Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases
- 494 Downloads
To review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures.
Materials and Methods
Between May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57–75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment.
Four pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1–4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2–3 months; one case could not be followed due to early post-procedural oncologic mortality.
Percutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.
KeywordsPercutaneous osteosynthesis Screw fixation Pathological fracture Shoulder girdle
Compliance with Ethical Standards
Conflict of interest
The authors declare no conflict of interest or relevant disclosures.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.Deschamps F, de Baere T, Hakime A, Pearson E, Farouil G, Teriitehau C, Tselikas L. Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol. 2015; [Epub ahead of print].Google Scholar
- 8.Patel IJ, Davidson JC. Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727–36.CrossRefPubMedGoogle Scholar
- 11.Cazzato RL, Palussière J, Buy X, Denaro V, Santini D, Tonini G, Grasso RF, Zobel BB, Poretti D, Pedicini V, Balzarini L, Lanza E. Percutaneous long bone cementoplasty for palliation of malignant lesions of the limbs: a systematic review. Cardiovasc Interv Radiol. 2015;38(6):1563–72.CrossRefGoogle Scholar
- 14.Kelekis A, Filippiadis D, Anselmetti G, Brountzos E, Mavrogenis A, Papagelopoulos P, Kelekis N, Martin JB. Percutaneous augmented peripheral osteoplasty in long bones of oncologic patients for pain reduction and prevention of impeding pathologic fracture: the rebar concept. Cardiovasc Interv Radiol. 2016;39(1):90–6.CrossRefGoogle Scholar
- 19.Pusceddu C, Ballicu N, Melis L. Combined microwave ablation and percutaneous screws fixation plus cementoplasty in the treatment of painful bone metastases. Poster session presented at: Society of Interventional Radiology 2016; 2–7 April Vancouver, CA.Google Scholar
- 21.Bostelmann R, Keiler A, Steiger HJ, Scholz A, Cornelius JF, Schmoelz W. Effect of augmentation techniques on the failure of pedicle screws under cranio-caudal cyclic loading. Eur Spine J. 2015;24(3):1–8.Google Scholar