Andrea Piccioli1, Raimondo Piana2, Michele Lisanti3, Alberto Di Martino4, Barbara Rossi5, Francesco Camnasio6, Marco Gatti7, Pietro Maniscalco8, Franco Gherlinzoni9, Maria Silvia Spinelli10, Davide Maria Donati11, Roberto Biagini12, Rodolfo Capanna13, Vincenzo Denaro14. 1. Centro Oncologico di Palazzo Baleani, Policlinico Umberto I, Roma. 2. SC Ortopedia Oncologica e Ricostruttiva, AOU Città della Salute e della Scienza di Torino. 3. Ortopedia, Dipartimento di ricerca traslazionale e delle nuove tecnologie in medicina e chirurgia, Università di Pisa. 4. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome. Electronic address: dimartino.cbm@gmail.com. 5. Ortopedia e Traumatologia, Presidio Ospedaliero Alto Chiascio, ASLUmbria1. 6. Orthopaedic Oncology, San Raffaele Hospital, Milan. 7. IRCC Candiolo, Torino. 8. U.O.C. Traumatologia Provinciale dell'Azienda Unità Sanitaria Locale di Piacenza. 9. S.O.C. Ortopedia Ospedale di Gorizia. 10. Università Cattolica del Sacro Cuore, Rome, Italy. 11. Clinica Ortopedica e Traumatologica III a prevalente indirizzo Oncologico, Istituto Ortopedico Rizzoli ed Università di Bologna. 12. IFO Regina Elena Hospital, Rome. 13. Orthopaedic and Traumatologic Clinic, University of Pisa, Italy. 14. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome.
Abstract
INTRODUCTION: Carbon fiber reinforced (CFR) implants have been proposed for the treatment of fractures or impending fractures of the long bones in the oncology patient. Aim of this study is to present the largest cohort of oncology patients operated by CFR nailing by the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. METHODS: 53 adult oncology patients were operated on with a CFR-PEEK nail. All the data from adjuvants therapies were collected. Bone callus formation, response to radiotherapy, relapse or progression of the osteolysis were recorded. Hardware survival and failure, breakage and need for implant revision were also analysed. RESULTS: Anatomical implantation of nails include humerus (n = 35), femur (n =11) and tibia (n = 7). The most frequent tumors affecting the bone were myeloma (n = 13), breast (n = 11), lung (n = 8), and renal cell cancer (n = 7). Acrylic cement reinforcement was used in 2 patients. One patient was subjected to electrochemotherapy after nail insertion. Intraoperative and early postoperative complications occurred in 13.2% and 7.54% of patients respectively. Eight patients had local progression and one developed a stress fracture proximally to the distal static screw. Radiographic union occurred in 14 patients; one screw loosening was recorded. DISCUSSION: There is currently a lack of solid evidence on the clinical use of CFR nails in oncologic patients. This is the first and largest study of CFR nailing, with the longest available follow up. CONCLUSIONS: Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
INTRODUCTION:Carbon fiber reinforced (CFR) implants have been proposed for the treatment of fractures or impending fractures of the long bones in the oncology patient. Aim of this study is to present the largest cohort of oncology patients operated by CFR nailing by the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. METHODS: 53 adult oncology patients were operated on with a CFR-PEEK nail. All the data from adjuvants therapies were collected. Bone callus formation, response to radiotherapy, relapse or progression of the osteolysis were recorded. Hardware survival and failure, breakage and need for implant revision were also analysed. RESULTS: Anatomical implantation of nails include humerus (n = 35), femur (n =11) and tibia (n = 7). The most frequent tumors affecting the bone were myeloma (n = 13), breast (n = 11), lung (n = 8), and renal cell cancer (n = 7). Acrylic cement reinforcement was used in 2 patients. One patient was subjected to electrochemotherapy after nail insertion. Intraoperative and early postoperative complications occurred in 13.2% and 7.54% of patients respectively. Eight patients had local progression and one developed a stress fracture proximally to the distal static screw. Radiographic union occurred in 14 patients; one screw loosening was recorded. DISCUSSION: There is currently a lack of solid evidence on the clinical use of CFR nails in oncologic patients. This is the first and largest study of CFR nailing, with the longest available follow up. CONCLUSIONS: Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
Authors: Caleb M Yeung; Abhiram R Bhashyam; Olivier Q Groot; Nelson Merchan; Erik T Newman; Kevin A Raskin; Santiago A Lozano-Calderón Journal: Bone Jt Open Date: 2022-08