RESUMEN
BACKGROUND: The gold-standard treatment for Vancouver type B2 and B3 fractures is revision arthroplasty. This procedure can be prolonged and complex, posing challenges for patients with severe medical comorbidities and reduced physical status. Recently, osteosynthesis has been proposed as an alternative treatment for B2 periprosthetic femoral fractures (PFF) in frail patients, though its efficacy compared to revision arthroplasty has not been studied in detail. METHODS: A retrospective study was conducted from 2012 to 2022, comparing complications, mortality, length of stay, gait ability, hemoglobin decrease, and blood transfusion rates between 44 patients undergoing treatment for B2 or B3 PPF with either stem-revision arthroplasty (n = 28) or open reduction and internal fixation (ORIF) with plates and screws (n = 16). RESULTS: The results showed no significant differences in mortality, complications, hemoglobin decrease, blood transfusion rate, or length of stay between the two groups. In the stem-revision group, 11 patients (60.7 %) experienced a medical complication, while 7 patients (43.8 %) in the ORIF group had complications (p = 0.778). The mortality rate within the first year post-surgery was 17.9 % (5 patients) in the stem-revision group compared to 18.8 % (3 patients) in the ORIF group (p = 0.943). Surgical complications occurred in 2 patients (7.1 %) in the stem-revision group and in 4 patients (25 %) in the ORIF group (p = 0.101). Blood transfusions were required in 17 patients (60.7 %) in the stem-revision group and in 8 patients (50 %) in the ORIF group (p = 0.829). CONCLUSIONS: This study suggests that ORIF is an acceptable treatment option for patients with B2 or B3 PFF, especially for those with severe medical comorbidities and reduced physical status who may not tolerate revision arthroplasty. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. LEVEL OF EVIDENCE: IV.
RESUMEN
La toma de decisiones en pacientes con metástasis vertebral es de gran complejidad. En ella intervienen distintos factores del paciente, de su enfermedad oncológica y de las opciones de tratamiento. Los esquemas y estrategias de tratamiento se han ido modificando con la propia evolución del conocimiento y tratamiento de la enfermedad oncológica diseminada. En este trabajo se analiza la bibliografía que se ha empleado para la toma de decisiones en las tres últimas décadas, así como la evolución a los esquemas que podríamos considerar contemporáneos.(AU)
Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Toma de Decisiones , Metástasis de la Neoplasia/terapia , Compresión de la Médula Espinal , Columna Vertebral , Traumatología , Procedimientos OrtopédicosRESUMEN
La toma de decisiones en pacientes con metástasis vertebral es de gran complejidad. En ella intervienen distintos factores del paciente, de su enfermedad oncológica y de las opciones de tratamiento. Los esquemas y estrategias de tratamiento se han ido modificando con la propia evolución del conocimiento y tratamiento de la enfermedad oncológica diseminada. En este trabajo se analiza la bibliografía que se ha empleado para la toma de decisiones en las tres últimas décadas, así como la evolución a los esquemas que podríamos considerar contemporáneos.(AU)
Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Toma de Decisiones , Metástasis de la Neoplasia/terapia , Compresión de la Médula Espinal , Columna Vertebral , Traumatología , Procedimientos OrtopédicosRESUMEN
Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.
RESUMEN
Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.