do we stand?. Curr Osteoporos Rep. 2004; 2:24–30. 5. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005; 90:1294-301. 6. Higgins M, Morgan-John S, Badhe S. Simultaneous, bilateral, complete atypical femoral fractures after longterm alendronate use. Journal of Orthopaedics. 2016; 13:401-403. 7. Shane E, Burr D, Ebeling PR et al. Atypical subtrohanteric and diaphyseal femoral fractures: report of a task force of the
Ioan Mihai Japie, Radu Rădulescu, Adrian Bădilă, Ecaterina-Maria Japie, Alexandru Papuc, Traian Ciobanu, Adrian Dumitru and Cătălin Cîrstoiu
Teodora Serban, Iulia Satulu, Ioana Cretu, Oana Vutcanu, Mihaela Milicescu and Mihai Bojinca
, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino M-A et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005; 32:2485-7. 12. Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 2004; 63:988-94. 13. Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003; 48:955-62. 14. Naredo E, Gamero F
G.O. Muntean, M. Nica and T.Ș. Dumitrescu
Aim. Short and mid-term analysis of postoperative results after hip vicinity tumor resection and reconstruction with salvage of the lower limb. Material and method. Retrospective study on a number of 13 cases: 6 pelvis tumors, 3 femur tumors and 4 femur and pelvis tumors. 3 out of the total pelvis tumors were treated using custom pelvis reconstruction prosthesis, the other ones using bone graft and standard implants. The femoral tumors were treated using modular prosthesis and bone graft and osteosynthesis implants. Results. Short-term outcome was favorable. Conclusion. Bone defect reconstruction after hip vicinity tumor resection is a technically difficult procedure, which requires significant material resources. In terms of quality of life, the results are clearly superior compared to tumor resection with the sacrifice of the affected member.
D. Popescu, R. Nedelcu, Şt. Trifu and C. Cîrstoiu
Purpose. The periprosthetic fractures are a more and more often encountered type of pathology, in which the main problem is the indication for surgery. The most important thing is the choice of the best therapeutic option in order to get a solid fixation of the fracture and, in the end, to allow an early patient’s mobilization. Materials and method. 38 cases of periprosthetic fractures have been treated in the Orthopedics and Traumatology Department of University Emergency Hospital in Bucharest, between 2010 and 2016. International Vancouver classification was used for all cases. The osteosynthesis saving the femoral stem was preferred in 22 cases, as its stability was not affected. Stem revision was performed in 16 cases, as this was unstable due to the fracture. Acetabular component was also revised in 4 cases, as the PE insert presented severe wear. The patients were aged 52 to 84 years old and sex ratio M/ F = 13/ 25. Osteosynthesis was performed using Dall-Miles plates and molded plates, with braided cables or wire cerclage. Long stems, uncemented with or without distal locking, were used in 16 cases. Results. Postoperatively, the bone repair was efficient regarding the stability in most of the cases. The patients’ mobilization was early in most of the cases, except for the very old patients with associated comorbidities and limited biological resources. Conclusions. An appropriate surgical indication, adapted on each type of peri-implant fracture, leads to a good result, with early mobilization and the best consolidation of the fracture.
A. Bădilă, R. Manolescu, I. Japie, E. Bădilă, A. Papuc, C. Popovici, M. Tihulcă, A. Bujdei, D. Rădulescu, C. Cîrstoiu and R. Rădulescu
Aim: To assess the clinical results after osteosynthesis with locked intramedullary nail in metastasis of the long bones. Material and methods. We designed a prospective study in which we included all the patients with metastasis of the long bones admitted and surgically treated in our department between 2013 and 2015. Data for 64 were available at the final check-up. Our cohort totalized a number of 69 fractures (2 long bones required surgical treatment in 5 patients). The mean follow-up for survivors was 37 months (limits: 18-49 months). The primary tumor was known in 51 patients (79,69%). For the remaining 13 cases (20,31%), the primary tumor was not known and the pathological fracture was the first sign of the malignant disease. In the last group, the tumor could be identified by imagistic methods in 6 cases, while in other 3 cases, a biopsy and histological examination (which were performed in all the remaining 7 cases) determined the source organ. Clinical and radiological check-ups were performed at every 3 months in the first year and at every 6 months after that. Results. Pain amelioration and mobilization of the involved limb were achieved in all the cases. In 3 patients, the osteosynthesis could not compensate the progressive bone loss and the permanent use of an external orthosis was mandatory. The survival rate was 82,81% at 6 months and 67,19% at 12 months. Conclusions. All patients could be mobilized. Two thirds of the patients will survive more than a year. The goals of osteosynthesis are the same, regardless the location of the fracture and implant used: pain amelioration, stability for immediate full weight bearing, durability for patient’s life expectancy.
Introduction. Osteosarcomas represent 40% of bone sarcomas and occur mainly in children and young adults. They are tumors with a high degree of pulmonary metastasis. Pulmonary metastases occur in about 80% of the relapsed patients after primary tumor therapy, whether or not they have received chemotherapy. As therapeutic solutions, both first intention resection of the metastasis and the post-chemotherapy resection or repeated resections in each relapse, represent satisfactory results with prolongation of survival. Material and method. The present study describes a group of 17 patients who were surgically treated for osteosarcoma with different localizations and who presented themselves in the thoracic surgery department during 2011-2016 with suspicion of pulmonary metastases. Three of them were at their second intervention for metastasis resection. Following investigations, 4 of them (23.5%) could not benefit from surgical resection of pulmonary metastases (lesional extension with postoperative vital risk or technical impossibility of metastatic excision). Surgical interventions were curative; lobectomies were performed in 4 cases (30.7%), atypical resections in 8 cases (61.6%) and one pneumonectomy (7.7%). Postoperative progression was favorable in all 13 patients. Discussions and conclusions. Surgical excision of osteosarcoma pulmonary metastases can prolong survival and sometimes even cure disease. In order to benefit from the intervention, the patient should be served by a thoracic surgery clinic in the shortest possible time after the discovery of the pulmonary nodules. Thus, the need for thoracic imaging is required in patients treated for osteosarcoma. Late presentation makes the intervention impossible, particularly because of the lesional extension in the lung parenchyma or the invasion of the adjacent structures, extension given by the number of metastases or their size.
Ana Uzunov, Dan Popescu, Oana Bodean, Octavian Munteanu, Diana Voicu, Luciana Arsene, Florina Pauleţ, Monica Cîrstoiu and Cătălin Cîrstoiu
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Osama Al-Odat, Mahmoud Mousa Odat, Ștefana Luca, Mădălina Fotea, Andrei Nicolae Avadanei and Mateusz Zarzecki
acute respiratory distress syndrome in patients with multiple traumatic injuries despite low use of damage control orthopedics. J Trauma. 2009; 67(5):1013-1021. 7. Morshed S, Miclau T III, Bembom O, Cohen M, Knudson MM, Colford JM Jr. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009; 91(1):3-13. 8. Vallier HA, Moore TA, Como JJ et al. Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation. J
Mihaela Olaru and Cornelia Nitipir
, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. ClinOrthopRelat Res. 1980; 153:106-120. 11. Smolle MA, Dimosthenis A, Per-Ulf T, Szkandera J, Liegl-Atzwanger B, Leithner A. Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk. EFORT Open Rev. 2017; 2:421-431. 12. The ESMO/ European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2014; 25:iii102-iii112. 13. Judson I, Verweij J, Gelderblom H et al
Ramona Dobre, Dan Niculescu, Gheorghe Popescu, Adrian Barbilian, Cătălin Cîrstoiu and Cătălina Poiană
:1–11. 11. Mesa-Lampré MP, Canales-Cortés V, Castro-Vilela ME. Initial experiences of an orthogeriatric unit. Rev Esp Cir Ortop Traumatol. 2015; 59:429–438. 12. Panula J, Pihlajamäki H, Mattila VM et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord. 2011; 12:105. 13. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010 Mar; 39