Percutaneous image-guided screws meditated osteosynthesis of impeding and pathological/insufficiency fractures of the femoral neck in non-surgical cancer patients

Eur J Radiol. 2017 May:90:1-5. doi: 10.1016/j.ejrad.2017.02.022. Epub 2017 Feb 17.

Abstract

Aim: To present percutaneous image-guided screw-mediated osteosynthesis (PIGSMO) for fixation of impending fractures (ImF) and non-displaced/mildly displaced pathological/insufficient fractures (PF/InF) of the femoral neck in non-surgical cancer patients.

Materials and methods: This is a double-centre single-arm observational study. Retrospective review of electronic records identified all oncologic patients who had undergone femoral neck PIGSMO. Inclusion criteria were: non-displaced or mildly displaced PF/InF, and ImF (Mirels' score ≥8); life expectancy ≥1 month; unsuitability for surgical treatment due to sub-optimal clinical fitness, refusal of consent, or unacceptable delay to systemic therapy.

Results: Eleven patients were treated (mean age 63.7±13.5 years) due to ImF (63.6%, mean Mirels' score 10.1), PF (27.3%) or post-radiation InF (9.1%) under CT/fluoroscopy- (36.4%) or CBCT- (63.6%) guidance. Thirty-two screws were implanted and cement injection was added in 36.4% cases. Technical success was 90.9%. No procedure related complications were noted. At 1-month clinical follow-up (pain/walking impairment), 63.6% and 27.3% patients reported significant and mild improvement, respectively. Imaging follow-up (available in 63.6% cases) showed no signs of secondary fractures, neither of screws loosening at mean 2.8 months. Five patients (45.5%) died after PIGSMO (mean time interval 3.6 months).

Conclusions: PIGSMO is technically feasible and safe in cancer patients with limited life expectancy; it offers good short-term results. Further prospective studies are required to corroborate mid- and to prove long-term efficacy of the technique.

Keywords: Bone metastasis; Impending fractures; Osteosynthesis; Pathological/insufficiency fractures; Proximal femur.

MeSH terms

  • Bone Cements
  • Bone Screws*
  • Femur Neck / physiopathology*
  • Fluoroscopy
  • Fracture Fixation, Internal / methods*
  • Fractures, Spontaneous / physiopathology*
  • Fractures, Stress / physiopathology*
  • Humans
  • Neoplasms
  • Prospective Studies
  • Retrospective Studies

Substances

  • Bone Cements