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1
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Griggers JI, Alcantar S, Gonzalez MR, Lozano-Calderon SA. Postoperative Complications of Intramedullary Nailing for Impending and Pathologic Fractures of the Humerus Due to Bone Metastases-A Systematic Review of the Literature. J Surg Oncol 2024. [PMID: 39508337 DOI: 10.1002/jso.27975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/06/2024] [Accepted: 10/12/2024] [Indexed: 11/15/2024]
Abstract
Intramedullary nailing (IMN) is a common option for managing impending or pathologic fractures of the humerus secondary to metastatic disease. We sought to assess the (1) early complications, (2) failure rates and mechanisms, and (3) functional outcomes. A systematic review using the PubMed, Embase, and Cochrane databases was performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The study was registered on PROSERO (CRD42023406905). The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Studies describing postoperative outcomes of patients with impending or pathologic fractures of the humerus treated with IMN were included. Implant failure was classified into mechanical and nonmechanical causes. Functional outcomes were assessed via the Musculoskeletal Tumor Society (MSTS) score. Overall, 41 studies comprising 1431 patients were included. Early complications occurred in 5.5% of patients, with 2.8% of patients having systemic complications. The overall implant failure rate was 4.9%, and the mean MSTS score at the last follow-up was 79.9%. IMN was associated with good postoperative functional outcomes and low implant failure rates. Systemic complications were the most common type of early complication, and tumor progression was the main cause of implant failure. LEVEL OF EVIDENCE: III.
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Affiliation(s)
| | | | - Marcos R Gonzalez
- Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderon
- Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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2
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Chen BK, Tai TH, Lin SH, Chen KH, Huang YM, Chen CY. Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors. J Clin Med 2024; 13:755. [PMID: 38337449 PMCID: PMC10856436 DOI: 10.3390/jcm13030755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for the treatment of PHSF. However, there is still no standard for optimal surgical treatment. Thus, we conducted a meta-analysis comparing the clinical outcomes of INF with PF for PHSF treatment. (2) Methods: We conducted searches in databases, such as Scopus, EMBASE, and PubMed, for studies published prior to May 2023. In total, nine studies with 485 patients were reviewed. (3) Results: There were no significant differences noted in the incidence of fixation failure, local recurrence, wound complication or overall complication. However, the INF group demonstrated a significantly lower incidence of postoperative radial nerve palsy than the PF group (OR, 5.246; 95% CI, 1.548-17.774; p = 0.008). A subgroup analysis indicated that there were no statistically significant differences in fixation failure or local recurrence among subgroups categorized by the design of intramedullary nail. (4) Conclusions: Considering the short life expectancy of end-stage patients, the choice of surgical method depends on the patient's individual condition, fracture and lesion patterns, the surgeon's experience, and comprehensive discussion between the surgeon and patient.
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Affiliation(s)
- Bing-Kuan Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (B.-K.C.); (T.-H.T.); (S.-H.L.)
- Division of General Medicine, Department of Medical Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Ting-Han Tai
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (B.-K.C.); (T.-H.T.); (S.-H.L.)
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-H.C.); (Y.-M.H.)
| | - Shu-Hsuan Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (B.-K.C.); (T.-H.T.); (S.-H.L.)
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-H.C.); (Y.-M.H.)
| | - Kuan-Hao Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-H.C.); (Y.-M.H.)
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Yu-Min Huang
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-H.C.); (Y.-M.H.)
| | - Chih-Yu Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (B.-K.C.); (T.-H.T.); (S.-H.L.)
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-H.C.); (Y.-M.H.)
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
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Singh I, Krasney L, Civatte W, Parrish W. Treatment of Epiphyseal Metastasis to the Proximal Humerus Secondary to Breast Carcinoma: A Case Report. Cureus 2023; 15:e47564. [PMID: 38022128 PMCID: PMC10666193 DOI: 10.7759/cureus.47564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Metastasis to the bone is a known risk of breast cancer, with the humerus being the most common upper extremity site of metastases, with most lesions located at the humeral diaphysis. We present a unique case of proximal humeral metastasis involving the epiphysis secondary to primary invasive ductal carcinoma in a middle-aged Caucasian female. It is important to have a high degree of suspicion for metastasis when musculoskeletal pain occurs in breast cancer patients, as it may be masked by common, degenerative conditions about the shoulder girdle. When humeral metastases involve the epiphysis, treatment options are complicated by its location, which jeopardizes the integrity of articular cartilage and the function of the shoulder girdle. External beam irradiation provides pain control in a non-invasive manner, sans surgical risks. Surgical intervention will vary depending on the characteristics of the bony lesion, but the use of endoprosthetics has emerged as the most effective option for restoring range of motion and pain control with acceptable rates of implant survival.
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Affiliation(s)
- Inderpreet Singh
- Orthopedic Surgery, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA
| | - Leighann Krasney
- Orthopedic Surgery, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA
| | - William Civatte
- Orthopedic Surgery, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA
| | - William Parrish
- Orthopedic Surgery, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA
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Sood A, Kashikar SV, Mishra GV, Parihar P, Khandelwal S, Suryadevara M, Manuja N, Saboo K, Batra N, Ahuja A. The Spectrum of Shoulder Pathologies on Magnetic Resonance Imaging: A Pictorial Review. Cureus 2023; 15:e44801. [PMID: 37809114 PMCID: PMC10558894 DOI: 10.7759/cureus.44801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.
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Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivali V Kashikar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishtha Manuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitish Batra
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhinav Ahuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wu K, Lin T, Lee CH. Intramedullary nailing versus cemented plate for treating metastatic pathological fracture of the proximal humerus: a comparison study and literature review. J Orthop Traumatol 2023; 24:45. [PMID: 37620629 PMCID: PMC10449752 DOI: 10.1186/s10195-023-00721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Pathological fracture of the humerus causes severe pain, limited use of the hand, and decreased quality of life. This study aimed to compare the outcomes of intramedullary nailing and locking plate in treating metastatic pathological fractures of the proximal humerus. METHODS This retrospective comparison study included 45 patients (22 male, 23 female) with proximal humerus metastatic pathological fractures who underwent surgical treatment between 2011 and 2022. All data were collected from medical records and were analyzed retrospectively. Seventeen cases underwent intramedullary nailing plus cement augmentation, and 28 cases underwent locking plate plus cement augmentation. The main outcomes were pain relief, function scores, and complications. RESULTS Among 45 patients with mean age 61.7 ± 9.7 years, 23 (51.1%) had multiple bone metastases, and 28 (62.2%) were diagnosed with impending fractures. The nailing group had significantly lower blood loss [100 (60-200) versus 500 (350-600) ml, p < 0.001] and shorter hospital stay (8.4 ± 2.6 versus 12.3 ± 4.3 days, p < 0.001) than the plating group. Average follow-up time of the nailing group was 12 months and 16.5 months for the plating group. The nailing group had higher visual analog scale (VAS) scores than the plating group, indicating greater pain relief with nailing [7 (6-8) versus 6 (5-7), p = 0.01]. Musculoskeletal Tumor Society functional scores [28 (27-29) versus 27 (26.5-28.5), p = 0.23] were comparable between groups. No complications, local recurrence, or revision surgery were reported until the last follow-up in either group. However, one case in the plating group had a humeral head collapse and fragmentation without needing revision surgery. CONCLUSIONS Intramedullary nailing with cement augmentation is a viable option for treating proximal humerus metastatic pathological fracture, providing rigid fixation and better pain relief resulting in earlier mobility to optimize functional outcomes. Less invasive procedure with less blood loss and shorter hospital stay also benefits patients. Level of evidence Level II. Trial registration statement Not applicable.
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Affiliation(s)
- Karl Wu
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan
- Department of Materials and Textiles, Oriental Institute of Technology, New Taipei City, 220, Taiwan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan (R.O.C.)
| | - Ting Lin
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Han Lee
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan (R.O.C.).
- Department of Orthopedic Surgery, Nantou Hospital, Ministry of Health and Welfare, Nantou, Taiwan.
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Kobryn A, Nian P, Baidya J, Li TL, Maheshwari AV. Intramedullary Nailing with and without the Use of Bone Cement for Impending and Pathologic Fractures of the Humerus in Multiple Myeloma and Metastatic Disease. Cancers (Basel) 2023; 15:3601. [PMID: 37509264 PMCID: PMC10377631 DOI: 10.3390/cancers15143601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Although intramedullary nailing (IMN) is considered the standard of care for the surgical management of most femur metastatic diseases, the optimal treatment of metastatic humeral impending and/or pathologic fractures is still debatable. Moreover, the use of cemented humeral nails has not been thoroughly studied, and only a few small series have compared their results with uncemented nails. The purpose of this study was to compare the (1) survivorship, (2) functional outcomes, and (3) perioperative complications in patients receiving cemented versus uncemented humerus IMN for impending or complete pathologic fractures resulting from metastatic disease or multiple myeloma. We retrospectively reviewed 100 IMNs in 82 patients, of which 53 were cemented and 47 were uncemented. With a mean survival of 10 months (Cemented: 8.3 months vs. Uncemented: 11.6 months, p = 0.34), the mean Musculoskeletal Tumor Society (MSTS) scores increased from 42.4% preoperatively (Cemented: 40.2% vs. Uncemented: 66.7%, p = 0.01) to 89.2% at 3 months postoperatively (Cemented: 89.8% vs. Uncemented: 90.9%, p = 0.72) for the overall group (p < 0.001). Both cohorts yielded comparable complication rates (overall [22.6% vs. 19.1%)], surgical ([11.3% vs. 4.3%], and medical [13.2% vs. 14.9%], all p > 0.05), but estimated blood loss was significantly higher in the cemented group (203 mL vs. 126 mL, p = 0.003). Thus, intramedullary nailing, with and without cement augmentation in select patients, is a relatively safe and effective therapeutic modality for metastatic humeral disease with similar clinical outcomes and acceptable complication rates. While controlling for possible selection bias, larger-scale, higher-level studies are warranted to validate our results.
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Affiliation(s)
- Andriy Kobryn
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Patrick Nian
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Joydeep Baidya
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Tai L Li
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA
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7
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Arguello AM, Houdek MT, Barlow JD. Management of Proximal Humeral Oncologic Lesions. Orthop Clin North Am 2023; 54:89-100. [PMID: 36402514 DOI: 10.1016/j.ocl.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The proximal humerus is a common location for primary tumors, benign lesions, and metastatic disease. Advances in neoadjuvant and adjuvant therapy have allowed for limb-salvage surgery in most of the cases. There are numerous of options for surgical management of proximal humerus lesions and the decision to pursue one over another depends on factors such as age, comorbidities, pathology, location within the proximal humerus, planned resection margins/size of defect, and bone quality. Long-term outcomes for these techniques tend to be retrospective comparative studies, with recent studies highlighting the improved outcomes of reverse total shoulders.
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Affiliation(s)
- Alexandra M Arguello
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Ege E, Chai T, Roldan CJ, Huh BK. Ultrasound-guided superficial cervical plexus block for cancer-related clavicle pain. INTERVENTIONAL PAIN MEDICINE 2022; 1:100152. [PMID: 39238861 PMCID: PMC11372992 DOI: 10.1016/j.inpm.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 09/29/2022] [Indexed: 09/07/2024]
Abstract
Pain is one of the most feared conditions a cancer patient may face. Bone is a common site of metastasis in many malignancies, including breast, prostate, kidney, and lung cancer. Conventional therapy for tumor-related bone pain involves the use of opioids, non-steroidal anti-inflammatory drugs, and bisphosphonates. Palliative radiation therapy may be incorporated for refractory bone pain. We describe an innovative case of cancer-related clavicle pain successfully managed with a superficial cervical plexus block in an opioid-intolerant patient. Considering the lack of guidelines for pain interventions in this setting, such peripheral nerve blocks may be a useful adjunctive tool in refractory cancer pain management.
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Affiliation(s)
- Eliana Ege
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Thomas Chai
- UT MD Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA
| | - Carlos J Roldan
- UT MD Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA
| | - Billy K Huh
- UT MD Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA
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9
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Abstract
Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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10
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Xu GQ, Wang G, Bai XD, Wang XJ. Intramedullary nailing for pathological fractures of the proximal humerus caused by multiple myeloma: A case report and review of literature. World J Clin Cases 2022; 10:3518-3526. [PMID: 35611188 PMCID: PMC9048571 DOI: 10.12998/wjcc.v10.i11.3518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/12/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple myeloma (MM) bone disease is indicative of MM, and reduces patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM is an essential treatment within the framework of supportive therapy measures and involves orthopedic tumor surgery. Nevertheless, there are few reports on intramedullary (IM) nailing in the treatment of MM-induced proximal humeral fracture to prevent fixation loss. We here describe a case of pathological fracture of the proximal humerus caused by MM successfully treated with IM nailing without removal of tumors and a review of the current literature.
CASE SUMMARY A 64-year-old male patient complaining of serious left shoulder pain and limited movement was admitted. The patient was finally diagnosed with MM (IgAλ, IIIA/II). After treatment of the pathological fracture with IM nailing, the patient's function recovered and his pain was rapidly relieved. Histopathological examination demonstrated plasma cell myeloma. The patient received chemotherapy in the Hematology Department. The humeral fracture displayed good union during the 40-mo follow-up, with complete healing of the fracture, and the clinical outcome was satisfactory. At the most recent follow-up, the patient's function was assessed using the Musculoskeletal Tumor Society score, which was 29.
CONCLUSION Early surgery should be performed for the fracture of the proximal humerus caused by MM. IM nailing can be used without removal of tumors. Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.
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Affiliation(s)
- Guo-Qiang Xu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Gang Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiao-Dong Bai
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xin-Jia Wang
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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11
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Onafowokan OO, Agrawal S, Middleton RG, Bartlett GE. Surgical management of renal cancer metastasis in the humerus: novel use of a trabecular metal spacer. BMJ Case Rep 2022; 15:e244313. [PMID: 35140079 PMCID: PMC8830110 DOI: 10.1136/bcr-2021-244313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/03/2022] Open
Abstract
Humeral metastases from renal cell carcinoma are not uncommon. Current surgical practice centres around adequate tumour resection, but often at the expense of functional outcome. The use of trabecular metal (TM) implants is well described in spine and joint surgery. However, their use as a reconstruction device in osseous tumour surgery has yet to be reported. We present our experience in using a TM vertebral body replacement device (VBR) in treating a patient with painful bilateral diaphyseal humeral metastases. Resection of the tumour resulted in defects which the TM-VBR was able to fill. The defect was then bridged with a locking plate and cables. At 2-year clinical and radiographic review, bony integration and a return to pain free, near-normal function was achieved.
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Affiliation(s)
| | - Somen Agrawal
- Department of Orthopaedic Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Rory G Middleton
- Department of Orthopaedic Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Gavin E Bartlett
- Department of Orthopaedic Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
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12
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Zhao Z, Ye Z, Yan T, Tang X, Guo W, Yang R. Intercalary prosthetic replacement is a reliable solution for metastatic humeral shaft fractures: retrospective, observational study of a single center series. World J Surg Oncol 2021; 19:140. [PMID: 33952258 PMCID: PMC8101207 DOI: 10.1186/s12957-021-02250-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Treatments for metastatic fracture of the humeral shaft continue to evolve as advances are made in both oncological and operative management. The purposes of this study were to critically evaluate the effectiveness of intercalary endoprostheses in treating metastatic humeral shaft fractures and to clarify the surgical indications for this technique. METHODS Sixty-three patients treated surgically for 66 metastatic fractures of the humerus shaft were retrospectively reviewed. Intramedullary nailing (IMN) was performed in 16 lesions, plate fixation (PF) in 33 lesions, and prosthetic replacement in 17 lesions. The operative time, intraoperative blood loss, and postoperative complications were noted. The function of the upper extremities was assessed by the Musculoskeletal Tumor Society (MSTS) score and American Shoulder and Elbow Surgeons (ASES) score. All included patients were followed until reconstructive failure or death. RESULTS The operative time was relatively shorter in the prosthesis group than in either the IMN group (p = 0.169) or PF group (p = 0.002). Notably, intraoperative blood loss was significantly less in the prosthesis group than in either the IMN group (p = 0.03) or PF group (p = 0.012). The average follow-up time was 20.3 (range, 3-75) months, and the overall survival rate was 59.7% at 12 months and 46.7% at 24 months. One rotator cuff injury, 3 cases of iatrogenic radial nerve palsy, 5 cases of local tumor progression, and 1 mechanical failure occurred in the osteosynthesis group, whereas one case of aseptic loosening of the distal stem and one case of local relapse were observed in the prosthesis group. There were no significant differences in functional scores among the three groups. CONCLUSIONS Intercalary prosthetic replacement of the humeral shaft may be a reliable solution for pathologic fractures patients; it is indicated for lesions with substantial bone loss, or accompanied soft tissue mass, or for those patients with better prognosis.
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Affiliation(s)
- Zhiqing Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Zhipeng Ye
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China.
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
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13
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Wilson WT, Pickup AR, Findlay H, Gupta S, Mahendra A. Stabilisation of pathological humerus fractures using cement augmented plating: A case series. J Clin Orthop Trauma 2021; 15:93-98. [PMID: 33680826 PMCID: PMC7919932 DOI: 10.1016/j.jcot.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022] Open
Abstract
The humerus is the second most common long bone for metastatic tumours. These lesions result in weakened bone architecture and increased fracture risk with patients suffering pain, loss of function and diminished quality of life, often when life expectancy is short. Fractures or impending fractures require surgical stabilisation to relieve pain and restore function for the remainder of the patient's life without the need for further surgery. Conventional management of these lesions in the humerus is intramedullary nailing, however there are issues with this technique, particularly regarding rigidity of fixation. Advances in contoured locking plates have led to the development of different stabilisation techniques. The preferred technique in our regional oncology unit is curettage of the tumour and plating, augmented with cement to fill the defect and restore the structural morphology. In this case series we evaluate the survivorship of the construct and the clinical outcomes in patients who had an established or prospective pathological humeral fracture treated with curettage and cement augmented plating, since 2010. We identified 19 patients; 17 had metastasis and 2 myeloma of whom 15 had established fractures and four impending. The mean age at surgery was 69 years (51-86), and mean time since surgery 3.2 years. Overall mean follow up time was 20 months with 14 patients deceased and 5 surviving. There was 100% survivorship of the construct with no mechanical failures and no re-operations. There were no post-operative wound complications. Excellent early pain control was achieved in 18 patients with one experiencing pain controlled by analgesia. Function was assessed using Toronto Extremity Salvage Score (TESS) and was satisfactory; mean 79/100 (range 72-85). Cement augmented plating for pathological humerus fractures is a suitable alternative to intramedullary nailing and addresses several of the concerns with that technique. It provides immediate rigidity and allows early unrestricted function.
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Affiliation(s)
- William T. Wilson
- Department of Orthopaedic Oncology, Glasgow Royal Infirmary, Glasgow, UK
| | - Alan R. Pickup
- Department of Orthopaedic Oncology, Glasgow Royal Infirmary, Glasgow, UK
| | - Helen Findlay
- Department of Orthopaedic Oncology, Glasgow Royal Infirmary, Glasgow, UK
| | - Sanjay Gupta
- Department of Orthopaedic Oncology, Glasgow Royal Infirmary, Glasgow, UK
| | - Ashish Mahendra
- Department of Orthopaedic Oncology, Glasgow Royal Infirmary, Glasgow, UK
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Ricard MAM, Stavropoulos NA, Nooh A, Ste-Marie N, Goulding K, Turcotte R. Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions. Cureus 2021; 13:e13788. [PMID: 33842162 PMCID: PMC8025793 DOI: 10.7759/cureus.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the event of surgical management of metastases to the humeral shaft, intramedullary nailing (IMN) is often preferred to plate osteosynthesis (PO) fixation despite a lack of consensus. In this study, we hypothesized that plate osteosynthesis will be associated with better functional and pain outcomes, thus better quality of life. Eighteen patients with the diagnosis of humeral shaft metastatic fracture or impending fracture were extracted from a prospective database of 140 metastatic patients collected across three hospitals over a five-year period. Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), Quality of Life (QOL) and Brief Pain Inventory (BPI) score were gathered during the year following the surgery. Statistical analysis was performed to compare the mean score differences between the two surgical options at baseline and five follow-up visits. Both treatment options were associated with an increase in functional outcomes based on both MSTS and TESS, and a decrease in pain level. However, no significant difference was found in quality of life and between the two treatment modalities. Thus, based on our results, a similar improvement in functional status and pain level can be achieved surgically by either intramedullary nailing or plating osteosynthesis.
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Affiliation(s)
- Marc-Antoine M Ricard
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa University, Ottawa, CAN
| | | | - Anas Nooh
- Department of Orthopaedic Surgery, McGill University Health Centre, Montréal, CAN
| | - Nathalie Ste-Marie
- Department of Orthopaedic Surgery, McGill University Health Centre, Montréal, CAN
| | - Krista Goulding
- Department of Orthopaedic Surgery, McGill University Health Centre, Montréal, CAN
| | - Robert Turcotte
- Department of Orthopaedic Surgery, McGill University Health Centre, Montréal, CAN
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Wu K, Huang YH. A rare case report: an inextricable shoulder pain as the exclusive presentation of lung adenocarcinoma with metastasis over contralateral clavicle. Eur J Med Res 2021; 26:23. [PMID: 33640029 PMCID: PMC7912515 DOI: 10.1186/s40001-021-00493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Lung cancer is the fourth most common form of the tumor spreading to the bone. Among all patients of lung carcinoma, the most common sites of bone metastasis are vertebrae, ribs, and pelvis. By comparison, the clavicle is an extremely rare site of metastases not only in the population of lung cancers but among all types of tumors. Enlightened by this existing fact, we would like to share our experience of management of an uncommon clavicular metastasis and illuminate the obscure mechanism of its scarcity. Case presentation A 56-year-old female without any preknown systemic disease had suffered from a sole intermittent right shoulder pain without any other discomfort for 3 months. Physical examination performed at our orthopedic department showed tenderness over the right distal third of the clavicle with limited range-of-motion of the right shoulder. EGFR-mutated lung adenocarcinoma with metastasis over the right clavicle resulting in a pathological fracture was diagnosed according to the result of the incisional biopsy. Concurrent chemoradiation therapy accompanied with target therapy was performed. Eighteen months postoperatively, the clavicle pain was found to be subsided with stationary bony lesion under appropriate medication and palliative radiotherapy during the subsequent follow-up. Conclusions The clavicle is an exceedingly unusual site with 2% of metastatic involvement of all type of tumors and only 1% among the population of carcinoma of lung due to its scanty red marrow and sparse vascular supply. Despite the unpleasant prognosis of clavicular metastasis from primary lung adenocarcinoma, promising quality of life is achievable under multidisciplinary management.
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Affiliation(s)
- Karl Wu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC. .,Department of Materials and Textiles, Oriental Institute of Technology, New Taipei City, Taiwan, ROC.
| | - Yu-Hao Huang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
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16
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Management of Metastatic Disease of the Upper Extremity. J Am Acad Orthop Surg 2021; 29:e116-e125. [PMID: 33492015 DOI: 10.5435/jaaos-d-20-00819] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/28/2020] [Indexed: 02/01/2023] Open
Abstract
Metastatic disease is the most common pathologic cause of bone destruction, and the upper extremity is frequently involved. This location presents many surgical challenges, but there have been several recent implant and technique-related advances that have improved outcomes. Patients can be treated nonsurgically, with radiation or with surgery, depending on patient characteristics, signs/symptoms, primary diagnosis, location, and extent of bone destruction. Most locations in the upper extremity besides the humerus can be treated nonsurgically or with radiation. This is also true of the humerus, but when surgery is indicated, plate fixation is acceptable when adequate proximal and distal cortical bone is present for screw purchase. Intramedullary nailing is used frequently in metastatic humeral disease as well, especially in the diaphysis. When extensive destruction or disease progression precludes internal fixation, a resection with endoprosthetic reconstruction can be considered. Oncologic hemiarthroplasty endoprosthetics still have a role, but reverse shoulder designs are beginning to show improved function. Humeral prosthesis designs are continuing to improve, and are becoming more modular, with custom implants still playing a role in certain challenging scenarios.
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Retrospective, multicenter, observational study of 112 surgically treated cases of humerus metastasis. Orthop Traumatol Surg Res 2020; 106:1047-1057. [PMID: 32768275 DOI: 10.1016/j.otsr.2020.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The humerus is the second most common site for metastasis in the peripheral skeleton. These humeral metastases (HM) occur in the midshaft in 42% to 61% of cases and theproximal humerus in 32% to 45% of cases. They are often secondary to primary breast (17-31%), kidney (13-15%) or lung (11-24%) cancer. The optimal surgical treatment between intramedullary (IM) procedures, fixation or arthroplasty is still being debated. HYPOTHESIS We hypothesized that fixation and/or arthroplasty are safe and effective options for controlling pain and improving the patients' function. MATERIALS AND METHODS Between 2004 and 2016, 11 French hospitals included 112 continuous cases of HM in 54 men (49%) and 57 women (51%). The average age was 63.7±13.4 years (30-94). The HM occurred in the context of primary breast (30%), lung (23%) or kidney (21%) cancers. The HM was proximal in 35% of cases, midshaft in 59% and distal in 7% of cases. Surgery was required in 69% of patients because of a pathological fracture. The surgical procedure consisted of bundle pinning, plate fixation, arthroplasty or locked IM nailing in 6%, 11%, 14% and 69% of patients, respectively. RESULTS Seven patients (6%) had to be reoperated due to surgical site complications including two infections and four fractures (periprosthetic or away from implant). Twelve patients (11%) experienced a general complication. The overall survival was 16.7 months, which was negatively and significantly impacted by the occurrence of a fracture, a diaphyseal location and the type of primary cancer. At the final assessment, 75% had normal or subnormal function and more than 90% were pain-free or had less pain. The final function was not related to the occurrence of a fracture or etiology of the metastasis. In epiphyseal and metaphyseal HM, there was a trend to better function after shoulder arthroplasty than after plate fixation or IM nailing. CONCLUSIONS Our initial hypothesis was confirmed. Our findings were consistent with those of other published studies. Based on our findings, we recommend using static locked IM nailing with cementoplasty for mid-shaft lesions and modular arthroplasty for destructive epiphyseal or metaphyso-epiphyseal lesions. The criteria for assessing humeral fracture risk should be updated to allow the introduction of a preventative procedure, which contributes to better survival. LEVEL OF EVIDENCE IV, retrospective study.
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Crenn V, Carlier C, Gouin F, Sailhan F, Bonnevialle P. High rate of fracture in long-bone metastasis: Proposal for an improved Mirels predictive score. Orthop Traumatol Surg Res 2020; 106:1005-1011. [PMID: 32782175 DOI: 10.1016/j.otsr.2020.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pathologic fracture is the most feared complication in long-bone metastasis. Various radiographic tools are available for identifying at-risk patients and guide preventive treatment. The Mirels score is the most frequently studied and widely used, but has been criticized, many patients not being operated on until the actual fracture stage. We therefore conducted a French national multicenter prospective study: (1) to determine the proportion of patients operated on at fracture stage versus preventively; (2) to compare Mirels score between the two; and (3) to identify factors for operation at fracture stage according to Mirels score and other epidemiological, clinical and biological criteria. HYPOTHESIS Simple discriminatory items can be identified to as to complete the Mirels score and enhance its predictive capacity. MATERIAL AND METHODS A non-controlled multicenter prospective study included 245 patients operated on for non-revelatory long-bone metastasis, comparing patients operated on for fracture versus preventively according to body-mass index (BMI), ASA score, Katagiri score items and the 4 Mirels items. RESULTS One hundred and twenty-six patients (51.4%) were operated on at fracture stage: 106 (84.1%) showed high risk on Mirels score (score>8), and 15 (11.9%) moderate risk (score=8). On multivariate analysis, 4 independent factors emerged: in increasing order, advanced age (OR=1.03; 95%CI 1.01-1.06), VAS pain score>6 (OR=1.47; 95%CI 1.02-2.11), WHO grade>2 (OR=2.74; 95%CI 1.22-6.15), and upper-limb location (OR=5.26; 95%CI 2.13-12.84). DISCUSSION The present study confirmed that more than half of patients with long-bone metastasis are operated on at actual fracture stage, in agreement with the literature. Several studies highlighted the weakness of the Mirels score as a predictive instrument. Comparison between preventive and fracture-stage surgery showed that upper-limb location, intense pain, advanced age and impaired functional status were associated with fracture-stage surgery, and should be taken into account alongside the original Mirels criteria. This improved scoring instrument remains to be validated in a prospective study. LEVEL OF EVIDENCE IV, prospective cohort study without control group.
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Affiliation(s)
- Vincent Crenn
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU de Nantes, Hôtel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France; Physos, Inserm UMR 1238, Faculté de Médecine de Nantes, Rue G. Veil, 44000 Nantes, France.
| | - Christophe Carlier
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU de Nantes, Hôtel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France
| | - François Gouin
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU de Nantes, Hôtel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France; Physos, Inserm UMR 1238, Faculté de Médecine de Nantes, Rue G. Veil, 44000 Nantes, France; Département de Chirurgie, Centre Léon Bérard, 28, Rue Laennec, 69008 Lyon, France
| | - Fréderic Sailhan
- Hôpital Cochin, 27, Rue du Faubourg-Saint-Jacques, 75014 Paris, France; Clinique Arago, Groupe Almaviva, 187a, Rue Raymond Losserand, 75014 Paris, France
| | - Paul Bonnevialle
- Département Universitaire d'Orthopédie Traumatologie de Toulouse, Hôpital P.P. Riquet, Place Baylac, 31052 Toulouse Cedex, France
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- Société Française de Chirurgie Orthopédique et de Traulatologie (So.F.C.O.T.), 56, rue Boissonnade, 75014 Paris, France
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Pan P, Lee EW, Eghbalieh N, Trieu H. Ipsilateral transradial access in transarterial embolization of upper extremity bony metastases. J Vasc Access 2018; 20:202-208. [PMID: 30064287 DOI: 10.1177/1129729818791990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Transarterial embolization of bone tumors is effective in both decreasing intraoperative hemorrhage and alleviating symptoms. Transradial access has been associated with a lower risk of access site complications when compared to transfemoral access. Three cases of transarterial embolization of bony metastases in the upper extremity and shoulder girdle were performed with an ipsilateral transradial access. In each case, significant decrease in tumor blush was noted after embolization, and no auxiliary access site was needed. Positive outcomes were observed in all three patients, including successful subsequent surgery without significant hemorrhage and notable post-procedural pain reduction.
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Affiliation(s)
- Patrick Pan
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Navid Eghbalieh
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Harry Trieu
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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20
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Casadei R, Drago G, Di Pressa F, Donati D. Humeral metastasis of renal cancer: Surgical options and review of literature. Orthop Traumatol Surg Res 2018; 104:533-538. [PMID: 29654934 DOI: 10.1016/j.otsr.2018.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy. HYPOTHESIS Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis. MATERIAL AND METHODS Fifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used. RESULTS The average age was 63years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases. DISCUSSION Solitary and metachronous bone metastases have a longer survival. Disease-free interval>2years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life. RETROSPECTIVE STUDY Level of evidence: IV.
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Affiliation(s)
- R Casadei
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Drago
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - F Di Pressa
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Donati
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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Md Radzi AB, Tan SS. A case report of metastatic hepatocellular carcinoma in the mandible and coracoid process: A rare presentation. Medicine (Baltimore) 2018; 97:e8884. [PMID: 29369168 PMCID: PMC5794352 DOI: 10.1097/md.0000000000008884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE We report a rare case of hepatocellular carcinoma (HCC) with metastases to the mandible and coracoid process of scapula without evidence of lung involvement. PATIENTS CONCERNS The patient was diagnosed with HCC, presented 5 months later with right lower tooth pain, swelling over the right mandible area and right shoulder pain. DIAGNOSES Histopathological examination of mandible showed findings suggestive of metastatic HCC. Magnetic resonance imaging (MRI) of the right shoulder revealed findings of irregular enhancing lesion at the right coracoid process causing erosion of the coracoid process. INTERVENTIONS Patient was subsequently referred for palliative medicine care. OUTCOMES He received adequate analgesia. LESSONS Oral cavity and scapula metastases from HCC are very rare. Most oral metastases are associated with lung metastases, and they possibly occur by hematogenous route. In our case, the possible pathway of metastasis is an anastomotic network of paravertebral veins that bypasses the pulmonary, inferior caval, and portal venous circulations.
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Affiliation(s)
- Ahmad Bakhtiar Md Radzi
- Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh
| | - Soek-Siam Tan
- Department of Hepatology, Hospital Selayang, Batu Caves, Selangor, Malaysia
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22
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Choi ES, Han I, Cho HS, Park IW, Park JW, Kim HS. Intramedullary Nailing for Pathological Fractures of the Proximal Humerus. Clin Orthop Surg 2016; 8:458-464. [PMID: 27904730 PMCID: PMC5114260 DOI: 10.4055/cios.2016.8.4.458] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/11/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes. METHODS We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes. RESULTS The mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up. CONCLUSIONS Proximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction.
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Affiliation(s)
- Eun-Seok Choi
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ilkyu Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hwan Seong Cho
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Woong Park
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Han-Soo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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The investigation and management of suspected malignant pathological fractures: a review for the general orthopaedic surgeon. Injury 2015; 46:1891-9. [PMID: 26254572 DOI: 10.1016/j.injury.2015.07.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/01/2015] [Accepted: 07/19/2015] [Indexed: 02/02/2023]
Abstract
The management of malignant pathological fractures necessitates careful diagnostic work-up, pre-operative investigation, planning and multidisciplinary input from specialists in the fields of radiology, pathology, oncology, trauma and orthopaedics. Malignant and non-malignant conditions including metabolic disorders, benign tumours and pharmacological therapies can be implicated. The majority of patients who present with suspected pathological fractures will be managed by general orthopaedic and trauma surgeons rather than specialists in orthopaedic oncology. Skeletal metastases can result in considerable morbidity and predispose to pathological fractures. With advances in the medical management of malignancy, life expectancy in cancer patients is increasing, leading to an increasing risk of skeletal metastasis and the potential for pathological fractures. Conventional modes of trauma fixation for pathological fractures may not be appropriate. The aim of this review is to outline diagnostic and management strategies for patients who present with a long bone fracture that is potentially pathological in nature.
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Janssen SJ, Teunis T, Hornicek FJ, Bramer JAM, Schwab JH. Outcome of operative treatment of metastatic fractures of the humerus: a systematic review of twenty three clinical studies. INTERNATIONAL ORTHOPAEDICS 2014; 39:735-46. [PMID: 25398471 DOI: 10.1007/s00264-014-2584-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/24/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE This systematic review aims to provide an overview of functional outcome and complications after surgery for metastatic humerus fractures. METHODS A literature search was performed in September 2013 using the Pubmed, Embase and Cochrane database. We included 23 studies reporting on 29 treatment arms: intramedullary nailing (19 studies, 596 cases), plate-screw fixation (five studies, 150 cases), endoprosthetic reconstruction (three studies, 81 cases), and diaphysis prosthesis (two studies, 82 cases), totalling 909 fractures. There were 414 pathological and 56 impending fractures. In 439 cases the type of fracture was not specified. Four studies reported functional outcome. RESULTS Average Musculoskeletal Tumor Society score ranged from 64 to 79 (three studies, 100 patients) after intramedullary nailing, was 90 (one study, 24 patients) after plate-screw fixation, and 73 (one study, 30 patients) after endoprosthetic reconstruction. Re-operation rate varied from 0 to 10 % after intramedullary nailing (overall 4.4 %), 5-14 % after plate-screw fixation (overall 9.3 %), 14-16 % after diaphysis prosthesis (overall 14.6 %), and 0-6 % after endoprosthetic reconstruction (overall 2.5 %). Systemic complication rate varied between 0 and 26 % after intramedullary nailing (overall 2.2 %), between 0 and 6 % after plate-screw fixation (overall 4.8 %), was 0 % after endoprosthetic reconstruction, and varied between 0 and 16 % after diaphysis prosthesis (overall 9.7 %). CONCLUSIONS Reported complication rates help surgeons inform their patients and could aid in surgical decision making. Functional outcome, pain and quality of life were poorly reported. Patient reported outcomes are therefore an important direction for future research.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Room 3.946, Yawkey building, 55 Fruit Street, Boston, MA, 02114, USA,
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Lee LC, Tsuei YC. Metastasis of hepatocellular carcinoma to the scapula. J Formos Med Assoc 2014; 113:976-7. [PMID: 24745609 DOI: 10.1016/j.jfma.2014.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/11/2014] [Accepted: 03/19/2014] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lin-Chien Lee
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan.
| | - Yu-Chuan Tsuei
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei, Taiwan
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Current concepts of shoulder arthroplasty for radiologists: Part 1--Epidemiology, history, preoperative imaging, and hemiarthroplasty. AJR Am J Roentgenol 2012; 199:757-67. [PMID: 22997365 DOI: 10.2214/ajr.12.8854] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this article is to provide a review of indications for shoulder arthroplasty, describe preoperative imaging assessment, present new and modified designs of shoulder arthroplasty, illustrate normal and abnormal postoperative imaging findings, and review key radiographic measurements. CONCLUSION Knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications is important in assessing shoulder prostheses.
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Wedin R, Hansen BH, Laitinen M, Trovik C, Zaikova O, Bergh P, Kalén A, Schwarz-Lausten G, Vult von Steyern F, Walloe A, Keller J, Weiss RJ. Complications and survival after surgical treatment of 214 metastatic lesions of the humerus. J Shoulder Elbow Surg 2012; 21:1049-55. [PMID: 21982491 DOI: 10.1016/j.jse.2011.06.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 06/23/2011] [Accepted: 06/25/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus. MATERIALS AND METHODS This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10. RESULTS The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosynthesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P < 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years. CONCLUSIONS Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral fractures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate.
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Affiliation(s)
- Rikard Wedin
- Department of Orthopaedics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Weiss KR, Bhumbra R, Biau DJ, Griffin AM, Deheshi B, Wunder JS, Ferguson PC. Fixation of pathological humeral fractures by the cemented plate technique. ACTA ACUST UNITED AC 2011; 93:1093-7. [PMID: 21768635 DOI: 10.1302/0301-620x.93b8.26194] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pathological fractures of the humerus are associated with pain, morbidity, loss of function and a diminished quality of life. We report our experience of stabilising these fractures using polymethylmethacrylate and non-locking plates. We undertook a retrospective review over 20 years of patients treated at a tertiary musculoskeletal oncology centre. Those who had undergone surgery for an impending or completed pathological humeral fracture with a diagnosis of metastatic disease or myeloma were identified from our database. There were 63 patients (43 men, 20 women) in the series with a mean age of 63 years (39 to 87). All had undergone intralesional curettage of the tumour followed by fixation with intramedullary polymethylmethacrylate and plating. Complications occurred in 14 patients (22.2%) and seven (11.1%) required re-operation. At the latest follow-up, 47 patients (74.6%) were deceased and 16 (25.4%) were living with a mean follow-up of 75 months (1 to 184). A total of 54 (86%) patients had no or mild pain and 50 (80%) required no or minimal assistance with activities of daily living. Of the 16 living patients none had pain and all could perform activities of daily living without assistance. Intralesional resection of the tumour, filling of the cavity with cement, and plate stabilisation of the pathological fracture gives immediate rigidity and allows an early return of function without the need for bony union. The patient's local disease burden is reduced, which may alleviate tumour-related pain and slow the progression of the disease. The cemented-plate technique provides a reliable option for the treatment of pathological fractures of the humerus.
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Affiliation(s)
- K R Weiss
- Department of Orthopaedic Surgery, Division of Musculoskeletal Oncology, Shadyside Medical Center, 5200 Centre Avenue, Suite 415, Pittsburgh, Pennsylvania 15232, USA.
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Treatment of pathological humerus shaft fractures with intramedullary nails with or without cement fixation. Arch Orthop Trauma Surg 2011; 131:503-8. [PMID: 20740287 DOI: 10.1007/s00402-010-1172-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Bone metastasis is a severe complication for patients with cancer. Not only does it cause intractable pain and other clinical problems such as fracture after trivial injury, it also signifies that the malignant process is incurable. Since life expectancy of metastasised cancer patients has improved due to advanced oncological treatment but is still limited, appropriate surgical intervention has increased. METHOD This is a retrospective control study of 21 patients who underwent cemented intramedullary nailing for pathological fractures in the humeral shaft between 2005 and 2009 as compared to a historical control group of 19 patients that underwent locked intramedullary nailing for pathological fractures in the humeral shaft between 1999 and 2004. Four major outcomes were assessed, namely, pain relief, use of analgesics, recovery of function and rate of complication. RESULTS Patients treated with cemented intramedullary nailing had better pain relief, less use of analgesics and better functional restoration immediately after surgical procedure when compared to the patients without cement fixing. The rate of complication did not differ between these two groups. CONCLUSION Since surgery for metastases does not prolong life but improves the quality of life, the aim towards a short postoperative rehabilitation time is recommended. Cement fixation gives immediate stabilisation to the fracture site and thus allows less pain but full range of motion from the first postoperative day.
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Muramatsu K, Ihara K, Iwanagaa R, Taguchi T. Treatment of metastatic bone lesions in the upper extremity: indications for surgery. Orthopedics 2010; 33:807. [PMID: 21053874 DOI: 10.3928/01477447-20100924-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pathological fractures caused by metastatic malignant disease have been the subject of increasing interest in recent years. This article describes our experience with the treatment of metastatic bone disease of the upper extremity and our attempt to clarify the indications for different surgical procedures. Of 53 patients with metastatic lesions to the upper extremity, 20 who had been surgically treated were analyzed retrospectively. These comprised 13 men and 7 women with a mean patient age of 62 years. The most common primary tumors to metastasize were lung and liver, with the humerus involved in 12 cases and the scapula and forearm in 4 cases each. Four patients with scapula and forearm involvement underwent tumor resection due to uncontrollable tumor size, while 3 were successfully treated by selective arterial embolization. Three metastases to the humeral head were reconstructed with endoprosthesis, but functional restriction was noted. Five cases with metastases to the humeral shaft were treated with tumor curettage, internal fixation using intramedullary nailing, adjuvant cryosurgery, and cementing. This achieved good results for pain relief and functional restoration with minimal complications. Two metastases to the humeral condyle were unable to be stabilized with plate and locking screws. Metastatic lesions to the scapula and forearm are commonly treated nonsurgically, but some patients with uncontrollable tumor mass require surgical resection. Endoprosthetic replacement is recommended if the lesion involves the humeral head or condyle. Most patients with the humeral shaft lesion are likely to benefit from tumor curettage, intramedullary nailing with locking screw, and cementing.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Abstract
BACKGROUND The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction. QUESTIONS/PURPOSES We describe (1) surgical technique using a synthetic mesh during humerus reconstructions; (2) functional level defined as shoulder ROM of patients undergoing the procedure; (3) incidence of postoperative dislocation and shoulder instability; and (4) complications associated with the use of the device. METHODS We retrospectively reviewed 16 patients with proximal humerus replacements reconstructed with a synthetic mesh from February 2006 to July 2008. Patients were followed clinically and radiographically for a minimum of 13 months (mean, 26 months; range, 13-43 months). RESULTS There were no shoulder dislocations at the latest followup. The mean shoulder flexion was 43° (range, 15°-170°) and mean shoulder abduction of 38 (range, 15°-110°). The mean operative time was 121 minutes (range, 80-170 minutes) and the mean blood loss was 220 mL (range, 50-750 mL). One patient had a superficial wound infection and none a deep infection requiring removal of the graft or prosthesis. CONCLUSIONS The data suggest the use of a synthetic vascular mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment and reconstruction after tumor resection.
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Clark JCM, Dass CR, Choong PFM. Current and future treatments of bone metastases. Expert Opin Emerg Drugs 2009; 13:609-27. [PMID: 19046130 DOI: 10.1517/14728210802584217] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bone metastases contribute to a significant degree of morbidity in patients with common cancers through the development of skeletal related events (SRE) such as bone pain and pathological fracture. Traditional therapy has relied on surgical removal of lesions and, with the advent of adjuvant therapies, has been combined with radiotherapy, chemotherapy, and more recently osteoclast inhibiting agents like bisphosphonates. Although these therapeutic combinations can achieve a degree of local control, and rarely cure, across the vast majority of metastatic cancers they provide only palliation. Newer molecular agents currently under investigation, combined with innovations in surgery and radiation therapy offer a more targeted approach to bone metastasis. These utilise our understanding of key steps in the metastatic cascade including chemotactic attraction to bone, secretion of proteases, the cancer supporting microenvironment of bone matrix and the RANK-RANKL interaction for osteoclast activation. Direct inhibition of metastasis progression and osteolysis with less reliance on cytotoxic agents and invasive therapy should result in improved metastatic control, longer survival and less overall morbidity.
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Affiliation(s)
- J C M Clark
- University of Melbourne, St Vincent's Hospital, St Vincent's Health, Department of surgery and Orthopaedics, Level 3 Daly Wing, 41 Victoria Parade, Fitzroy, Vic, 3053, Australia
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Teixeira LEM, Miranda RH, Ghedini DF, Aguilar RB, Novais ENV, de Abreu E Silva GM, Araújo ID, de Andrade MAP. EARLY COMPLICATIONS IN THE ORTHOPEDIC TREATMENT OF BONE METASTASES. Rev Bras Ortop 2009; 44:519-23. [PMID: 27077063 PMCID: PMC4816859 DOI: 10.1016/s2255-4971(15)30151-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess the early complications in the orthopedic treatment of metastatic bone lesions and the factors associated with these complications. Method: There were assessed, retrospectively, 64 patients that underwent surgical treatment for bone metastases, analyzing the complications that occurred in the pre-operative and early post- operative period and associating them with the tumor origin, type of procedure done, the need of blood reposition before the surgery, the need of new surgical procedures and the mortality due to the complications. Results: Early complications in the treatment were observed in 17 (26.6%) patients, of which six (35.2%) ended up dying due to these complications. Regarding the type, 15 (23.8%) cases were due to surgical complications, four (6.3%) clinical and three (4.7%) patients showed clinical and surgical complications. There was no significant difference in the frequency of complications or mortality when assessed the type of reconstruction or affected region. The tumors with a renal origin needed more blood reposition and showed a bigger frequency of complications. Conclusion: The complications occurred in 26.6%. The complications are not related to the kind of treatment performed or to the region affected. The renal origin tumors showed a higher risk of hemorrhage.
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Affiliation(s)
- Luiz Eduardo Moreira Teixeira
- Master's degree in Medicine; Coordinator, Orthopedic Oncology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG)
| | | | - Daniel Ferreira Ghedini
- Assistant Physician, Department of Orthopedics and Traumatology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG)
| | - Rafael Bazílio Aguilar
- Assistant Physician, Department of Orthopedics and Traumatology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG)
| | - Eduardo Nilo Vasconcelos Novais
- Master's degree in Medicine; Assistant Physician, Department of Orthopedics and Traumatology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG)
| | | | - Ivana Duval Araújo
- Associate Professor, Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais (UFMG)
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Verma GG, Sahni V. Noninvasive blood pressure cuff causing humerus fracture. Am J Emerg Med 2008; 26:1073.e1-2. [DOI: 10.1016/j.ajem.2008.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 04/02/2008] [Indexed: 12/26/2022] Open
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Unveiling the 'unique bone': a study of the distribution of focal clavicular lesions. Skeletal Radiol 2008; 37:749-56. [PMID: 18483738 DOI: 10.1007/s00256-008-0507-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/26/2008] [Accepted: 04/07/2008] [Indexed: 02/02/2023]
Abstract
AIM Clavicle is a unique bone for many reasons. There is no study discussing the differential diagnosis of clavicular lesions based on the site of occurrence or age at presentation. This study aims to determine whether the distribution of lesions affecting the clavicle and age at presentation aid in the differential diagnosis of focal clavicular lesions. MATERIALS AND METHODS Clinical notes, imaging and histopathological reports of the clavicular lesions between Jan 1999 and Jan 2006 were reviewed. Virtually, all patients had been referred as suspected neoplasm. RESULTS Fifty-nine patients were identified. Patients <20 years (n = 27) had non-neoplastic or benign lesions. Patients between 20-50 years (n = 14) had predominantly non-neoplastic lesions. Patients >50 years (n = 18) had predominantly malignant lesions. The lesions most commonly affected the medial third (n = 35) and were predominantly non-neoplastic or benign. The middle third was affected in 15 patients and showed both benign and malignant lesions. The lateral third was least affected with predominance of malignant lesions. CONCLUSIONS The clavicle is not a primary common site for any particular tumour; hence, diagnosis of the lesions can be challenging. Our study has suggested that few factors like age and site of the lesions may be helpful in diagnosis.
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Fan G, Sinclair E, Christakis M, Erhlich L, Zubovits J, Chow E. Solitary bone metastasis beneath the shoulder shield: coincidence or cause? Curr Oncol 2006; 13:121-3. [PMID: 17576452 PMCID: PMC1891183 DOI: 10.3747/co.v13i4.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Post-mastectomy radiotherapy has been demonstrated to improve locoregional control in breast cancer patients. We report a case involving a 44-year-old breast cancer patient who presented with a solitary bone metastasis in the area beneath the shoulder shield, likely from a coincidental recurrence.
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Affiliation(s)
| | | | | | | | | | - E. Chow
- Correspondence to: Edward Chow, Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5. E-mail:
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