Surgical treatment of humeral metastatic tumors

Objective. To evaluate the functional outcome and pain control in patients after resection of humeral metastases. Material and methods. A prospective randomized study of 24 cases of metastatic disease of the humerus with an associated pathologic fracture was carried out. The selected cases were divided into two groups based on the using methylmethacrylate cement for fracture fixation. Group 1 (n=12) included all cases in which the fracture was treated with bone cement augmentation. Group 2 (n=12) included all cases in which the fracture was treated without bone cement augmentation. Functional outcome was evaluated according to the American Musculoskeletal Tumor Society system. Results. Good and excellent pain control was achieved in 95% of cases in both groups. Functional outcome after resection of humeral metastases and pathological fracture fixation was significantly better in Group 1. Total function in five patients (45%) accounted for 86% and in three patients (25%) for 83% of full normal upper extremity function, whereas in Group 2, total function in six patients (50%) accounted for 70% and in three patients (25%) for 83% of full normal upper extremity function. The rate of fixation failure was significantly greater in Group 2, where fixation instability was observed in 50% (n=6) of cases (P=0.03). There were no significant differences in complication rate (in 50% of cases, mechanical instability occurred after fixation with intramedullary nail and in 50% of cases after fixation with plates). Conclusions. The introduction of bone cement as an adjunct to fixation of pathologic fracture improved clinical results and reduced the rate of fixation failure

Surgical treatment of metastatic tumors of the femur

Objective. To evaluate the patients functional outcome and pain control after resection of metastatic femoral tumors. Material and methods. A prospective randomized clinical study was conducted, which included 26 cases of metastatic tumors of the femur with an associated pathologic fracture. These selected cases were randomly divided into two groups based upon the using of methylmethacrylate cement in fracture fixation. Group 1 (n=13) included all cases where the fractures were treated with bone cement augmentation. Group 2 (n=13) included all cases where the fractures were treated without bone cement augmentation. Functional outcome was evaluated according the American Musculoskeletal Tumor Society system. Results. Good and excellent pain control was achieved in 61.5%, satisfactory in 38.5% of all cases in the Group 1 versus 15.5% (P=0.015) and 69% (χ2=2.4762; P=0.115) of all cases in the Group 2. Functional outcome after femoral metastasis resection and pathologic fracture fixation was significantly better in the Group 1. Total lower extremity function of full normal function was 67% in the Group 1 versus 49% in the Group 2 (P<0.05). We did not observe significant difference between patients’ postoperative survival in the groups (P>0.05). The postoperative durability of stable pathologic fracture fixation was shorter in the Group 2 (273.9±51.7 vs. 358.9±116.8 days) comparing with Group 1 (P=0.03). Conclusions. The introduction of bone cement as the adjunct to the pathologic femoral fracture fixation significantly improved the clinical our study results: we achieved better functional outcome and better pain control

The assessment of clinical evaluation and treatment results of high-energy blunt polytrauma patients

The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome. Materials and methods. Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively. Results. The mean age of multiple trauma patients was 43.9±1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17–64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5±0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5±0.7, 7.0±0.8, and 23.6±1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died. Conclusions. Working-age male pedestrians (17–64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common