RESUMEN
Resumen: Objetivo: Reportar la incidencia de fracturas en terreno patológico secundarias a metástasis que se presentaron en un hospital de referencia nacional en un período de cinco años. Métodos: Se registraron los ingresos totales a nuestro centro, así como los pacientes que satisficieran la condición de presentar una fractura de fémur proximal en terreno patológico. Con base en información oficial, se calculó el tamaño de población derechohabiente potencial de acuerdo al área de influencia. Con base en los datos se hizo el cálculo de la incidencia anual y de la densidad de incidencia. Resultados: Se identificaron 98 fracturas en 95 individuos. El cálculo de la densidad de incidencia fue de 0.70/100,000 personas durante el período de observación. Se incluyeron 54 sujetos femeninos y 41 masculinos con un promedio de edad de 65.3 años, aunque el rango fue muy variable (de 18 a 90 años). La mayor parte de las personas presentó metástasis por tumores sólidos. De los casos, 29% fue tratado de manera conservadora y el resto requirió tratamiento quirúrgico que incluyó desde osteosíntesis hasta artroplastía protésica. El promedio de estancia hospitalaria fue ligeramente mayor a una semana. Conclusiones: La incidencia reportada es relativamente baja. Encontramos una gran variedad de orígenes y localizaciones anatómicas. No se puede, al momento, generalizar tratamientos o predecir supervivencia.
Abstract: Objective: To report the incidence of pathological fractures secondary to metastasis at a national referral hospital during a 5-year period. Methods: Total admissions to our center were recorded, together with the patients who met the requirement of having a proximal femur fracture in a pathological area. The potential number of beneficiaries was estimated based on official figures and the hospital's area of influence. The annual incidence rate and the incidence density were calculated using the latter data. Results: 98 fractures were identified in 95 patients. The calculated incidence density was 0.70/100,000 population during the observation period. Fifty-four female patients and 41 male patients were included. Mean age was 65.3 years, with a very wide age range (18-90 years). Most patients had metastasis of solid tumors. Twenty-nine percent of patients were treated conservatively and the rest of them required surgery that included from osteosynthesis to prosthetic arthroplasty. The mean length of stay was over one week. Conclusions: The reported incidence of this type of fractures is relatively low. We found a wide variety of anatomical origins and locations. As of now, it is not possible to generalize the treatment or predict the survival.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Neoplasias Óseas/complicaciones , Fracturas del Fémur/cirugía , Fracturas del Fémur/etiología , Fracturas del Fémur/epidemiología , Fracturas Espontáneas/etiología , Fracturas Espontáneas/epidemiología , Derivación y Consulta , Fémur , Fijación Interna de Fracturas , Persona de Mediana EdadRESUMEN
BACKGROUND: Locking reconstruction plates are used in the treatment of jaw trauma and diseases if there is a need for surgical resection and to prevent pathologic fracture after tumor excision. Fixation is typically performed using an extraoral approach. METHODS: This article describes a technique for the intraoral fixation of locking reconstruction plates that uses prototyping to model the plate before the procedure as well as an implant handpiece with adapted drills for bone drilling and the insertion of screws into relatively inaccessible areas. CONCLUSION: Intraoral fixation not only prevents nerve damage and facial scarring but also minimizes the plate's risk of extraoral exposure and reduces surgical morbidity. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1436-1439, 2016.
Asunto(s)
Placas Óseas , Fracturas Espontáneas/cirugía , Imagenología Tridimensional , Fracturas Mandibulares/cirugía , Neoplasias Mandibulares/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Tornillos Óseos , Femenino , Fijación de Fractura/instrumentación , Fijación de Fractura/métodos , Curación de Fractura/fisiología , Fracturas Espontáneas/diagnóstico por imagen , Humanos , Masculino , Fracturas Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/diagnóstico por imagen , Procedimientos Quirúrgicos Orales/métodos , Radiografía Panorámica/métodos , Procedimientos de Cirugía Plástica/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
OBJECTIVE: To report the incidence of pathological fractures secondary to metastasis at a national referral hospital during a 5-year period. METHODS: Total admissions to our center were recorded, together with the patients who met the requirement of having a proximal femur fracture in a pathological area. The potential number of beneficiaries was estimated based on official figures and the hospitals area of influence. The annual incidence rate and the incidence density were calculated using the latter data. RESULTS: 98 fractures were identified in 95 patients. The calculated incidence density was 0.70/100,000 population during the observation period. Fifty-four female patients and 41 male patients were included. Mean age was 65.3 years, with a very wide age range (18-90 years). Most patients had metastasis of solid tumors. Twenty-nine percent of patients were treated conservatively and the rest of them required surgery that included from osteosynthesis to prosthetic arthroplasty. The mean length of stay was over one week. CONCLUSIONS: The reported incidence of this type of fractures is relatively low. We found a wide variety of anatomical origins and locations. As of now, it is not possible to generalize the treatment or predict the survival.
Reportar la incidencia de fracturas en terreno patológico secundarias a metástasis que se presentaron en un hospital de referencia nacional en un período de cinco años.
Asunto(s)
Neoplasias Óseas , Fracturas del Fémur , Fracturas Espontáneas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/complicaciones , Femenino , Fracturas del Fémur/epidemiología , Fracturas del Fémur/etiología , Fracturas del Fémur/cirugía , Fémur , Fijación Interna de Fracturas , Fracturas Espontáneas/epidemiología , Fracturas Espontáneas/etiología , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: To describe the surgical treatment of patients with a pathologic fracture through a benign tumor of the proximal femur to determine if there is a difference in local recurrence, complications or functional outcome compared to patients with tumors in the same location without pathologic fractures. METHODS: From 1989-2010, of 97 patients, 29 presented with a pathologic fracture (PF) through a proximal femoral benign bone tumor and 68 presented without a pathologic fracture (NPF). Outcomes of the two groups were compared in terms of surgical management, postoperative complications, local recurrence and functional scores. RESULTS: Fibrous dysplasia, giant cell tumor of bone and chondroblastoma were the most common subtypes. Most patients were managed with joint preservation in both PF (86.2%) and NPF (98.5%) groups (P = 0.03). Local recurrence risk was similar for patients in the PF (10.3%) and NPF (8.8%) groups. Mean follow-up was 105.7 months (P = 0.8). Functional outcome scores were high in both groups and not statistically significantly different. CONCLUSIONS: The majority of pathologic fractures through a benign bone tumor of the proximal femur can be successfully treated with curettage, burring, bone grafting and internal fixation without increasing the risk of local recurrence or negatively impacting functional outcome.