Surgery and Functional Results of Pathological Fractures of Long Bones of Lower Extremities in Malignant Tumors

Abstract

ÖZETGiriş ve Amaç: Bu çalışmanın amacı; alt ekstremite uzun kemiklerinde malign patolojik kırıkların cerrahi ve fonksiyonel sonuçlarını değerlendirmek ve bu sonucu etkileyebilecek faktörleri ortaya koyabilmektir. Yöntem ve Gereçler: Çalışmaya alt ekstremite uzun kemiklerindeki malign patolojik kırık nedeniyle tedavi edilen 24'ü erkek 21'i kadın 45 hasta dahil edildi. Olguların yaşları 14-80 arasında ve ortalama yaş 59.8 idi. Hastalar ortalama 10.3 (1-60) ay süreyle takip edildi. Patolojik kırık lokalizasyonları 32 hastada femur proksimal, 7 hastada femur diafiz, 6 hastada ise femur distal yerleşimli idi. Bulgular: Fonksiyonel değerlendirmede Enneking'in MSTS skorlaması kullanıldı. Hastalarımızın tüm serilerdeki ortalama postoperatif MSTS skoru % 57.6 (% 26-% 93) idi. Bu oran Femur proksimali için ortalama % 57.3, Femur diafiz için ortalama % 61.7, Femur distal için ortalama % 54.6 olarak bulunmuştur. Tüm seride: Mükemmel: 3 (% 6), iyi: 12 (% 27), Orta: 16 (% 36), kötü 14 (% 31) sonuç elde edilmiştir. Sonuçlarımız litaratürle benzerdir. Tartışma ve Sonuç: Uzun kemik metastazlarının tedavi algoritmasının düzenlenmesi ve uygun cerrahi tedavinin planlanması halen günümüzde önemli bir problemdir. Tedaviye karar vermede ve hastaların evrelendirilmesinde onkolojinin temel prensipleri uygulanmalı ve multidisipliner bir yaklaşım sergilenmelidir. Cerrahi tedavide amaç ağrıyı azaltmak ve sonrasında hastaya yük verebileceği bir ekstremite kazandırmaktır. Anahtar Kelimeler: Patolojik kırık, Alt ekstremite, Cerrahi ABSTRACT Introduction: The aim of this study is to analyze the surgical and functional results of malign pathologic fractures of long bones of lower ekstremity and the factors releated with this results. Methods: 45 patients (24 male and 21 female) were included in the study who were treated with the diagnosis of pathologic fractures in the lower extremities. Mean age of the patients were between 14-80 years and average 59.8 years. Patients were followed up with a mean period of 10.3(1-60) months. 32 patients had proximal femur, 7 patients had femoral diaphysis and 6 patients had distal femoral fractures. Results: Enneking's MSTS classification system was used for functional assesment. The average postoperative score was 57.6(% 26-% 93) in all series. This average score was % 57.3 for proximal femur, % 61.7 for distal femoral diaphysis and % 54.6 for distal femur. Excellent results were recorded for 3(% 6), good results for 12(% 27), average results for 16 (% 36)and poor results for 14 (% 31) patients. The results were similar with literature. Discussion and Conclusion: The treatment algorithm and proper surgical technique is still a major problem in long bone metastases. While deciding the treatment method, we should use the basic oncologic rules and perform mutidisciplinar approach. The aim is to decrease pain and to provide a weight bearing extremity.

Are Daily Life Activities of Patients with Proximal Femoral Tumor Resection Prosthesis as Good as those of Patients Undergoing Total Hip Prosthesis for Non-Tumor Causes?

“…Which treatment is to be chosen to which patient is planned considering the type of the tumor, stage and the patient factors. 2,3 Radical resection of metastatic tumors gives good results, this protects the patient against local recurrences, cut-outs or the destruction of the implants. The best result is obtained by prosthesis use.…”

“…62 I No. 3 most frequent metastasis to bone stems from breast, kidney, thyroid, prostate cancer or myeloma. 2 The most important aim of treatment in malignant tumors around proximal femur is to decrease the pain in order to provide a better quality of life to patients.…”

“…A malignant tumor around proximal femur generally manifests with pain, and patients without proper follow-up present with pathological fractures. 3 The Barthel Index was introduced by Mahoney and Barthel in 1965 and then it was modified by Shah et al in 1992. 4 This scale is made up of 10 items as follows: feeding, cleaning, self-care, wearing, bowel control, bladder control, going to toilette, moving from wheelchair to bed, walking or dependency on wheel-chair, motion state, and ascending and descending stairs.…”

Concurrent Bilateral Subtrochanteric Femoral Fracture Related with Long-Term Biphosphonate Usage

“…In this case, we performed bilateral surgical treatment and determined that treatment was adequate in follow-up visits. Atypical femoral fractures can be treated with plaque fixation or intramedullary nailing, but intramedullary nailing is technically challenging due to cortical thickening (4,(14)(15)(16). We performed plaque fixation on one side and intramedullary proximal femoral nailing on the other.…”

Which one of the benign tumors and tumor-like lesions located in long bones needs prophylactic fixation during surgery?

“…Adjuvant measures such as phenol instillation or cryotherapy with liquid nitrogen may additionally be applied due to their chemical and physical effects improving the local effect of curettage. [1][2][3][4][5] Large bone cavities have been reinforced with autologous bone grafts, allografts, polymethylmethacrylate bone cement and bone substitutes. [6] Factors affecting the biomechanics of Objectives: This study aims to define the simultaneous prophylactic fixation indications of benign tumors and tumor-like lesions located in long bones that were treated by curettage and grafting/cementing.Patients and methods: Fifty-six patients (33 males, 23 females; mean age 30.9±15.9; range, 15 to 65 years) who were treated by curettage and grafting or cementation for their benign tumors or tumor-like lesions in long bones between January 2013 and June 2016 were retrospectively analyzed.…”