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2.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472804

RESUMO

Six days after a normal delivery, a 24-year-old woman with atraumatic lumbosacral pain radiating to the left groin was referred to the orthopaedic surgeon due to worsening pain and impossible load bearing on the left lower limb. Standard pelvic radiographs revealed an unstable displaced left neck of femur (NOF) fracture. A CT scanner and MRI showed diffuse osteopaenia of the left proximal femur and the corresponding acetabulum. A diagnosis of transient osteoporosis of the hip (TOH) complicated by a pathological displaced subcapital NOF fracture was established. The patient underwent total hip arthroplasty without complication and recovered excellent function after rehabilitation. Awareness of the differential diagnosis of TOH in pregnancy, a high index of suspicion and early MRI to make an early diagnosis and to prevent devastating fracture complications are mandatory.


Assuntos
Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Dor Lombar/diagnóstico , Osteoporose/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Artroplastia de Quadril , Feminino , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/cirurgia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Osteoporose/complicações , Gravidez , Terceiro Trimestre da Gravidez , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Anticancer Res ; 41(2): 679-686, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517272

RESUMO

AIM: This study aimed to identify the risk of pathological fractures after bone tumour biopsy. MATERIALS AND METHODS: Fifty rabbit femurs were divided into groups according to defect size: Control (no defect), type 1 (10% width), type 2 (20% width), type 3 (30% width), and type 4 (40% width). Another 20 were also divided into control, type A (27% length), type B (40% length), and type C (53% length) groups. Performing femoral head compression testing allowed each parameter (maximum load, displacement, elastic modulus, and fracture energy) to be calculated individually. RESULTS: Compressive maximum load was significantly higher for type 1 than for the other types when testing rectangular defects of different widths, while there were no significant differences between the three types when testing by defect length. CONCLUSION: It may be useful for orthopaedic oncologists to make a rectangular biopsy hole with a width measuring less than 10% of the circumference and to enlarge the hole longitudinally to avoid pathological fracture.


Assuntos
Biópsia/efeitos adversos , Neoplasias Ósseas/patologia , Fêmur/lesões , Fraturas Espontâneas/etiologia , Animais , Feminino , Fêmur/patologia , Fraturas Espontâneas/patologia , Coelhos , Fatores de Risco
4.
Instr Course Lect ; 70: 453-464, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438927

RESUMO

Bone and soft-tissue tumors are common in the pediatric population. It is important to be familiar with the appropriate workup, principles of biopsy, differences between unicameral and aneurysmal bone cysts, and principles of managing pathologic fractures in children. The management approach to pediatric soft-tissue masses and some of the recent advances in the field warrant discussion.


Assuntos
Cistos Ósseos Aneurismáticos , Cistos Ósseos , Fraturas Espontâneas , Osso e Ossos , Criança , Fraturas Espontâneas/etiologia , Humanos
5.
Instr Course Lect ; 70: 465-474, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438928

RESUMO

This chapter is largely drawn from the recently published (2019) clinical practice guideline on the treatment of metastatic carcinoma and myeloma of the femur jointly produced by the Musculoskeletal Tumor Society, American Society for Radiation Oncology, and American Society of Clinical Oncology. Previous clinical practice guidelines on this topic broadly addressed the potential benefits of bone-targeted agents (eg, diphosphonates) on skeletal-related events, a broad term that encompasses pathologic fractures of any bone, need for surgery or radiation, and hypercalcemia. Guidelines on the use of palliative radiation therapy primarily focused on short-term pain control and long-term radiation-induced adverse effects. The starting goals of this guideline were twofold-focus on the femur, as fractures of the femur almost always require surgery and, when about the hip, dramatically alter patients' quality of life and, potentially, survival; and to address this topic in a multidisciplinary fashion that includes the insights of orthopaedic surgeons, along with radiation oncologists and medical oncologists. For many important clinical topics, there is a dearth of evidence, which will hopefully prompt researchers and funding agencies to help fill these evidentiary gaps.


Assuntos
Fraturas Ósseas , Fraturas Espontâneas , Difosfonatos/uso terapêutico , Fêmur , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Qualidade de Vida
7.
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
8.
Jt Dis Relat Surg ; 31(2): 184-192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584713

RESUMO

OBJECTIVES: This study aims to investigate the characterization, treatment approaches, and follow-up results of tumors and tumor-like lesions located in the pelvic ramus. PATIENTS AND METHODS: Thirty-one patients (9 males, 22 females; mean age 48.9 years; range, 7 to 79 years) with benign and malignant tumors or tumor-like lesions in the pelvic ramus region treated and followed-up in our clinic between January 2005 and January 2019 were evaluated retrospectively. Surgical procedures were performed with anterior approach or inner-thigh approach. Twelve patients were diagnosed with malignant tumors, 12 patients with benign tumors, and seven patients with tumor-like lesions. RESULTS: Seventeen patients who underwent surgical treatment were followed-up for a mean period of 61.7 months. The diameters of benign and malignant tumors were similar (p=0.425). Of all lesions, 64.5% were located in the pubis. Ischium location was significantly higher in patients with malignant lesions than tumor-like lesions. The most common complication was diffuse subcutaneous edema in the inguinal region and thigh (8.3%). CONCLUSION: There are many different tumoral lesions in the pelvic ramus. Pelvic ramus tumors tend to settle more frequently in pubic ramus, whereas ramus ischium tumors are more likely to be malignant. In addition, the diagnosis of insufficiency fracture should be considered primarily in pathologic fractures of pubic ramus in females over 50 years of age. In the postoperative follow-up of pelvic ramus tumors, diffuse edema may occur even if there is no intraoperative vascular damage.


Assuntos
Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Edema/etiologia , Fraturas Espontâneas/etiologia , Ísquio/lesões , Osso Púbico/lesões , Adolescente , Adulto , Idoso , Neoplasias Ósseas/complicações , Criança , Feminino , Fraturas de Estresse/etiologia , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto Jovem
9.
PLoS One ; 15(6): e0233501, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497105

RESUMO

INTRODUCTION: People living with HIV (PLWH) had a higher prevalence and incidence rate of bone fracture compared to general population. Although several studies have explored this phenomenon, the prevalence and incidence rate of fracture were varied. OBJECTIVE: The aim of the study is to determine and analyze the pooled prevalence, incidence rate of fracture and fracture risk factors among people living with HIV (PLWH). METHODS: PubMed, Cochrane Library, CINAHL with full Text, and Medline databases for studies published up to August 2019 were searched. Studies reporting the prevalence or incidence of fracture among PLWH were included. Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool. A meta-analysis with random-effects model was performed to determine pooled estimates of prevalence and incidence rates of fracture. A meta-regression was performed to determine the source of heterogeneity. RESULTS: The pooled estimated prevalence of fracture among PLWH was 6.6% (95% CI: 3.8-11.1) with pooled odds ratio of 1.9 (95%CI: 1.1-3.2) compared to the general population. The pooled estimates of fracture incidence were 11.3 per 1000 person-years (95% CI: 7.9-14.5) with incidence rate ratio (IRR) of 1.5 (95% CI: 1.3-1.8) compared to the general population. Risk factors for fracture incidence were older age (aHR 1.4, 95% CI: 1.3-1.6), smoking (aHR 1.3, 95% CI: 1.1-1.5), HIV/HCV co-infection (aHR 1.6, 95% CI: 1.3-1.9), and osteoporosis (aHR 3.3, 95% CI: 2.2-5.1). CONCLUSIONS: Our finding highlights a higher risk of fracture among PLWH compared to the general population. Osteoporosis, smoking and HIV/HCV coinfection as the significant modifiable risk factors should be prioritized by the HIV health providers when care for PLWH.


Assuntos
Fraturas Ósseas/epidemiologia , Infecções por HIV/epidemiologia , Adolescente , Adulto , Comorbidade , Feminino , Fraturas Espontâneas/epidemiologia , Fraturas Espontâneas/etiologia , Humanos , Incidência , Masculino , Osteoporose/complicações , Osteoporose/epidemiologia , Prevalência , Viés de Publicação , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Adulto Jovem
10.
Cancer Radiother ; 24(5): 374-378, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32527694

RESUMO

Therapeutic advances in oncology have led to longer survival in many forms of cancer, including those complicated by bone metastases. When a bone metastasis is painful or when there is a risk of fracture, interventional radiology procedures can be carried out for pain control and/or stabilisation. All of these techniques can be performed under local anaesthesia. Cementoplasty and vertebroplasty are stabilisation procedures consisting in the percutaneous injection of acrylic cement into a lytic bone lesion. The effect on pain can be explained by the consolidation of weakened, fractured or pre-fractured bone, but also to a lesser extent by the toxic, chemical and thermal effect of the cement. Tumour ablation techniques include alcoholisation or thermal ablation (by heat with radiofrequency and microwave or cold by cryoablation). Percutaneous thermal ablation of bone tumours is most often performed as a palliative measure resulting in a significant and lasting reduction in symptoms. Radiofrequency ablation consists in placing needles through which an electrical current passes. Microwave ablation acts by causing very high frequency vibrations of water molecules. Cryoablation releases argon gas at the tip of the needle, forming an "ice ball" effectively destroying tumour cells. Any of these techniques can be combined to radiation therapy, performed before or after radiation. Finally, tumour embolisation can have a goal of pain control, or preparation of surgery to reduce the risk of peroperative haemorrhage.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Dor do Câncer/terapia , Fraturas Espontâneas/terapia , Radiologia Intervencionista/métodos , Anestesia Local , Cimentos para Ossos/uso terapêutico , Ablação por Cateter/métodos , Cementoplastia/métodos , Criocirurgia/métodos , Embolização Terapêutica/métodos , Etanol/administração & dosagem , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Hemorragia/prevenção & controle , Humanos , Micro-Ondas/uso terapêutico , Bloqueio Nervoso/métodos , Cuidados Paliativos/métodos , Ablação por Radiofrequência/métodos , Solventes/administração & dosagem , Vertebroplastia/métodos
11.
Medicine (Baltimore) ; 99(23): e20563, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502025

RESUMO

Unicameral bone cyst (UBC) is a benign fluid-filled lesion, mainly located in the metaphyses of long bones in children and adolescents. Elastic stable intramedullary nail (ESIN) is adopted in our institute for UBCs since 2010, and bone grafting was performed simultaneously. This study aims to evaluate the efficacy of ESIN decompression combined with different bone graft materials.All patients with the diagnoses of UBCs of the humerus, treated with ESINs and bone grafting between January 2010 and June 2018, were analyzed retrospectively. The bone grafting included injectable calcium sulfate, a mixture of the autologous iliac bone and allogeneic bone. All patients were categorized into 2 groups: ICS (injectable calcium sulfate) group and MIX (a mixture of the autologous iliac bone and allogeneic bone, ratio: 1:3) group. All the information was collected from the Hospital Database.In all, 17 patients (8.8 ±â€Š2.3-year-old, male 8, female 9) in the ICS group and 19 patients (8.9 ±â€Š1.9-year-old, male 10, female 9) in the MIX group were included in this study. Patients in both groups were followed up for more than 2 years (average, 3.4 ±â€Š1.3 years). No recurrence was observed in either group. There was no significant difference between the two groups concerning the patient's demographic parameters, including sex, age, and affected side. All patients in both groups displayed excellent and good shoulder function, and there was no significant difference between the 2 groups (P = .29). As for the Capanna classification, there was no significant difference between these 2 groups (P = .78).Intramedullary nailing has the advantage of a minimally invasive procedure, immediate stability, and continuous decompression. ICS showed similar results as a mixture of the autologous iliac bone and allogeneic bone.


Assuntos
Cistos Ósseos/cirurgia , Transplante Ósseo/métodos , Fixação Intramedular de Fraturas/instrumentação , Transplante Homólogo/métodos , Cistos Ósseos/complicações , Pinos Ortopédicos , Sulfato de Cálcio/administração & dosagem , Criança , Descompressão Cirúrgica/métodos , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Úmero/lesões , Úmero/patologia , Úmero/cirurgia , Ílio/transplante , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(22): e20219, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481387

RESUMO

INTRODUCTION: Enchondromas arise from cartilaginous cells derived from the physis that persists throughout development. They are difficult to diagnose and are often discovered on radiographs after a trauma. PATIENT CONCERNS: We discuss the case of a 32-year-old woman with a pathologic mallet fracture of the distal phalanx that was initially misdiagnosed as common mallet fracture. DIAGNOSIS: Magnetic resonance imaging revealed an eccentrically located lesion expanding to the cortex, with a high signal intensity at T2 weighted image, suggesting pathologic fracture. INTERVENTIONS: We performed a operation, involving curettage and bone grafting. Complete removal of the lesion was confirmed intraoperatively with the image intensifier, and the cavity was irrigated and subsequently filled with allogenous bone and demineralized bone matrix. OUTCOMES: With an uneventful recovery, she gradually return to normal function within 3 months. Her symptoms improved and nearly full range of motion of the finger was seen at 1-year follow-up. CONCLUSION: Our case of pathologic mallet fracture was misdiagnosed as a simple fracture, suggesting that the mechanism of fracture and radiological diagnosis should be carefully considered.


Assuntos
Condroma/complicações , Condroma/diagnóstico por imagem , Erros de Diagnóstico , Falanges dos Dedos da Mão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Adulto , Feminino , Falanges dos Dedos da Mão/lesões , Humanos , Imagem por Ressonância Magnética
13.
Am J Med Sci ; 360(2): 206-207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32387118

Assuntos
Fraturas por Compressão/etiologia , Fraturas Espontâneas/etiologia , Plasmocitoma/complicações , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Descompressão Cirúrgica , Dexametasona/administração & dosagem , Progressão da Doença , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Laminectomia , Lenalidomida/administração & dosagem , Mieloma Múltiplo/sangue , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/tratamento farmacológico , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/patologia , Plasmocitoma/cirurgia , Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
14.
PLoS One ; 15(5): e0232842, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384131

RESUMO

OBJECTIVE: The risk of complications of nonsurgical hypoparathyroidism in Asia is unclear. We estimated the prevalence and risk of complications in patients with nonsurgical hypoparathyroidism. METHODS: We performed a retrospective cohort study using a nationwide claims database from 2005 to 2016. Among the entire Korean population, we identified 897 patients diagnosed with nonsurgical hypoparathyroidism during 2005-2015. We selected 210 patients with nonsurgical hypoparathyroidism during 2005-2008 who had no complications at baseline and followed them to 2016. Control subjects (n = 2075) were matched using propensity scores based on age, sex, and comorbid disease with a 1:10 ratio and monitored until 2016. RESULTS: The age-standardized prevalence of nonsurgical hypoparathyroidism was 0.2 cases per 100,000 persons in 2005. During a mean follow-up period of 9.5 years, patients with nonsurgical hypoparathyroidism had a higher risk of cardiovascular disease, especially arrhythmia (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.11-3.70) and heart failure (HR, 2.43; 95% CI, 1.22-4.83). The risk of vertebral fracture was higher in patients than in controls (HR, 2.27; 95% CI, 1.09-4.72). Patients had a significantly increased risk of renal disease (HR, 2.57; 95% CI, 1.56-4.21), seizure (HR, 5.74; 95% CI, 3.34-9.86), depression and bipolar disease (HR, 1.82; 95% CI, 1.30-2.56), and cataract (HR, 1.90; 95% CI, 1.30-2.79) compared with controls. CONCLUSIONS: The prevalence of nonsurgical hypoparathyroidism was very low in Korea but was associated with a higher risk of incident cardiovascular disease and vertebral fracture as well as known complications including renal disease, seizure, and cataract.


Assuntos
Hipoparatireoidismo/epidemiologia , Adulto , Doenças Autoimunes/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Catarata/epidemiologia , Catarata/etiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Feminino , Fraturas Espontâneas/epidemiologia , Fraturas Espontâneas/etiologia , Humanos , Hipoparatireoidismo/complicações , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Prevalência , Pontuação de Propensão , República da Coreia/epidemiologia , Convulsões/epidemiologia , Convulsões/etiologia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Cálculos Urinários/epidemiologia , Cálculos Urinários/etiologia , Adulto Jovem
15.
Radiologe ; 60(6): 498-505, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32410104

RESUMO

BACKGROUND: Pathologic fractures are fractures that occur without an adequate traumatic event due to focal benign or malignant skeletal lesions. The most common causes of pathologic fractures are cystic bone lesions, plasmocytoma or multiple myeloma, and the development of osseous metastases, which is increasing due to an aging general population and advances in cancer treatment. The differentiation of pathologic fractures from stress fractures, especially osteoporotic insufficiency fractures is crucial for correct treatment planning. OBJECTIVES: This review intends to explain the imaging characteristics of pathologic fractures. Moreover, it explains the role of imaging when pathologic fractures are suspected. In addition, the Mirels' score and the SINS (Spinal Instability Neoplastic Score), which are powerful yet easy-to-use tools for the assessment of the fracture risk of benign or malignant bony lesions of the extremities and the vertebral column, shall be introduced. MATERIALS AND METHODS: A PubMed literature search with the following terms was conducted: "pathologic fracture", "fatigue fracture", "insufficiency fracture", "treatment of pathologic fractures", "imaging of pathologic fractures", "fracture risk", "bone metastases", "MRI of pathologic fractures", "CT of pathologic fractures", "differentiation of pathologic and insufficiency fractures", "Mirels' score", "SINS" and "spinal instability neoplastic score". RESULTS: The definitions of pathologic, fatigue, and insufficiency fractures are explained. Moreover, the role of imaging in the clinical workup of suspected pathologic fractures and the differentiation of pathologic fractures from fatigue or insufficiency fractures as well as common scoring systems to assess the fracture risk of pathologic fractures are described.


Assuntos
Neoplasias Ósseas , Fraturas Espontâneas , Plasmocitoma , Fraturas da Coluna Vertebral , Neoplasias Ósseas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Humanos , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral
16.
J Orthop Res ; 38(6): 1175-1190, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32162711

RESUMO

Metastatic breast, prostate, lung, and other cancers often affect bone, causing pain, increasing fracture risk, and decreasing function. Management of metastatic bone disease (MBD) is clinically challenging when there is potential but uncertain risk of pathological fracture. Management of MBD has become a major focus within orthopedic oncology with respect to fracture and impending fracture care. If impending skeletal-related events (SREs), particularly pathologic fracture, could be predicted, increasing evidence suggests that prophylactic surgical treatment improves patient outcomes. However, current fracture risk assessment and radiographic metrics do not have high accuracy and have not been combined with relevant patient survival tools. This review first explores the prevalence, incidence, and morbidity of MBD and associated SREs for different cancer types. Strengths and limitations of current fracture risk scoring systems for spinal stability and long bone fracture are highlighted. More recent computed tomography (CT)-based structural rigidity analysis (CTRA) and finite element (FE) analysis methods offer advantages of increased specificity (true negative rate), but are limited in availability. Other fracture prediction approaches including parametric response mapping and positron emission tomography/computed tomography measures show early promise. Substantial new information to inform clinical decision-making includes measures of survival, clinical benefits, and economic analysis of prophylactic treatment compared to after-fracture stabilization. Areas of future research include use of big data and machine learning to predict SREs, greater access and refinement of CTRA/FE approaches, combination of clinical survival prediction tools with radiographically based fracture risk assessment, and net benefit analysis for fracture risk assessment and prophylactic treatment.


Assuntos
Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Tomada de Decisão Clínica , Fraturas Espontâneas/etiologia , Medição de Risco , Neoplasias Ósseas/epidemiologia , Análise de Elementos Finitos , Humanos , Morbidade , Tomografia Computadorizada por Raios X
17.
Phys Ther ; 100(3): 554-563, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32043130

RESUMO

Bones are the third most common site for cancer metastases, and the axial skeleton is the most frequent skeletal location. In a postmortem study, bone metastases were reported in 70% of breast and prostate cancer patients. Bone metastases from breast, lung, prostate, thyroid, and kidney cancers account for 80% of all bone metastases. Bone lesions exist in 60% of newly diagnosed multiple myeloma patients. With increasing numbers of people who have survived cancer, many patients with cancer and axial skeletal bony metastases will be seen by physical and occupational therapists. Guidelines are lacking on how to perform physical examinations and provide exercise programs for these patients without compromising the diseased spine. In this article, we discuss the available evidence for similar spinal conditions, the biomechanics of spinal load, and changes associated with posture and weight load. We provide recommendations on how to assess a patient's strength, how to strengthen without compromising the diseased spine, and how to teach patients to use correct body mechanics during mobility and activities of daily living.


Assuntos
Sobreviventes de Câncer , Compressão da Medula Espinal/terapia , Neoplasias da Coluna Vertebral/secundário , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Instabilidade Articular/diagnóstico , Movimento/fisiologia , Postura/fisiologia , Fatores de Risco , Sensibilidade e Especificidade , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico , Fraturas da Coluna Vertebral/prevenção & controle , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Suporte de Carga
18.
Phys Ther ; 100(4): 662-676, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-31899499

RESUMO

BACKGROUND: Regular exercise is advocated in osteoporosis guidelines to prevent fractures. Few studies have evaluated the effect of exercise on functional performance, posture, and other outcomes that are important to patients after vertebral fractures. OBJECTIVE: This pilot study will explore the effect of home exercise versus control on functional performance, posture, and patient-reported outcome measures. DESIGN: This study was a parallel 2-arm pilot feasibility trial with 1:1 randomization to exercise or attentional control groups. SETTING: This study took place in 5 Canadian and 2 Australian academic or community hospitals/centers. PARTICIPANTS: This study included 141 women ≥65 years of age with radiographically confirmed vertebral fractures. INTERVENTION: A physical therapist delivered exercise and behavioral counseling in 6 home visits over 8 months and monthly calls. Participants were to exercise ≥3 times weekly. Controls received equal attention. MEASUREMENTS: Functional performance, posture, quality of life, pain, and behavior-change outcomes were assessed at baseline and after 6 (questionnaires only) and 12 months. Adherence to exercise was assessed by calendar diary. All t tests examined between-group mean differences (MD) in change from baseline in intention-to-treat and per-protocol analyses. RESULTS: There was a small effect of exercise on 5 times sit-to-stand test versus control (MD = -1.58 [95% CI = -3.09 to -0.07], intention-to-treat; MD = -1.49 [95% CI = -3.12 to 0.16], per-protocol). There were no other major or statistically significant MDs for any other measured outcomes after follow-up. Adherence declined over time. LIMITATIONS: Treatment effects on variables may have been underestimated due to multiple comparisons and underpowered analyses. CONCLUSIONS: Our exploratory estimate of the effect of exercise on functional leg muscle strength was consistent in direction and magnitude with other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long-term adherence might be important in future confirmatory trials.


Assuntos
Terapia por Exercício/métodos , Fraturas Espontâneas/reabilitação , Medidas de Resultados Relatados pelo Paciente , Desempenho Físico Funcional , Postura , Fraturas da Coluna Vertebral/reabilitação , Idoso , Estudos de Viabilidade , Feminino , Fraturas Espontâneas/etiologia , Humanos , Análise de Intenção de Tratamento , Perna (Membro) , Força Muscular , Osteoporose/complicações , Medição da Dor , Cooperação do Paciente/estatística & dados numéricos , Seleção de Pacientes , Projetos Piloto , Qualidade de Vida , Método Simples-Cego , Fraturas da Coluna Vertebral/etiologia
19.
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
20.
Int J Radiat Oncol Biol Phys ; 106(3): 475-484, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31580930

RESUMO

PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Espontâneas/epidemiologia , Neoplasias dos Genitais Femininos/radioterapia , Ossos Pélvicos/lesões , Intervalos de Confiança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Humanos , Ossos Pélvicos/efeitos da radiação , Radioterapia de Intensidade Modulada , Análise de Regressão
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