Compound Osteosynthesis for Osteolyses and Pathological Fractures of the Proximal Femur

Kinkel, Stefan; Stecher, Jens; Gotterbarm, Tobias; Brückner, Thomas; Holz, U.

doi:10.3928/01477447-20090511-14

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…In other words, osteosynthesis alone is not regarded as sufficient in proximal femoral fractures. This was confirmed by a recently published retrospective study [18]. In our study, seven major complications occurred in the resection group versus three in the stabilisation group without statistically significant differences.…”

Section: Discussionsupporting

confidence: 90%

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Zacherl

Gruber

Glehr

et al. 2010

International Orthopaedics (SICOT)

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Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n=33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n=31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n=7) vs. the S group (n=3), with no statistically significant difference.Patients with surgery-related complications had a higher survival rate (p=0.049), as did patients with mechanical implant failure (p=0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

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Section: Discussionsupporting

confidence: 90%

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Zacherl

Gruber

Glehr

et al. 2010

International Orthopaedics (SICOT)

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“…studies that also include primary tumors, other anatomical areas, or revision procedures without reporting results separately). We contacted authors if studies published after the year 2000 included indiscernible treatment arms but were otherwise eligible (20 studies) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Only one of these could eventually be included [8].…”

Section: Article Selectionmentioning

confidence: 99%

“…The systemic complication rate varied from 1 to 8% after endoprosthetic reconstruction, 0-27% after intramedullary nailing, and 0-8% after ORIF. There were 54 systemic complications reported in 53 patients: deep venous thrombosis (17), pneumonia (9), pulmonary embolism (6), respiratory failure (5), intraoperative mortality (3), fat-embolism (2), cardiac failure (2), urinary tract infection (2), perforated colon (1), cerebrovascular accident (1), multi-organ failure (1), ileus (1), respiratory arrest (1), cardiovascular embolism (1), and not specified (2). Fat-embolism and intraoperative mortality occurred in the same case [56].…”

Section: Systemic Complicationsmentioning

confidence: 99%

Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies

et al. 2016

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Endoprosthetic reconstruction, intramedullary nailing, and open reduction internal fixation (ORIF) are the most commonly practiced surgical strategies for treatment of metastatic proximal femoral fractures. This review describes functional outcome, local, and systemic complications. All three surgical strategies result in reasonable function on average; however, wide ranges indicate that both poor and good functional levels are obtained. We found that the overall reoperation rate was comparable for endoprosthesis and intramedullary nailing, but was higher for ORIF. J. Surg. Oncol. 2016;114:507-519. © 2016 Wiley Periodicals, Inc.

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“…Biomechanically demanding locations such as the femur are at highest risk [ 10 , 19 ], but fractures also occur in the upper extremity including the proximal humerus [ 13 , 18 , 23 ]. Bone cement compound osteosynthesis may increase stability [ 23 , 24 ], but it remains unclear whether this approach is beneficial at the proximal humerus or not [ 25 ]. Advantages and disadvantages have not been analyzed so far, so we for the first time compared intralesional tumor resection and bone cement filling with and without additional plate osteosynthesis at the proximal humerus.…”

Section: Discussionmentioning

confidence: 99%

Enchondromas and atypical cartilaginous tumors at the proximal humerus treated with intralesional resection and bone cement filling with or without osteosynthesis: retrospective analysis of 42 cases with 6 years mean follow-up

et al. 2018

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BackgroundEnchondromas and atypical cartilaginous tumors (ACT) are often located at the proximal humerus. Most lesions can be followed conservatively, but surgical resection may alleviate pain, avoid pathological fractures, and prevent transformation into higher grade chondrosarcomas. Rigorous intralesional resection and filling with polymethylmethacrylate bone cement has been proposed for enchondromas but also for ACT, as an alternative for extralesional resection. We intended to analyze radiological, clinical, and functional outcome of this strategy and compare bone cement without osteosynthesis to bone cement compound osteosynthesis, which has not been analyzed so far.MethodsWe retrospectively analyzed 42 consecutive patients (mean follow-up 73 months; range 8–224) after curettage and bone cement filling with or without osteosynthesis. Exclusion criteria were Ollier’s disease and cancellous bone filling. Twenty-five patients only received bone cement. Seventeen patients received additional proximal humerus plate for compound osteosynthesis to increase stability after curettage. Demographics and radiological and clinical outcome were analyzed including surgery time, blood loss, hospitalization, recurrences, and complications. An additional telephone interview at the final follow-up assessed postoperative satisfaction, pain, and function in the quick disabilities of the arm, shoulder, and hand (DASH) score and the Musculoskeletal Tumor Society (MSTS) score. Statistics included the Student T tests, Mann-Whitney U tests, and chi-square tests.ResultsNo osteosynthesis compared to compound osteosynthesis showed smaller tumors (4.2 (± 1.5) cm versus 6.6 (± 3.0) cm; p = 0.005) and smaller bone cement fillings after curettage (5.7 (± 2.1) cm versus 9.6 (± 3.2) cm; p = 0.0001). A score evaluating preoperative scalloping and soft-tissue extension did not significantly differ (1.9 (± 0.9) versus 2.0 (± 1.0); rating scale 0–4; p = 0.7). Both groups showed high satisfaction (9.2 (± 1.5) versus 9.2 (± 0.9); p = 0.5) and low pain (1.0(±1.7) versus 1.9(±1.8); p = 0.1) in a rating scale from 0 to 10. Clinical and functional outcome was excellent for both groups in the DASH score (6.0 (± 11.8) versus 11.0 (± 13.2); rating scale 0–100; p = 0.2) and the MSTS score (29.0 (± 1.7) versus 28.7 (± 1.1); rating scale 0–30; p = 0.3). One enchondroma recurrence was found in the group without osteosynthesis. Complications (one fracture and one intra-articular screw) were only detected after osteosynthesis. Osteosynthesis had longer surgery time (70 (± 21) min versus 127 (± 22) min; p < 0.0001), more blood loss (220 (± 130) ml versus 460 (± 210) ml; p < 0.0001), and longer stay in the hospital (6 (± 2) days versus 8 (± 2) days; p = 0.004).ConclusionsIntralesional tumor resection was oncologically safe and clinically successful with or without osteosynthesis. Osteosynthesis did not reduce the risk for fracture but was more invasive.

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Compound Osteosynthesis for Osteolyses and Pathological Fractures of the Proximal Femur

Cited by 10 publications

References 16 publications

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies

Enchondromas and atypical cartilaginous tumors at the proximal humerus treated with intralesional resection and bone cement filling with or without osteosynthesis: retrospective analysis of 42 cases with 6 years mean follow-up

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