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Recent Advances in the Management of Pathological Fractures
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Recent Advances in the Management of Pathological Fractures

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 15 September 2024 | Viewed by 2585

Special Issue Editors

Prof. Dr. Giulio Maccauro

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Guest Editor
Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
Interests: pathological fractures; bone tumors; metastases; infection; prosthesis; hip; sarcoma; biomaterial
Dr. Raffaele Vitiello

E-Mail Website
Guest Editor
Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli—IRCCS, Largo Agostino Gemelli 8, Rome, Italy
Interests: infections; bone and soft tissue tumor; traumatology; foot and ankle surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Fractures occurring in the presence of pathological conditions present a complex and challenging scenario for orthopedic surgeons worldwide. In this Special Issue, we aim to shed light on the multifaceted nature of pathological fractures, extending beyond oncological pathology. Our focus will encompass metabolic bone disorders, post-radiation therapy complications, infections, and rheumatic diseases, highlighting the diverse spectrum of pathological tissue fractures.

Understanding the mechanisms underlying these fractures is paramount, as they pose unique diagnostic and therapeutic dilemmas. The orthopedic community is constantly striving to refine its knowledge and surgical approaches to effectively manage these intricate cases. By examining the intricacies of pathological fractures, we hope to advance our understanding of their pathophysiology and improve treatment strategies.

We invite researchers, clinicians, and experts in the field to contribute their original research and perspectives to this Special Issue. We aim to create a comprehensive platform for sharing innovative techniques, novel diagnostic methods, and therapeutic interventions that can enhance patient outcomes.

We look forward to receiving a multitude of submissions, which will undoubtedly enrich our understanding of these distinctive aspects of orthopedic care.

Prof. Dr. Giulio Maccauro
Dr. Raffaele Vitiello
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pathological fracture
  • metastasis
  • genetic disease
  • sarcoma
  • infection
  • rheumatic disease
  • bone tumor
  • insufficiency fractures

Published Papers (4 papers)

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10 pages, 1176 KiB  
Article
Pathological Fractures in Patients Affected by Pycnodysostosis: A Case Series
by Maria Beatrice Bocchi, Cristina Giuli, Francesco Farine, Camilla Ravaioli, Sara Martellini, Pasquale Farsetti and Osvaldo Palmacci
J. Clin. Med. 2024, 13(9), 2522; https://doi.org/10.3390/jcm13092522 - 25 Apr 2024
Viewed by 240
Abstract
Background/Objectives: Pycnodysostosis is a rare genetic disorder causing skeletal dysplasia. It is determined by a gene mutation leading to cathepsin K deficiency and predisposes a patient to osteosclerosis, resulting in increased bone fragility. The altered bone quality typical of this disease is [...] Read more.
Background/Objectives: Pycnodysostosis is a rare genetic disorder causing skeletal dysplasia. It is determined by a gene mutation leading to cathepsin K deficiency and predisposes a patient to osteosclerosis, resulting in increased bone fragility. The altered bone quality typical of this disease is responsible for an increased risk of fractures. The purpose of our study was to evaluate the orthopedic manifestations and potential pitfalls in the surgical treatments of pathological fractures in a series of patients treated in our institution who were affected by pycnodysostosis. Methods: We retrospectively evaluated clinical and radiographic characteristics of five patients with pycnodysostosis treated for pathological fractures at our hospital in the past 5 years. Results: Two male and three female patients were included in this study. Four patients had a family history of pycnodysostosis. All the patients were of short stature, but only two underwent growth hormone treatment. All the patients experienced fractures, mostly in their lower limbs and occurring as a result of low-energy trauma. Most of the patients experienced either consolidation delay or nonunion. Conclusions: The orthopedic management of fractures in patients with pycnodysostosis poses an ongoing challenge for orthopedic surgeons. The fact that the bone is simultaneously sclerotic and brittle makes any orthopedic surgical treatment challenging and at a high risk of nonunion in any case. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Pathological Fractures)
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10 pages, 708 KiB  
Article
Fragility Fractures in End-Stage Chronic Kidney Disease (CKD) Population: Patient-Related and CKD-Related Factor Analysis—A Single-Center Experience
by Domenico De Mauro, Gianmarco De Luca, Silvia Marino, Amarildo Smakaj, Giuseppe Rovere, Francesco Liuzza, Marcello Covino, Pierluigi Fulignati, Giuseppe Grandaliano and Omar El Ezzo
J. Clin. Med. 2024, 13(8), 2430; https://doi.org/10.3390/jcm13082430 - 21 Apr 2024
Viewed by 696
Abstract
Background: Chronic kidney disease (CKD) stands as a prevalent global health concern, and mineral and bone disease are among the most impactful consequences. A severe complication arising from mineral and bone disease is the occurrence of fragility fractures, which disproportionately affect individuals with [...] Read more.
Background: Chronic kidney disease (CKD) stands as a prevalent global health concern, and mineral and bone disease are among the most impactful consequences. A severe complication arising from mineral and bone disease is the occurrence of fragility fractures, which disproportionately affect individuals with CKD compared to the general population. The prevalence of these fractures impacts both survival rates and quality of life. The aims of this study are analyzing and identifying (i) patient-related risk factors and (ii) CKD-related risk factors to contribute to the development of preventive measures for fragility fractures for this population. Methods: A retrospective, single-center observational study was conducted, encompassing patient data from the years 2021 to 2023. Registry data were recorded, including patient-related and CKD-related data. Patients were interviewed about traumatological history, and their answers were recorded. Logistic regression analysis was employed to investigate the association between independent variables and dependent variables. Results: Eighty-four patients, with a mean age of 64.3 ± 15.2 years and a male percentage of 58.3%, were included in this study. Among them, 19.5% exhibited smoking habits. The mean Charlson Comorbidity Index was 3.06 ± 1.21. All patients were diagnosed with end-stage chronic kidney disease, with mean durations of 208 months from the diagnosis and 84.5 months from the beginning of dialysis. The logistic regression analysis, adjusted for age, sex, and CCI, revealed that smoking habits play a significant role as a risk factor for fragility fractures in lower limbs (p: 0.011 *). The incidence of fragility fractures increases directly proportionally to the time since diagnosis (p-value: 0.021 *) and the beginning of dialysis treatment (p-value: 0.001 *). Conclusions: Among patient-related factors, smoking habits seem to significantly affect lower-limb fracture rates (p < 0.05), whereas among CKD-related factors, time since CKD diagnosis and time since the beginning of dialysis treatment are directly related to higher risks of fragility fractures. No relevant correlations emerged in the studied treatments, except for a reduction in proximal femur fracture occurrence when patients underwent a combined treatment of a calcimimetic and a vitamin D analog. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Pathological Fractures)
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16 pages, 557 KiB  
Systematic Review
Pathological Fractures in Aneurysmal Bone Cysts: A Systematic Review
by Doriana Di Costa, Elena Gabrielli, Mariagrazia Cerrone, Emidio Di Gialleonardo, Giulio Maccauro and Raffaele Vitiello
J. Clin. Med. 2024, 13(9), 2485; https://doi.org/10.3390/jcm13092485 - 24 Apr 2024
Viewed by 240
Abstract
Background: Aneurysmal bone cysts (ABCs) are osteolytic, non-malignant, vascular lesions of the bone. Pathological fractures can be a manifestation of the ABCs, which occur in about 8% of ABCs. Different treatments have been described in the literature, but, nowadays, an optimal management of [...] Read more.
Background: Aneurysmal bone cysts (ABCs) are osteolytic, non-malignant, vascular lesions of the bone. Pathological fractures can be a manifestation of the ABCs, which occur in about 8% of ABCs. Different treatments have been described in the literature, but, nowadays, an optimal management of the pathological fractures in patients with ABCs is still a matter of debate and there are no standard guidelines for treatment nor any shared indication about the best surgical intervention. The aim of our study is to review the current literature available on this matter exploring and confronting different surgical treatments for pathological fractures in ABC in order to clarify the surgical approach to these patients. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases was carried out. The Preferred Reporting Items for Systematically Reviews and Meta-Analyses (PRISMA) were followed. Results: A total of 37 articles were relevant and were finally included in the study. In total, we reached a population of 140 patients. Of the 140 patients included in the review, 124 patients (88.6%) underwent curettage surgery, 15 patients (10.7%) underwent en bloc resection surgery. A total of 47% of patients (70) underwent synthesis surgery with a plate, screw, nail, or external fixator. Adjuvant treatments were used in 8.6% of patients (12). Complications involved 20.7% of the patients (29). Conclusions: In conclusion, the treatment of pathological fractures in aneurysmal bone cysts requires careful patient assessment, considering factors such as age, the presence of open growth plates, the location of the lesion, and the surgeon’s expertise. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Pathological Fractures)
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16 pages, 5264 KiB  
Systematic Review
Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors
by Bing-Kuan Chen, Ting-Han Tai, Shu-Hsuan Lin, Kuan-Hao Chen, Yu-Min Huang and Chih-Yu Chen
J. Clin. Med. 2024, 13(3), 755; https://doi.org/10.3390/jcm13030755 - 28 Jan 2024
Viewed by 1050
Abstract
(1) Background: Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for [...] Read more.
(1) Background: Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for the treatment of PHSF. However, there is still no standard for optimal surgical treatment. Thus, we conducted a meta-analysis comparing the clinical outcomes of INF with PF for PHSF treatment. (2) Methods: We conducted searches in databases, such as Scopus, EMBASE, and PubMed, for studies published prior to May 2023. In total, nine studies with 485 patients were reviewed. (3) Results: There were no significant differences noted in the incidence of fixation failure, local recurrence, wound complication or overall complication. However, the INF group demonstrated a significantly lower incidence of postoperative radial nerve palsy than the PF group (OR, 5.246; 95% CI, 1.548–17.774; p = 0.008). A subgroup analysis indicated that there were no statistically significant differences in fixation failure or local recurrence among subgroups categorized by the design of intramedullary nail. (4) Conclusions: Considering the short life expectancy of end-stage patients, the choice of surgical method depends on the patient’s individual condition, fracture and lesion patterns, the surgeon’s experience, and comprehensive discussion between the surgeon and patient. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Pathological Fractures)
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