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Pathological fracture of a solitary bone cyst in the calcaneus: a case series and literature review.Archives of Orthopaedic and Trauma... Mar 2023Solitary bone cysts in the calcaneus (calcaneal bone cysts) are often asymptomatic. Pathological fractures are rare, and few reports are available concerning its risk... (Review)
Review
INTRODUCTION
Solitary bone cysts in the calcaneus (calcaneal bone cysts) are often asymptomatic. Pathological fractures are rare, and few reports are available concerning its risk assessment. Therefore, the indication for operative interventions remains debatable, and further discussion on the treatment of symptomatic cysts and pathological fractures in calcaneal bone cysts is necessary.
MATERIALS AND METHODS
Clinical data of 21 patients with calcaneal bone cysts (16 men and five women) was retrospectively reviewed. The average age was 13.3 (range, 7-23) years. Clinical data, such as concerning symptoms, radiological findings, pathological findings and outcomes, were investigated, and the pathogenesis of symptomatic cysts was studied.
RESULTS
Thirteen cysts were symptomatic, and eight were incidentally discovered. Computed tomography revealed no fracture in 12 cases, microfracture in eight and complete fracture in one. The areas under the curves of the receiver operating characteristic curves calculated to establish an association between cyst size and symptoms and cyst size and pathological fractures (microfracture and complete fracture) were 0.78 and 0.71, respectively. Symptomatic cysts and pathological fractures were associated with the cyst ratio (cyst size/calcaneus ≥ 0.20). On magnetic resonance imaging (MRI), fluid levels were observed in 11 of 21 (52%) patients. At the time of surgery, blood from the haemorrhage was aspirated from 15 of 21 (71%) cysts.
CONCLUSIONS
Orthopaedic surgeons should be aware that the cyst ratio is associated with clinical symptoms and pathological fractures. MRI and gross findings revealed haemorrhage in the cystic fluid. In calcaneal bone cysts, repeated microfractures and spontaneous healing might occur.
Topics: Male; Humans; Female; Adolescent; Fractures, Spontaneous; Calcaneus; Fractures, Stress; Retrospective Studies; Bone Cysts
PubMed: 34623493
DOI: 10.1007/s00402-021-04202-6 -
The Pan African Medical Journal 2021
Topics: Bone Neoplasms; Fractures, Spontaneous; Humans; Osteolysis
PubMed: 34754357
DOI: 10.11604/pamj.2021.39.280.25695 -
Saudi Medical Journal Jan 2015
Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Female; Femoral Fractures; Fractures, Spontaneous; Humans; Osteitis Deformans
PubMed: 25630017
DOI: 10.15537/smj.2015.1.11249 -
Injury Aug 2023
Topics: Humans; Fractures, Spontaneous; Neoplasms
PubMed: 37268531
DOI: 10.1016/j.injury.2023.05.048 -
The Surgeon : Journal of the Royal... Apr 2023We aimed to investigate the relationship between central sarcopenia and survival in patients with pathological fracture. (Review)
Review
INTRODUCTION
We aimed to investigate the relationship between central sarcopenia and survival in patients with pathological fracture.
METHODS
We reviewed records of patients who were treated for pathological fracture of axial and appendicular skeleton in our clinic between 2011 and 2020. We used the psoas: lumbar vertebral index (PLVI) on axial computer tomographic evaluation to assess for central sarcopenia. A multivariate Cox algorithm was applied to recognize these factors independently associated with one month, six months, one year, and overall survival.
RESULTS
A total of 147 patients [61 (41.4%) male and 86 (58.6%) female] were included, with an average age of 62.4 years. During the study, 108 (73.4%) patients died, and 39 (26.6%) were alive. The survival rates at 1 month, 6 months, and 1 year after surgery were 94.6%, 68.7%, and 53.1%, respectively. PLVI values ranged from 0.21 to 1.20 with a mean of 0.536 and a median of 0.520. According to the median value of PLVI, 68 patients with sarcopenia had low PLVI and 79 patients without sarcopenia had high PLVI. For the first month, only the preoperative albumin level was identified as a prognostic factor. Eastern Cooperative Oncology Group Performance Status (ECOG), American Society of Anesthesia (ASA) scores and primary malignancy (rapid grade) were strong predictor of poor survival. The PLVI was independent significant predictor of first month (HR, 0.083 [95% CI, 0.011-0.649], p = 0.018) and overall survival (HR, 0.129 [95% CI, 0.034-0.492], p = 0.003).
CONCLUSION
The PLVI was a strong predictor of first year, and overall survival in patients with pathological fracture.
Topics: Humans; Male; Female; Middle Aged; Fractures, Spontaneous; Sarcopenia; Retrospective Studies; Prognosis
PubMed: 35430110
DOI: 10.1016/j.surge.2022.03.005 -
Journal of Orthopaedic Science :... May 2021The aim of this retrospective study is to analyze history and treatment outcomes of pathological fracture (PF) in dedifferentiated chondrosarcoma (DdChS) of the limbs..
BACKGROUND
The aim of this retrospective study is to analyze history and treatment outcomes of pathological fracture (PF) in dedifferentiated chondrosarcoma (DdChS) of the limbs..
METHODS
We retrospectively reviewed 175 adult patients with primary DdChS of the limbs.Disease-specific survival (OS) and local recurrence (LR) were analyzed.
RESULTS
Median age was 66 years (range, 29-91). Most DdChS (121, 69.1%) were localized in the femur. Forty-nine (28.0%) had metastasis at diagnosis; thirty-nine DdChS (22.3%) had a PF.OS rate was lower in patients with metastasis at diagnosis (8.6% Vs 41.0% at 10 years, p < 0.001). A similar OS was observed among patients with localized disease, whether with/without PF (p = 0.638), with/without chemotherapy (p = 0.543) and independently from the type of surgery (resection/amputation) (p = 0.877). Amputation reduces the risk of LR (80.0% vs 63.1% at 5 years, p = 0.039), particularly in the PF group..
CONCLUSION
Patients with metastases have a particularly poor prognosis in DdChS, but pathological fracture does not influence prognosis in terms of survival and local control. Initial curative resection is essential in order to reduce the chance of recurrences. Amputation might be an option in patients with localized disease and a PF to reduce the risk of LR..
Topics: Adult; Aged; Bone Neoplasms; Chondrosarcoma; Fractures, Spontaneous; Humans; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies
PubMed: 32564907
DOI: 10.1016/j.jos.2020.04.013 -
The Lancet. Oncology Mar 2021
Topics: Aged; Breast Neoplasms; Female; Fractures, Spontaneous; Humans; Prognosis
PubMed: 33662289
DOI: 10.1016/S1470-2045(21)00074-7 -
Lancet (London, England) Jul 1966
Topics: Aged; England; Female; Fractures, Spontaneous; Humans; Jurisprudence
PubMed: 4161067
DOI: 10.1016/s0140-6736(66)91768-5 -
The Bone & Joint Journal Oct 2014Opinion remains divided as to whether the development of pathological fracture affects the prognosis of patients with an osteosarcoma of the extremities. We conducted a... (Meta-Analysis)
Meta-Analysis Review
Opinion remains divided as to whether the development of pathological fracture affects the prognosis of patients with an osteosarcoma of the extremities. We conducted a comprehensive systematic review and meta-analysis of papers which reported the outcomes of osteosarcoma patients with and without a pathological fracture. There were eight eligible papers for final analysis which reported on 1713 patients, of whom 303 (17.7%) had a pathological fracture. The mean age for 1464 patients in six studies was 23.2 years old (2 to 82). The mean follow-up for 1481 patients in seven studies was 90.1 months (6 to 240). The pooled estimates of local recurrence rates in osteosarcoma patients with and without pathological fractures were 14.4% (8.7 to 20.0) versus 11.4% (8.0 to 14.8). The pooled estimate of relative risk was 1.39 (0.89 to 2.20). The pooled estimates of five-year event-free survival rates in osteosarcoma patients with and without a pathological fracture were 49.3% (95% CI 43.6 to 54.9) versus 66.8% (95% CI 60.7 to 72.8). The pooled estimate of relative risk was 1.33 (1.12 to 1.59). There was no significant difference in the rate of local recurrence between patients who were treated by amputation or limb salvage. The development of a pathological fracture is a negative prognostic indicator in osteosarcoma and is associated with a reduced five-year event-free survival and a possibly higher rate of local recurrence. Our findings suggest that there is no absolute indication for amputation, as similar rates of local recurrence can be achieved in patients who are carefully selected for limb salvage.
Topics: Bone Neoplasms; Combined Modality Therapy; Fractures, Spontaneous; Global Health; Humans; Incidence; Osteosarcoma; Prognosis; Survival Rate
PubMed: 25274928
DOI: 10.1302/0301-620X.96B10.34370 -
The British Journal of Radiology Sep 2021To determine the incidence and causes of pathological fractures in paediatric bone tumours and tumour-like lesions, and to determine if they are predictive of benign...
OBJECTIVE
To determine the incidence and causes of pathological fractures in paediatric bone tumours and tumour-like lesions, and to determine if they are predictive of benign lesions.
METHODS AND MATERIALS
Retrospective review of children with suspected bone tumours referred to a specialist musculoskeletal oncology service between September 2019 and August 2020. Data recorded included patient age and gender, lesion location, the presence of a pathological fracture on the initial plain radiograph, and the final diagnosis made either by image-guided biopsy/curettage or based on typical imaging features.
RESULTS
231 patients were included with 233 lesions (138 males and 93 females with mean age 10.5 years, range 3 months-18 years). Final diagnosis was based on histology in 85 (36.5%) cases and imaging in 148 (63.5%) cases, 52 (22.3%) lesions classed as non-neoplastic, 139 (59.7%) as benign and 42 (18%) as malignant. Pathological fractures were seen in 41 cases (17.6%) at presentation, involving the humerus in 19 (46.3%), the femur in 14 (34.1%), the tibia in 3 (7.3%), the fibula and radius in two each (4.9%) and the second toe proximal phalanx in 1 (2.4%) ( < 0.001). The commonest underlying lesions included simple bone cyst ( = 17; 41.5%) and non-ossifying fibroma ( = 10; 24.4%). Only 4 cases (9.75%) were malignant, one case each of osteosarcoma, Ewing sarcoma, leukaemia and BCOR undifferentiated round cell sarcoma. Pathological fracture occurred in 27.7% of non-malignant lesions and 9.5% of malignant lesions, this difference being statistically significant ( < 0.001).
CONCLUSION
Pathological fractures were seen in 17.6% of paediatric bone tumours, tumour-like lesions, being significantly associated with humeral location and non-malignant diagnosis.
ADVANCES IN KNOWLEDGE
Demonstrates the frequency, location and underlying diagnosis of pathological fractures in paediatric bone tumour and tumour-like lesions.
Topics: Adolescent; Bone Neoplasms; Bone and Bones; Child; Child, Preschool; Diagnosis, Differential; Female; Fractures, Spontaneous; Humans; Image-Guided Biopsy; Infant; Male; Radiography; Retrospective Studies
PubMed: 34319796
DOI: 10.1259/bjr.20201341