Julien Garnon1, Guillaume Koch2, Nitin Ramamurthy3, Jean Caudrelier2, Pramod Rao4, Georgia Tsoumakidou2, Roberto Luigi Cazzato2, Afshin Gangi2. 1. Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France. juliengarnon@gmail.com. 2. Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France. 3. Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK. 4. ICube, University of Strasbourg, Strasbourg, France.
Abstract
OBJECTIVE: To review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures. MATERIALS AND METHODS: Between May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57-75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment. RESULTS: Four pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1-4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2-3 months; one case could not be followed due to early post-procedural oncologic mortality. CONCLUSION: Percutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.
OBJECTIVE: To review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures. MATERIALS AND METHODS: Between May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57-75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment. RESULTS: Four pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1-4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2-3 months; one case could not be followed due to early post-procedural oncologic mortality. CONCLUSION: Percutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.
Authors: Roberto Luigi Cazzato; Julien Garnon; Nitin Ramamurthy; Guillaume Koch; Georgia Tsoumakidou; Jean Caudrelier; Francesco Arrigoni; Luigi Zugaro; Antonio Barile; Carlo Masciocchi; Afshin Gangi Journal: Med Oncol Date: 2016-11-11 Impact factor: 3.064