pathological fractures
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- MeSH
- lidé MeSH
- revmatoidní artritida komplikace MeSH
- stresové fraktury MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- fraktury spontánní etiologie chirurgie MeSH
- metastázy nádorů chirurgie MeSH
- nádory kostí chirurgie MeSH
- Publikační typ
- kazuistiky MeSH
ÚVOD: Cílem práce je zhodnocení souboru dětí léčených operačně na našem pracovišti pro patologickou zlomeninu v juvenilní kostní cystě. MATERIÁL A METODIKA: V letech 1999-2004 bylo operováno 22 chlapců a 7 dívek s juvenilní kostní cystou. Do našeho sledování byli zahrnuti pouze pacienti s patologickou zlomeninou v cystě. Ve skupině 15 chlapců a jedné dívky bylo léčeno celkem 22 patologických zlomenin (retrospektivně byla u 4 dětí zdokumentována léčba dvou opakovaných patologických zlomenin a u jednoho dítěte pak 3 patologických zlomenin opakovaně v časovém odstupu). Věk dětí v době zlomeniny byl od 7 do 16 roků. Lokalizace juvenilní kostní cysty se vzniklou patologickou zlomeninou byly následující: proximální humerus 11, diafýza humeru 1, proximální femur 2 a distální tibie 2. Všichni pacienti byli po ošetření patologické zlomeniny kontrolováni klinicky a rentgenologicky po dobu 1,5-9 roků s průměrem 6 roků. Rentgenologické hodnocení bylo prováděno ve standardních projekcích s využitím klasifikačního systému podle Neera. VÝSLEDKY: Při klinickém hodnocení bylo všech 16 pacientů zcela bez subjektivních obtíží. Nebyly zjištěny zánětlivé změny měkkých tkání, pasivní a aktivní pohyb sousedních kloubů byl možný v plném rozsahu a nosnost operované končetiny byla ve všech případech plná. Při rentgenologickém hodnocení byl výborný výsledek bez přítomnosti rezidua nebo recidivy v 11 případech. Zbytkový defekt byl zjištěn u 5 pacientů, ve všech případech se přitom jednalo o aktivní juvenilní kostní cystu proximální metafýzy humeru. ZÁVĚR: Při postižení skeletu horních končetin je obvyklé odložené definitivní léčení juvenilní kostní cysty, zatímco při patologické fraktuře femuru je upřednostňováno jednodobé operační léčení.
PURPOSE OF THE STUDY: The aim of this study is the evaluation of children with pathologic fractures through unicameral bone cysts treated at our department. MATERIAL AND METHODS: Twenty-two boys and seven girls operated on between 1999 and 2004 for unicameral bone cyst. Fifteen boys and one girl with pathologic fracture through bone cyst were included in this study. Twenty-two cases of pathologic fracture were identified in patients younger or equal to 16 years old (2 repeated pathologic fractures were recorded in 4 children and 3 repeated pathologic fractures in one patient). The primary cyst location were the proximal humerus in 11 patients, the humeral diaphysis in 1 case, the proximal femur and the distal tibia in 2 cases each. The patients were followed up for an average of 6 years (range, 18 months - 9 years). Radiological evaluation was based on standard X-ray images assessed according to the classification system of Neer. RESULTS: The clinical examination showed that all patients were free from subjective complaints. No inflammatory changes of soft tissue were found. Both passive and active motion of the adjacent joints was possible in the full range and the treated limb retained its complete function in all patients. X-ray examination showed excellent results, i.e., no residuum or cysts recurrence, in 11 cases. A residual lesion was present in 5 patients with active unicameral bone cyst of proximal humerus. CONCLUSIONS: Specific treatment of the uni-cameral bone cyst is delayed until the fracture is well healed. However, if the fracture is located in a weightbearing bone, the operative management of the fracture and lesion simultaneously is required.
- MeSH
- dítě MeSH
- fraktury femuru chirurgie MeSH
- fraktury humeru chirurgie MeSH
- fraktury spontánní chirurgie patologie terapie MeSH
- kostní cysty komplikace MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
The number of papers reporting the occurrence of specific pathological fractures in long-term biphosphonate users has recently increased. They refer to the forms of stress fracture probably resulting from an extreme decrease in bone turnover, which may involve sub-trochanteric or isolated transverse fractures, or short transverse fractures with a unicortical beak in an area of cortrical hypertrophy. At the time of prodromal signs and symptoms, cortical bone at the site of impeding fracture appears rougher on radiographs. Gradually, an incomplete fracture develops, with a subsequent complete fracture often sustained without any mechanism of injury noted. The occurrence of such fractures is reported in the range of 2 to 8 years from the start of biphosphonate use. the fractures are often bilateral and, at the time the first occurs, it is often possible to diagnose contralateral pathological changes similar to those before the first fracture. The paper presents the case of a female patient who sustained a bilateral pathological sub-trochanteric fracture; the first fracture occurred after 5 and the other after 9 years of Rizendronat use. She was followed up for unilateral incomplete sub-trochanteric fracture from the fourth year of its use. In that period, magnetic resonance imaging showed a pathological finding in the contralateral extremity. She had already had prodromal signs manifested as lasting hip pain before the first fracture. Both fractures were surgically treated. Thirty-three months later she had to undergo repeat surgery for pseudoarthrosis at the site of the first fracture. The pseudoarthrosis healed without complications. However, in the second fracture non-union was still present at 7 months after surgery. The patient took Rizendronat during the whole treatment period and thereafter. In the discussion, certain aspects of long-term biphosphonate use are addressed, as well as some preventive, diagnostic and therapeutic procedures related to this rare complication.
- MeSH
- fraktury femuru diagnóza chemicky indukované MeSH
- fraktury spontánní diagnóza chemicky indukované MeSH
- inhibitory kostní resorpce škodlivé účinky MeSH
- kyselina etidronová analogy a deriváty škodlivé účinky MeSH
- lidé MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY Exploring the therapeutic potential of pathological fractures treatment of the proximal femur in childhood with LCP paediatric hip plate system according to the principles of AO. MATERIAL AND METHODS Six children with pathological fractures of the proximal femur and with an unicameral bone cyst have undergone surgery in our institution, in the period between June 2018 up until December 2020. All patients were young boys with a mean age of 11.83 ± 3.43 years. According to the classification of Delbet-Colonna, three of the fractures were Type IV - intertrochanteric fractures and three were Type III - basocervical fractures. ccording to the AO Trauma classification, one of the fractures was complete transtrochanteric multifragmentary (31-M/3.2.III), two were complete transtrochanteric simple (31-M/3.1.III), one was Complete basocervical multifragmentary (31-M/3.2.II) and two were complete basicervical simple (31-M/3.1.II). All patients have undergone open reposition and osteosynthesis with a 130° LCP pediatric hip plate system (DePuy Synthes Pediatric LCP Plate System). In four of the patients, one or two of the proximal locking screws pass through the growth plate, to ensure more stability. The anatomical correction of the proximal femur has been measured through the cervico-diaphyseal angle, consolidation of the fracture, the spontaneous reparation of the cyst according to the Capanna classification and cystic index, presence of avascular necrosis of the epiphysis, shortening of the extremity, and functional grading by the Musculoskeletal Tumor Society (MSTS) staging system. The Mann-Whitney (Wilcoxon W) test was used for data processing. RESULTS The mean timing of the follow-up after the surgery was 22 months (range 6-32). A radiographically supported consolidation of the fracture has occurred at an average timing of 4.8 months (range 3-6) in all patients. There is no clinical or radiological evidence of postoperative avascular necrosis in any of the patients. According to the classification of Capanna, in five of the six patients a spontaneous reparation of the cyst has occurred. In one of the cases, the reparation is classified as grade II with a pathological cystic index of 2.27. A postoperative correction of the varus fracture deformity of the proximal femur has been achieved in all children. The cervical-diaphysary angle of 112.50° preoperatively has been corrected to 137.17° (p=0.002). The achieved correction is lasting and the average value of the CDS at the final follow-up is 138.17° (p=0.794). Intraoperative correction, statistically equal to the CDA of the healthy side (p=0.942) is achieved with this operative technique. Data from the MSTS show functional correction on the third postoperative month with 38.33% of the norm (p=0.002) and 85% on the final follow-up (p=0.002). A contralateral distal femoral surgical epiphysiodesis by the method of Métaizeau has been used for the correction of the difference in the length of the extremities (with an average of 2.9 cm). CONCLUSIONS Osteosynthesis with an LCP paediatric hip plate system gives the opportunity for anatomical correction of the proximal femur with a low risk of avascular necrosis and achieving optimal functional results in pathological basocervical and intertrochanteric fractures in childhood. The use of 5mm plates and penetration of the proximal screw through the growth plate holds an increased risk of growth disruption. Key words: LCP paediatric hip plate system, pathological fracture, unicameral bone cysts, proximal femur.
Úvod: Základem léčby sarkomů měkkých tkání je chirurgický výkon, v indikovaných případech následovaný pooperační radioterapií. Patologická fraktura vzniklá jako pozdní toxicita radioterapie, zejména v oblasti dolních končetin, ovlivňuje velmi významně kvalitu života pacienta. Cílem sdělení je analýza četnosti výskytu patologických fraktur u pacientů léčených adjuvantní radioterapií. Soubor pacientů a metody: V letech 2007-2018 bylo v Ústavu radiační onkologie Fakultní nemocnice Bulovka (ÚRO FNB) léčeno adjuvantní radioterapií 41 pacientů. Všichni pacienti podstoupili 3D konformní radioterapii. Výsledky: Medián doby sledování činí 94 měsíců (9-184 měs.). Relaps onemocnění byl potvrzen u 17 (41,5%) pacientů, k lokální recidivě došlo u 4 (23,5% relapsů) pacientů. Bylo dosaženo mediánu doby do progrese (PFS - Progression Free Survival) 56 měsíců a mediánu celkového přežití (OS - Overall Survival) 94 měsíců. Poradiační patologická fraktura se vyskytla u 4 pacientů (9,8%), v 1 případě došlo k následné refrakturě (2,4%). Medián doby do vzniku patologické fraktury od ukončení radioterapie je v našem souboru 26 měsíců (15-35 měsíců). Závěr: V našem souboru byl prokázán výskyt poradiačních fraktur odpovídající datům dostupným v literatuře. Vzhledem k výraznému negativnímu dopadu zlomenin na kvalitu života pacientů je nezbytné pokračovat v hledání možností prevence jejich vzniku.
Background: The mainstay of treatment of soft tissue sarcomas is surgery, in indicated cases followed by postoperative radiotherapy. Pathological fracture resulting from late toxicity of radiotherapy, especially in the lower extremities, significantly affects the patient's quality of life. The aim of this report is to analyze the frequency of pathological fractures in patients treated with adjuvant radiotherapy. Patients and methods: During the period 2007-2018 forty one patients were treated with adjuvant radiotherapy at the Institute of Radiation Oncology of Bulovka University Hospital (IRO BUH). All patients underwent 3D conformal radiotherapy. Results: Median Progression Free Survival (PFS) was 56 months and median Overall Survival (OS) was 94 months. Post-radiation pathologic fracture occurred in 4 patients (9.8%), with 1 case of subsequent refracture (2.4%). The median time to pathological fracture from the end of radiotherapy in our cohort was 26 months (15-35 months). Conclusion: In our group, the occurrence of post-radiation fractures corresponding to the data available in the literature was proved. Given the significant negative impact of fractures on the quality of life of patients, it is necessary to continue to search for ways to prevent their occurrence.
