Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region

Abstract

• Reinforced cementoplasty (RC) combines intralesional spindling with cementoplasty. • RC provides effective bone stability and pain relief. • RC is a suitable minimally invasive option for patients in poor general condition.

Biomechanical effects of osteoplasty with or without Kirschner wire augmentation on long bone diaphyses undergoing bending stress: implications for percutaneous imaging-guided consolidation in cancer patients

“…Despite the clinical inadequacy of stand-alone osteoplasty for consolidation of long bone pathological/impending fractures [6] and the rapid implementation of numerous alternative techniques [9–18], there has been little evaluation of the biomechanical efficacy of these procedures. In the proximal femur, a few cadaveric studies have shown that femoroplasty effectively consolidates osteoporotic bone subjected to sideways falling [20–22] and may reduce mechanical stress around stance-loaded simulated femoral neck tumours provided that cement filling is adequate [23].…”

“…In several reports, osteoplasty has been combined with dedicated spindles, modified mandrins, and multiple micro-needle mesh to optimise biomechanical resistance of PMMA to multi-directional stresses ( rebar concept ) [10]. Studies in the proximal femur [9, 10, 12] and long bone diaphyses [10] have illustrated good analgesia and restoration of functional status, with either no secondary fractures [9, 10] or fewer than with osteoplasty alone [12], at 6–16-month follow-up. Our study did not demonstrate any beneficial effect of osteoplasty augmented with K-wires, although this may reflect sample limitations, test protocol, or suboptimal composite material properties.…”

“…This has been attributed to suboptimal material properties of polymethyl methacrylate (PMMA) cement, weaker under bending stress (64 MPa) than under compression (93 MPa); and osteoplasty alone has been discouraged for long bone tumours [7, 8]. Multiple clinical studies have recently implemented a wide range of adjunctive techniques to optimise long bone consolidation [9–18] (Table 1). However, pre-clinical biomechanical studies are substantially lacking.…”

“…Multiple clinical studies have recently implemented a wide range of adjunctive techniques to optimise long bone consolidation [9–18] (Table 1). However, pre-clinical biomechanical studies are substantially lacking.…”

Musculoskeletal interventional oncology: current and future practices

“…64 Accordingly, several different methods have been described with the intent of increasing the biomechanical efficacy of osteoplasty performed with poly-methyl methacrylate (PMMA) injection into long bones. [65][66][67][68][69] Unfortunately, many of these described techniques still lack a formal biomechanical validation, limiting the available repertoire of percutaneous biomechanically validated consolidation procedures in long bones to flexible or bundle intramedullary nailing. [70][71][72][73] Concerning the biomechanical reinforcement granted by standard osteoplasty in areas undergoing compressive stress, recent studies have suggested that effective biomechanical stabilisation is achieved when extensive and complete filling of the bone defect is obtained, thus preventing new, or worsening of pre-existing fractures.…”