; 99(50): e23587, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327321

RESUMO

RATIONALE: Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra. PATIENT CONCERNS: A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months. DIAGNOSES: Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra. INTERVENTIONS: The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time. OUTCOMES: The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later. CONCLUSION: This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.


Assuntos
Fraturas Espontâneas/diagnóstico , Hemangiossarcoma/diagnóstico , Vértebras Lombares , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/cirurgia , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Parafusos Pediculares , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia
2.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370952

RESUMO

A 60-year-old man presented to our hospital with complaints of pain and deformity on his right thigh for the past 2 days following a history of accidental slip and fall. Radiological investigations suggested a pathological type 2 Seinsheimer subtrochanteric fracture of the right femur with a 'bone within bone' appearance, which posed a diagnostic dilemma as this radiological appearance is seen in a spectrum of conditions. Radiographic skeletal survey failed to identify a similar appearance elsewhere in the body. Laboratory investigations pointed in favour of bone mineral disease, and histopathological examination of the bone narrowed it down to Paget's disease. The fracture was fixed with a contralateral distal femur locking compression plate. The fracture site failed to show signs of union until 6 months postsurgery and hence the patient was advised for grafting procedure. The patient deferred surgery and remains without major complications until 18 months of follow-up.


Assuntos
Acidentes por Quedas , Fixação Interna de Fraturas/instrumentação , Fraturas Espontâneas/diagnóstico , Fraturas do Quadril/diagnóstico , Osteíte Deformante/diagnóstico , Biópsia , Placas Ósseas , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Diagnóstico Diferencial , Fêmur/diagnóstico por imagem , Fêmur/lesões , Fêmur/patologia , Fêmur/cirurgia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteíte Deformante/complicações , Osteíte Deformante/patologia , Radiografia
3.
World Neurosurg ; 134: e808-e814, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715405

RESUMO

BACKGROUND: Vertebral osteomyelitis manifesting as a compression fracture misdiagnosed in the setting of steroid-induced or senile osteoporosis is very rare, although such patients are prone to infection or reactivation, as their immune system is exhausted. Spondylodiscitis occurring at adjacent levels following instrumented spinal fusion leading to pathologic fracture and proximal junctional failure, especially caused by tuberculosis, to our knowledge, has not been discussed in the literature. METHODS: In case 1, a 61-year-old woman with osteoporotic T12 collapse was treated with corpectomy, anterior reconstruction, and posterior fixation from T9-L2. Initial biopsy and culture were normal. She presented 4 months later with compression fracture of T8; T8 corpectomy with anterior reconstruction and proximal extension of the construct was performed. In case 2, a 65-year-old woman with multiple comorbidities and osteoporotic L1 compression fracture was treated with L1 corpectomy, anterior reconstruction, and posterior instrumentation from T11-L3. She presented 4 months later with T10 vertebral body acute collapse; 2-stage anterior corpectomy and reconstruction was performed. In both cases, probing the affected vertebral body yielded pus. Pus and bone tissue samples sent for culture and histopathologic examination were positive for tuberculosis suggesting tuberculous spondylitis in both cases. RESULTS: In both patients, tuberculous spondylodiscitis at the proximal adjacent level was diagnosed <1 year after the initial spinal surgery. Neither patient had a previous history of pulmonary or extrapulmonary tuberculosis. They were successfully treated with antituberculous therapy and proximal extension of the construct with anterior reconstruction. CONCLUSIONS: Adjacent segment spondylodiscitis should be suspected and intraoperative biopsy must be considered for histopathologic and microbiologic examination to rule out subclinical infection in immunosuppressed patients with multiple comorbidities. Management should be individualized, considering the context of infection, causative organism, extent of bone destruction, and neurologic involvement.


Assuntos
Discite/diagnóstico , Fraturas Espontâneas/diagnóstico , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Espondilite/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Tuberculose da Coluna Vertebral/diagnóstico , Idoso , Antituberculosos/uso terapêutico , Discite/complicações , Discite/terapia , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Espondilite/complicações , Espondilite/cirurgia , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/terapia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/terapia , Vertebroplastia
5.
BMC Musculoskelet Disord ; 20(1): 449, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615567

RESUMO

BACKGROUND: Simultaneous bilateral femoral neck fracture is a very rare condition, even in osteoporotic elderly individuals. We report an atypical case of a young male adult who developed simultaneous bilateral femoral neck fractures without previous trauma or overuse. CASE PRESENTATION: A 33-year-old man presented with discomfort in the bilateral groin, which had started 2 weeks previously. Bilateral femoral neck fractures were observed on a radiograph, and in addition, a fracture line was seen at the right subchondral region of the acetabulum using magnetic resonance imaging (MRI). Although the patient had no obvious risk factors associated with bone fragility, his bone mineral density measured using dual X-ray absorptiometry indicated severe osteoporosis (lumber spine: T score - 3.4 standard deviation [SD]; femoral neck: T score - 2.8 SD). Serum 25-hydroxyvitamin D level was deficient (19 ng/mL), which was considered to be partly due to non-sunlight exposure for 3 years owing to social withdrawal. Bilateral osteosynthesis was performed, considering his young age, although more than 2 weeks had passed since the onset of the fracture. Bone union and non-occurrence of osteonecrosis of the femoral head were confirmed via radiography and MRI 8 months after the surgery. CONCLUSIONS: Our case suggests that simultaneous non-traumatic bilateral femoral neck fractures can occur in healthy young men.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/cirurgia , Osteoporose/diagnóstico , Absorciometria de Fóton , Adulto , Densidade Óssea , Fraturas do Colo Femoral/diagnóstico , Fraturas do Colo Femoral/etiologia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/lesões , Colo do Fêmur/cirurgia , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoporose/sangue , Osteoporose/complicações , Tempo para o Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue
6.
Osteoporos Int ; 30(9): 1893-1896, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147735

RESUMO

We describe a novel disease of diffuse skeletal histiocytosis associated with multiple fragility fractures and high osteoclast activity. Clinical, radiographic, biochemical, genetic, and histopathological investigations were performed to characterize the diagnosis of an Asian man who presented with hip fracture and diffuse skeletal lytic lesions. After excluding malignancy and other common metabolic bone diseases, open bone biopsy yielded several pathological samples all showing extensive skeletal histiocytosis likely to explain the diffuse axial and appendicular lytic lesions. Rare disorders such as Langerhans histiocytosis, Erdheim-Chester disease, and diffuse cystic skeletal angiomatosis were excluded through careful pathological examination and lack of CD1a and S-100 staining. Whole exome sequencing did not yield diagnostic findings to explain this likely acquired disease. High markers of osteoclast activity suggested excessive focal bone resorption but normalized after zoledronic acid treatment. A novel disease of skeletal histiocytosis with high bone turnover is differentiated from other histiocytic and lytic skeletal diseases.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Fraturas Espontâneas/diagnóstico , Histiocitose/diagnóstico , Doenças Ósseas Metabólicas/patologia , Diagnóstico Diferencial , Fraturas Espontâneas/patologia , Histiocitose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva
8.
Korean J Radiol ; 20(5): 812-822, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30993932

RESUMO

OBJECTIVE: To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. MATERIALS AND METHODS: Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). RESULTS: Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p < 0.05) and specificity (R1, 71.4% vs. 93.9%, p < 0.005; R2, 85.7% vs. 98%, p = 0.07), with no difference in sensitivities (p > 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9-84.4% vs. 95.6-96.3%, p < 0.05; R2, 90.2-91.1% vs. 95.1-95.6%, p < 0.05) and specificity (R1, 68.3-72.9% vs. 92.7-95.8%, p < 0.005; R2, 83.0-85.4% vs. 97.6-98.0%, p = 0.07). CONCLUSION: Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities.


Assuntos
Imagem de Difusão por Ressonância Magnética , Fraturas Espontâneas/diagnóstico , Idoso , Feminino , Fêmur/lesões , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/patologia , Humanos , Úmero/lesões , Processamento de Imagem Assistida por Computador , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos
9.
J Pediatr Orthop ; 39(4): e308-e311, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30839484

RESUMO

BACKGROUND: Pediatric Langerhans cell histiocytosis (LCH) often results in vertebral compression fracture. However, few reports have reported vertebral remodeling during the course of LCH. We aimed to investigate the longitudinal reconstitution and transformation of the affected vertebrae and the adjacent structures in young children with spinal LCH. METHODS: We recruited 13 patients, including 16 affected vertebrae, diagnosed with LCH via biopsy. The average age at first visit was 3.6 years. The average follow-up period was 10.2 years. Vertebral lesions involved L2 in 3 cases; T12, L1, or L5 in 2 cases; and C4, C5, C7, T5, T8, T9, or L3 in 1 case. We measured the ratios of the height of the affected vertebra and 1 vertebra above the affected one to that of the second vertebra above the affected one, local kyphotic angles, and the ratio of the height of the center of the adjacent disk to that of one disk above it. RESULTS: The collapse of the affected vertebra was most severe after 1 year of disease onset. The rate of reconstitution accelerated at 2 years or later of disease onset. The recovery speed of the anterior wall was faster than that of the center height. While the height of the affected vertebrae was restored, the thickness of the adjacent disk also increased. Further, the height of the adjacent vertebrae increased in a similar manner. The average local kyphosis angle shifted to lordosis within the first 3 years. CONCLUSIONS: The heights of not only the disk but also the adjacent vertebra increased during the vertebral collapse phase in pediatric spinal LCH patients. These transformations may affect the realignment of the sagittal spinal balance at the earlier stage of the disease. During the collapse phase, the heights of the adjacent vertebrae and disks increase but after the affected vertebrae reconstituted, the augmentation of adjacent vertebrae and disks diminished. LEVEL OF EVIDENCE: Level IV.


Assuntos
Previsões , Fraturas por Compressão/cirurgia , Fraturas Espontâneas/cirurgia , Histiocitose de Células de Langerhans/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fraturas da Coluna Vertebral/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/etiologia , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Humanos , Lactente , Vértebras Lombares , Masculino , Radiografia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas
10.
Acta Clin Croat ; 58(3): 403-409, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31969750

RESUMO

Unicameral bone cysts (UBC) are benign bone tumor-like lesions. Mostly they are located in the metaphyseal-diaphyseal region of long bones in children and adolescents. The etiology of UBC is still unclear. There is no consensus about the protocol of UBC treatment. The aim of this study was to evaluate the effectiveness of three different techniques for the treatment of UBC. This study included 129 pediatric patients with UBC treated at University Children's Hospital in Belgrade during the 8-year period. The mean follow up was 7.14 years. The following parameters were observed: gender, age, site, length of cyst, cyst index, cortical thickness, presentation of pathologic fracture, healing of cyst, treatment complications and length of hospitalization. These parameters were correlated to three treatment modalities, i.e. intracystic methylprednisolone acetate injection (group 1), curettage with bone grafting (group 2) and osteoinductive procedure using demineralized bone matrix (group 3). We found statistically significant differences in healing of the cysts and length of hospital treatment between groups 1 and 2, and between groups 2 and 3. In conclusion, complete healing of UBC can be achieved only using open surgery procedure. Intracystic methylprednisolone acetate instillation can be considered a good option for initial treatment of UBC.


Assuntos
Cistos Ósseos , Transplante Ósseo/métodos , Dentina/transplante , Fraturas Espontâneas , Acetato de Metilprednilosona/administração & dosagem , Adolescente , Cistos Ósseos/complicações , Cistos Ósseos/diagnóstico , Cistos Ósseos/epidemiologia , Cistos Ósseos/terapia , Regeneração Óssea , Criança , Croácia/epidemiologia , Feminino , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde
11.
Acta Orthop Traumatol Turc ; 53(1): 68-73, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30522929

RESUMO

Tumor-to-tumor metastasis in the same bone is an extremely rare condition. Limited number of case reports exists for coincidence of benign and malign neoplasms but none for malignant to malignant metastasis. Occurrence of several individual malignancies in the same patient may eventually cause such coexistences. We report an Ollier's disease patient with malignant transformation to chondrosarcoma complicated by a pathologic fracture and eventually whose pathological examination revealed that the lesion was not only the chondrosarcoma but an accompanying metastasis from existing lung adenocarcinoma. This report includes clinical, radiological, histological diagnostic challenges in an unexpected lesion and a review of literature.


Assuntos
Adenocarcinoma de Pulmão/patologia , Neoplasias Ósseas , Condrossarcoma , Encondromatose , Fraturas Espontâneas , Úmero , Neoplasias Pulmonares/patologia , Procedimentos Ortopédicos/métodos , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Transformação Celular Neoplásica/patologia , Condrossarcoma/patologia , Condrossarcoma/secundário , Encondromatose/complicações , Encondromatose/diagnóstico , Encondromatose/patologia , Feminino , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radiografia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Endocrine ; 63(2): 376-384, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30244350

RESUMO

PURPOSE: The aim of this study was to evaluate the effect of combining human parathyroid hormone (1-34) (PTH1-34; PTH) and menaquinone-4 (MK-4) on calvarial bone defect repair in osteopenic rats. METHODS: Fourteen week olds were subject to craniotomy for the establishment of osteopenic animal models fed through a chronically low-protein diet. After that, critical calvarial defect model was established and all rats were randomly divided into four groups: sham, MK-4, PTH, and PTH + MK-4. The animals received MK-4 (30 mg/kg/day), PTH1-34 (60 µg/kg, three times a week), or PTH1-34 (60 µg/kg, three times a week) plus MK-4 (30 mg/kg/day) for 8 weeks, respectively. Serum γ-carboxylated osteocalcin (Gla-OC) levels, histological and immunofluorescent labeling were employed to evaluate the bone formation and mineralization in calvarial bone defect. In addition, Microfil perfusion, immunohistochemical, and micro-CT suggested enhanced angiogenesis and bone formation in calvarial bone healing. RESULTS: In this study, treatment with either PTH1-34 or MK-4 promoted bone formation and vascular formation in calvarial bone defects compared with the sham group. In addition, combined treatment of PTH1-34 plus MK-4 increased serum level of Gla-OC, improved vascular number and vascular density, and enhanced bone formation in calvarial bone defect in osteopenic conditions as compared with monotherapy. CONCLUSIONS: In summary, this study indicated that PTH1-34 plus MK-4 combination therapy accelerated bone formation and angiogenesis in calvarial bone defects in presence of osteopenia.


Assuntos
Doenças Ósseas Metabólicas/tratamento farmacológico , Neovascularização Fisiológica/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Hormônio Paratireóideo/administração & dosagem , Crânio/efeitos dos fármacos , Vitamina K 2/análogos & derivados , Animais , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/patologia , Quimioterapia Combinada , Feminino , Consolidação da Fratura/efeitos dos fármacos , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/tratamento farmacológico , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/patologia , Ratos , Ratos Sprague-Dawley , Crânio/diagnóstico por imagem , Crânio/lesões , Crânio/patologia , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/tratamento farmacológico , Fraturas Cranianas/etiologia , Fraturas Cranianas/patologia , Vitamina K 2/administração & dosagem , Microtomografia por Raio-X
14.
Bone Joint J ; 100-B(12): 1626-1632, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30499317

RESUMO

AIMS: The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB). PATIENTS AND METHODS: A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics. RESULTS: The initial surgical treatment was curettage with or without adjuvants in 55 patients (51%), en bloc resection with or without reconstruction in 45 patients (42%), and neoadjuvant denosumab, followed by resection (n = 3, 3%) or curettage (n = 4, 4%). The choice of treatment depended on tumour location, Campanacci tumour staging, intra-articular involvement, and fracture displacement. Neoadjuvant denosumab was used only in fractures through Campanacci stage 3 tumours. Local recurrence occurred in 28 patients (25%). Surgery more than six weeks after the fracture did not affect the risk of recurrence in any of the groups. In Campanacci stage 3 tumours not treated with denosumab, en bloc resection had lower local recurrences (13%), compared with curettage (39%). In tumours classified as Campanacci 2, intralesional curettage and en bloc resections had similar recurrence rates (21% and 24%, respectively). After univariate analysis, the type of surgical intervention, location, and the use of denosumab were independent factors predicting local recurrence. Further surgery was required 33% more often after intralesional curettage in comparison with resections (mean 1.59, 0 to 5 vs 1.06, 0 to 3 operations). All patients treated with denosumab followed by intralesional curettage developed local recurrence. CONCLUSION: In patients with pathological fractures through GCTB not treated with denosumab, en bloc resection offers lower risks of local recurrence in tumours classified as Campanacci stage 3. Curettage or resections are both similar options in terms of the risk of local recurrence for tumours classified as Campanacci stage 2. The benefits of denosumab followed by intralesional curettage in these patients still remains unclear.


Assuntos
Neoplasias Ósseas/complicações , Fraturas Espontâneas/etiologia , Tumor de Células Gigantes do Osso/complicações , Recidiva Local de Neoplasia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/epidemiologia , Feminino , Fluoroscopia , Seguimentos , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/epidemiologia , Tumor de Células Gigantes do Osso/diagnóstico , Tumor de Células Gigantes do Osso/epidemiologia , Humanos , Biópsia Guiada por Imagem , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Reino Unido/epidemiologia , Adulto Jovem
15.
J Fam Pract ; 67(11): E8-E15, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30481254

RESUMO

This review can help you refine your approach to the diagnosis and management of adult foot fractures, while offering guidance on when to pursue advanced imaging.


Assuntos
Medicina de Família e Comunidade/métodos , Ossos do Pé/lesões , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/terapia , Atenção Primária à Saúde/métodos , Adulto , Atitude do Pessoal de Saúde , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/terapia , Humanos , Exame Físico/métodos
16.
BMC Cancer ; 18(1): 859, 2018 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-30170568

RESUMO

BACKGROUND: This was a prespecified secondary analysis of a randomized trial, which analyzed bone density following stereotactic body radiotherapy (SBRT) versus conventional three-dimensional conformal radiotherapy (3DCRT) as part of palliative management of painful spinal metastases. METHODS: Fifty-five patients were enrolled in this single-institutional randomized exploratory trial (NCT02358720). Participants were randomly assigned to receive SBRT (single-fraction 24 Gy) or 3DCRT (30 Gy/10 fractions). Quantitative bone density was evaluated at baseline, 3 and 6 months in both irradiated and unirradiated spinal bodies, along with rates of pathologic fractures and vertebral compression fractures. RESULTS: As compared to baseline, bone density became significantly higher at 3 and 6 months following SBRT by a median of 33.8% and 72.1%, respectively (p < 0.01 for both). These figures in the 3DCRT cohort were 32.9% and 41.2%, respectively (p < 0.01 for both). There were no statistical differences in bone density between SBRT and 3DCRT at 3 (p = 0.629) or 6 months (p = 0.327). Subgroup analysis of osteolytic metastases showed an increase in bone density relative to baseline in the SBRT (but not 3DCRT) arm. Bone density in unaffected vertebrae did not show substantial changes in either group. The 3-month incidence of new pathological fractures was 8.7% in the SBRT arm vs. 4.3% in the 3DCRT arm. CONCLUSIONS: Despite high ablative doses in the SBRT arm, the significant increase in bone density after 3 and 6 months was similar to that of 3DCRT. Our trial demonstrated a moderate rate of subsequent pathological fracture after SBRT. Future randomized investigations with larger sample sizes are recommended. TRIAL REGISTRATION: www.clinicaltrials.gov : NCT02358720 on 9nd of February 2015.


Assuntos
Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Idoso , Densidade Óssea , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Radiocirurgia , Radioterapia Conformacional , Neoplasias da Coluna Vertebral/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Clin Orthop Relat Res ; 476(10): 2052-2061, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30179923

RESUMO

BACKGROUND: Previous studies have shown that venous thromboembolism (VTE) is a complication associated with neoplastic disease and major orthopaedic surgery. However, many potential risk factors remain undefined. QUESTIONS/PURPOSES: (1) What proportion of patients develop symptomatic VTE after surgery for long bone metastases? (2) What factors are associated with the development of symptomatic VTE among patients receiving surgery for long bone metastases? (3) Is there an association between the development of symptomatic VTE and 1-year survival among patients undergoing surgery for long bone metastases? (4) Does chemoprophylaxis increase the risk of wound complications among patients undergoing surgery for long bone metastases? METHODS: A retrospective study identified 682 patients undergoing surgical treatment of long bone metastases between 2002 and 2013 at the Massachusetts General Hospital and Brigham and Women's Hospital. We included patients 18 years of age or older who had a surgical procedure for impending or pathologic metastatic long bone fracture. We considered the humerus, radius, ulna, femur, tibia, and fibula as long bones; metastatic disease was defined as metastases from solid organs, multiple myeloma, or lymphoma. In general, we used 40 mg enoxaparin daily for lower extremity surgery and 325 mg aspirin daily for lower or upper extremity surgery. The primary outcome was a VTE defined as any symptomatic pulmonary embolism (PE) or symptomatic deep vein thrombosis (DVT; proximal and distal) within 90 days of surgery as determined by chart review. The tertiary outcome was defined as any documented wound complication that might be attributable to chemoprophylaxis within 90 days of surgery. At followup after 90 days and 1 year, respectively, 4% (25 of 682) and 8% (53 of 682) were lost to followup. Statistical analysis was performed using multivariable logistic and Cox regression and Kaplan-Meier. RESULTS: Overall, 6% (44 of 682) of patients had symptomatic VTE; 22 patients sustained a DVT, and 22 developed a PE. After controlling for relevant confounding variables, higher preoperative hemoglobin level was independently associated (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.60-0.93; p = 0.011) with decreased symptomatic VTE risk, the presence of symptomatic VTE was associated with a worse 1-year survival rate (VTE: 27% [95% CI, 14%-40%] and non-VTE: 39% [95% CI, 35%-43%]; p = 0.041), and no association was found between wound complications and the use of chemoprophylaxis (OR, 3.29; 95% CI, 0.43-25.17; p = 0.252). CONCLUSIONS: The risk of symptomatic 90-day VTE is high in patients undergoing surgery for long bone metastases. Further study would be needed to determine the VTE prevention strategy that best balances risks and benefits to address this complication. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Neoplasias Ósseas/cirurgia , Fraturas Espontâneas/cirurgia , Osteotomia/efeitos adversos , Embolia Pulmonar/etiologia , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Boston , Feminino , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/mortalidade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/diagnóstico , Trombose Venosa/mortalidade , Trombose Venosa/prevenção & controle
18.
BMJ Case Rep ; 20182018 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-30249736

RESUMO

'Ping-pong' fractures are depressed skull fractures in newborn infants that occur as inward buckling of the calvarial bones, forming a cup shape. These fractures are often associated with maintenance of bone continuity. These fractures may occur spontaneously during the intrauterine period or secondary to birth trauma. Currently, there is no standard protocol for the management of depressed skull fractures. Neurosurgical or non-surgical approaches may be administered depends on the severity of the fracture. Most untreated ping-pong fractures resolve spontaneously within 6 months. Therefore, it is recommended to reserve surgical elevation or non-surgical techniques for infants not demonstrating spontaneous resolution during this period. In addition, neurosurgical interventions are usually considered for cases with intracranial pathology or neurological deficits or for infants who do not respond to conservative treatment. Herein, we report a case of a newborn infant with a spontaneous intrauterine ping-pong fracture, which spontaneously resolved, without surgical or non-surgical intervention.


Assuntos
Fraturas Espontâneas/congênito , Fraturas Espontâneas/diagnóstico , Osso Parietal/lesões , Fratura do Crânio com Afundamento/congênito , Fratura do Crânio com Afundamento/diagnóstico , Humanos , Recém-Nascido , Masculino
19.
J Orthop Surg (Hong Kong) ; 26(2): 2309499018783905, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29954245

RESUMO

BACKGROUND: Aneurysmal bone cyst (ABC) is an aggressive benign lesion that may sometimes be difficult to treat. Lesions that occur in the proximal femur require to be addressed aggressively because of the high rate of local recurrence and the risk of fracture. Few articles report the experience of management of ABC in the proximal femur. This location presents a surgical challenge due to its anatomical and biomechanical peculiarity. METHODS: We retrospectively reviewed 16 cases with ABC in the proximal femur that were treated in our institution between 2005 and 2014, utilizing extended curettage and liquid nitrogen as adjuvant therapy and reconstruction using nonvascularized autogenous fibular strut graft. The mean follow-up period was 50.5 months. Five cases presented as recurrent cases, while four cases presented with pathological fractures. RESULTS: The functional score ranged from 70 to 90 on modified Musculoskeletal Tumor Society score with a mean score of 81.25, which is considered to be excellent function. Time for graft incorporation ranged from 10 to 12 weeks. One case got local recurrence, and one case got early surgical site infection. CONCLUSIONS: Extended curettage and cryotherapy represent a recommended approach for management of ABC in the proximal femur with favorable results.


Assuntos
Cistos Ósseos Aneurismáticos/cirurgia , Criocirurgia/métodos , Curetagem/métodos , Fêmur/cirurgia , Fíbula/transplante , Fraturas Espontâneas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Autoenxertos , Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/diagnóstico , Criança , Feminino , Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Adulto Jovem
20.
J Orthop Surg (Hong Kong) ; 26(2): 2309499018778366, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29914289

RESUMO

PURPOSE: To evaluate the role of fractures on pathologic bone in healing of proximal humerus unicameral bone cysts (UBCs) and investigate the clinical factors that affect healing of UBCs after fractures on pathologic bone. METHODS: This prospective study was carried out between 2002 and 2014. We evaluated 56 patients with a UBC accompanying fractures on pathologic bone in the proximal humerus. Clinical data were collected from the patients' medical records. Age, gender, degree of fracture displacement, location of cyst, and cyst size were investigated, and we assessed how these factors affected cyst healing. RESULTS: The overall healing rate of UBCs 1 year after fracture was 66% (37 of 56 cases). The healing rate was significantly lower in pubescent patients (10-14 years old; 45%) than in those who were 9 years old (76%) or 15 years old (80%). The rate of healing of fractures in the metaphysis (53%) was lower than that of breaks in the diaphysis (85%). The mean cyst ratio was 1.31 in the 37 patients who experienced cyst healing within 1 year and 1.79 in the 19 patients who needed surgical treatment within 1 year. CONCLUSION: In latent lesions and in patients who are older (after puberty), UBCs of the humerus after fracture have better clinical results than do active lesions and those in younger patients (before puberty). Fractures on pathologic bone in proximal humerus UBCs often dramatically decrease cyst size, and patients with such fractures have excellent clinical results in terms of healing rate.


Assuntos
Cistos Ósseos/complicações , Consolidação da Fratura , Fraturas Espontâneas/etiologia , Úmero/diagnóstico por imagem , Adolescente , Cistos Ósseos/diagnóstico , Cistos Ósseos/cirurgia , Criança , Pré-Escolar , Feminino , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/cirurgia , Humanos , Úmero/cirurgia , Masculino , Estudos Prospectivos , Radiografia
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