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Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases

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Abstract

Objective

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.

Results

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.

Conclusion

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.

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References

  1. Agarwal MG, Nayak P. Management of skeletal metastases: an orthopaedic surgeon’s guide. Indian J Orthop. 2015;49(1):83–100.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Iguchi T, Ogawa K, Koi T, Miyasho K, Munetomo K, Hiraki T, Ozaki T, Kanazawa S. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Skeletal Radiol. 2010;39(7):701–5.

    Article  PubMed  Google Scholar 

  3. Strobl FF, Haeussler SM, Paprottka PM, Hoffmann RT, Pieske O, Reiser MF, Trumm CG. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring. Skeletal Radiol. 2014;43(8):1093–100.

    Article  PubMed  Google Scholar 

  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].

  5. Muramatsu K, Ihara K, Iwanagaa R, Taguchi T. Treatment of metastatic bone lesions in the upper extremity: indications for surgery. Orthopedics. 2010;33(11):807.

    PubMed  Google Scholar 

  6. Sun JZ, Zheng GH, Zhao KY. Minimally invasive treatment of clavicular fractures with cannulated screw. Orthop Surg. 2014;6(2):121–7.

    Article  PubMed  Google Scholar 

  7. Bhatia DN. Orthogonal biplanar fluoroscopy-guided percutaneous fixation of a coracoid base fracture associated with acromioclavicular joint dislocation. Tech Hand Up Extrem Surg. 2012;16(1):56–9.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  9. Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. AJNR Am J Neuroradiol. 1994;15(1):83–6.

    CAS  PubMed  Google Scholar 

  10. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.

    Article  PubMed  Google 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.

    Article  Google Scholar 

  12. Filippiadis DK, Tutton S, Mazioti A, Kelekis A. Percutaneous image-guided ablation of bone and soft tissue tumours: a review of available techniques and protective measures. Insights Imaging. 2014;5(3):339–46.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tian QH, He CJ, Wu CG, Li YD, Gu YF, Wang T, Xiao QP, Li MH. Comparison of percutaneous cementoplasty with and without interventional internal fixation for impending malignant pathological fracture of the proximal femur. Cardiovasc Interv Radiol. 2016;39(1):81–9.

    Article  Google 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.

    Article  CAS  Google Scholar 

  15. Kelekis A, Filippiadis DK, Kelekis NL, Martin JB. Percutaneous augmented osteoplasty of the humeral bone using a combination of microneedles mesh and cement. J Vasc Interv Radiol. 2015;26(4):595–7.

    Article  PubMed  Google Scholar 

  16. Abdel-Aal AK, Underwood ES, Saddekni S. Use of cryoablation and osteoplasty reinforced with Kirschner wires in the treatment of femoral metastasis. Cardiovasc Interv Radiol. 2012;35(5):1211–5.

    Article  Google Scholar 

  17. Kurup AN, Morris JM, Schmit GD, Atwell TD, Schmitz JJ, Rose PS, Callstrom MR. Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation. J Vasc Interv Radiol. 2015;26(4):588–94.

    Article  PubMed  Google Scholar 

  18. Zachos A, Leali PT, Doria C. Percutaneous treatment of the spinal metastases. J Spine. 2012;1:110. doi:10.4172/2165-7939.1000110.

    Article  Google 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.

  20. Tsoumakidou G, Borensztein M, Zini C, Garnon J, Gangi A. Postablation insufficiency fracture of the iliac crest: management by percutaneous screw fixation. Cardiovasc Intervent Radiol. 2014;37(4):1126–8.

    Article  PubMed  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 

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Authors and Affiliations

  1. Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France

    Julien Garnon, Guillaume Koch, Jean Caudrelier, Georgia Tsoumakidou, Roberto Luigi Cazzato & Afshin Gangi

  2. Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK

    Nitin Ramamurthy

  3. ICube, University of Strasbourg, Strasbourg, France

    Pramod Rao

Authors
  1. Julien Garnon
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  2. Guillaume Koch
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  3. Nitin Ramamurthy
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  4. Jean Caudrelier
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  5. Pramod Rao
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  6. Georgia Tsoumakidou
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  7. Roberto Luigi Cazzato
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  8. Afshin Gangi
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Correspondence to Julien Garnon.

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The authors declare no conflict of interest or relevant disclosures.

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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.

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Informed consent was obtained from all individual participants included in the study.

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Garnon, J., Koch, G., Ramamurthy, N. et al. Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases. Cardiovasc Intervent Radiol 39, 1332–1338 (2016). https://doi.org/10.1007/s00270-016-1333-2

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  • DOI: https://doi.org/10.1007/s00270-016-1333-2

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