Outcomes of long bones treated with carbon-fiber nails for oncologic indications: international multi-institutional study

Background: Intramedullary nail fixation is commonly used for prophylactic stabilization of impending and fixation of complete pathological fractures of the long bones. However, metallic artifacts complicate imaging evaluation for bone healing or tumor progression and postoperative radiation planning. Carbon-fiber implants have gained popularity as an alternative, given their radiolucency and superior axial bending. This study evaluates incidences of mechanical and nonmechanical complications.Methods: Adult patients (age 18 years and older) treated with carbon-fiber nails for impending/complete pathological long bone fractures secondary to metastases from 2013 to 2020 were analyzed for incidences and risk factors of mechanical and nonmechanical complications. Mechanical complications included aseptic screw loosening and structural failures of host bone and carbon-fiber implants. Deep infection and tumor progression were considered nonmechanical. Other complications/adverse events were also reported.Results: A total of 239 patients were included; 47% were male, and 53% were female, with a median age of 68 (IQR, 59 to 75) years. Most common secondary metastases were related to breast cancer (19%), lung cancer (19%), multiple myeloma (18%), and sarcoma (13%). In total, 17 of 30 patients with metastatic sarcoma received palliative intramedullary nail fixation for impending/complete pathological fractures, and 13 of 30 received prophylactic nail stabilization of bone radiated preoperatively to manage juxta-osseous soft-tissue sarcomas, where partial resection of the periosteum or bone was necessary for negative margin resection. 33 (14%) patients had complications. Mechanical failures included 4 (1.7%) structural host bone failures, 7 (2.9%) implant structural failures, and 1 (0.4%) aseptic loosening of distal locking screws. Nonmechanical failures included 8 (3.3%) peri-implant infections and 15 (6.3%) tumor progressions with implant contamination. The 90-day and 1-year mortalities were 28% (61/239) and 53% (53/102), respectively. The literature reported comparable failure and mortality rates with conventional titanium treatment.Conclusions: Carbon-fiber implants might be an alternative for treating impending and sustained pathological fractures secondary to metastatic bone disease. The seemingly comparable complication profile warrants further cohort studies comparing carbon-fiber and titanium nail complications.</div

Skeletal reconstruction after tumor resection of the distal femur

After tumor resection of the distal femur, limb salvage with preservation of joint function may be achieved using endoprostheses or osteoarticular allografts or a combination of the two (composite allografts). The choice among these reconstructive solutions must be made considering the functional results achievable and the risk of failure of the implant. The present literature review suggested that prosthetic replacement of the distal femur is more reliable than osteoarticular allograft at long-term follow-up

Unicameral and aneurysmal bone cysts.

Unicameral and aneurysmal bone cysts are considered tumorlike conditions of unclear origin. The diagnosis of unicameral bone cysts is almost always based on the radiographic appearance, whereas aneurysmal bone cyst imaging may sometimes mimic a sarcomatous lesion. Several pathogenetic hypotheses [correction of hypothesis] reported in literature have been described. Classifications have been proposed to detect the activity of the cysts and to predict the prognostic behavior. The results observed with different options of treatment have been discussed

"Innesti osteoarticolari di gomito totale"

Innesti osteoarticolari di gomito total

"Megaprostheses Versus Osteoarticular Grafts in Limb Salvage Surgery"

Megaprostheses Versus Osteoarticular Grafts in Limb Salvage Surger

"Sacral Resection for Bone Tumor"

Sacral Resection for Bone Tumo

Metastatic Carcinoma of Long Bones and Girdles. Preliminary Results of a Multicentric Sutdy on a New Protocol of Treatment

Metastatic Carcinoma of Long Bones and Girdles. Preliminary Results of a Multicentric Sutdy on a New Protocol of Treatmen

Brachytherapy and External Beam Irradiation as Adjuvant Treatment of Soft Tissue Sarcomas

Brachytherapy and External Beam Irradiation as Adjuvant Treatment of Soft Tissue Sarcoma

Chirurgia ricostruttiva nel trattamento dei sarcomi delle parti molli

Chirurgia ricostruttiva nel trattamento dei sarcomi delle parti moll

Prosthetic reconstruction after shoulder girdle resection for bone tumours

Prosthetic reconstruction after shoulder girdle resection for bone tumour