Deep vein thrombosis following the treatment of lower limb pathologic bone fractures - a comparative study.

BACKGROUND: Deep vein thrombosis is a well-known complication of fracture occurrence, lower limb surgery and periods of prolonged immobilisation. Its incidence can be increased even more in specific cases with metastatic bone disease and adjuvant treatment. There is a small amount of literature that addresses the incidence of DVT by comparing osteosynthesis and arthroplasty as surgical treatments. Current recommended anticoagulation protocols might be inadequate for specific groups of cancer patients undergoing osteosynthesis or arthroplasty. METHODS: The study was designed and performed in a retrospective manner and carried out on patients that presented at our Emergency Clinical County Hospital between 01.01.2008-31.12.2016. The patients' evolution was followed for a standard of 2 months. All our deep vein thrombosis events were diagnosed via venous duplex imaging. The studied lot (n = 85) was paired with a control group (n = 170) with similar baseline characteristics. RESULTS: Our lot was comprised of 85 patients that underwent 85 surgeries, on both of our hospital's Orthopaedic and Traumatology wards. When performing the student t-test and calculating OR (odds ratio) and RR (risk ratio) we encountered 11 cases of DVT in our studied group and 12 cases of DVT in our control group (p < 0.04). We found statistical significance when correlating DVT with type of implant (prosthesis), the presence of metastases over primary tumour and the choice of implant (prosthesis over intramedullary nail). There was no statistical significance found when correlating DVT events with the type of anticoagulation and the amount of blood transfusion units required. CONCLUSION: Patients who undergo surgical treatment for lower limb pathological fracture due to malignancy are at increased risk of DVT or death due to PE under current general thromboprophylaxis regimens. The risk is higher for the immediate postoperative period (10 days). The risk is increased by metastasis, arthroplasty and adjuvant therapy (radiotherapy, chemotherapy), and we think that a more aggressive prophylactic protocol should be used.

Long term results after arthroscopic resection of medial plicae of the knee-a prospective study.

PURPOSE: The medial plica (MP) is a normal anatomic structure consisting of a fold in the synovial layer of the joint. Arthroscopic resection is currently used as a gold standard procedure in patients with medial plica syndrome (MPS), but there are few prospective studies that analyze the long-term functional outcomes of plica resection. METHODS: The purpose of this prospective study was to evaluate the long-term results of arthroscopic resection of the medial plicae of the knee. Between 1999 and 2014 we included 267 patients that showed MRI evidence of MP out of the 5682 knee arthroscopies that we performed. We recorded pre and post-operative Tegner Lysholm knee scale scores (TLKSS) for up to 36 (3, 6, 12, 24, 36) months. The EQ-5D questionnaire was used to measure the patients' generic health status. RESULTS: The mean values of the TLKSS were 68 (61-82) pre-operative, 87 (81-94) at the 3-month follow-up and 94 (92-97) at the 6-month follow-up. The long term results (TLKSS at 12, 24, and 36 months post-operatively) were 94.8 (91-98), 94.8 (90-97), and 94.5 (92-97) respectively. The EQ-5D and EQ-VAS showed significant improvement between each of the first three data registering moments (pre-operative, 3 and 6 month follow-up). CONCLUSION: The quality of the treatment and the final functional result is directly influenced by the type of plica that creates the symptomatology. We have achieved good overall results for our patients, the ones with less cartilage damage having the fastest recovery time. The arthroscopic resection is a very good option for medial plicae that do not respond to conservative treatment, and it must be initiated as a first option when cartilage damage is suspected.

The utility of bone remodeling markers in the diagnosis, evolution and treatment response evaluation in bone metastases.

After the lungs and liver, the bone is the third most common site for metastatic disease, appearing frequently in breast and prostate malignancies. These pathological bone events that occur during the evolution of the metastatic disease are usually the onset of osteolysis and they lower the patient's life quality, and are sometimes the cause of death due to the required treatments (surgery, radiotherapy). Due to the nature of the bone remodeling process, the markers that control bone resorption are the main early indicators of bone malignancy. These markers can be found in excess quantities of 50-150% in patients with bone metastases. Analyzing these indicators in conjunction with traditional tumoral markers such as the prostate specific antigen (PSA) and the type I collagen cross-linked telopeptide (ICTP) can often increase the sensibility of the investigation and the chances of diagnosing bone metastases. The studies that were carried out in order to research this area of knowledge have had good and expected results. Most of the efforts are now channeled into developing a better therapeutic strategy that would allow for the early diagnosis and treatment of the pathological bone events. Until these markers can be used as standard investigation methods in all of our patients, some controlled studies must be carried out in order to statistically prove these results, which are purely observational.