Keypoints
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Bone metastases are frequently complicated by three different types of fractures.
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Percutaneous image-guided osteoplasty and osteosynthesis can be used to fix cancer-related bone fractures.
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Percutaneous osteoplasty and osteosynthesis should be mainly offered to “non-surgical” patients.
Introduction
Type of fractures
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Bone insufficiency fractures resulting from the bone necrosis secondary to percutaneous ablation or radiotherapy or resulting from the bone resorption as a result of tumor metabolism or certain treatments (e.g., chemotherapy, long-term steroid treatment) (Fig. 1).
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Pathologic fractures resulting from bone replacement by infiltrating tumor (Fig. 2).
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Impending fractures being consistent with painful and extensive metastatic tumor involvement of the weight-bearing bones, which are therefore at an increased risk of fracture; subsequently, preventive consolidation is highly advised (Fig. 3).
Interventional strategies
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Demonstrating soft-tissue infiltration requiring tumor debulking to prevent the complications to the adjacent organs or to control pain [15].
Percutaneous techniques and their selection
Osteoplasty
Solid phase composition | • PMMA pre-polymer and/or copolymers of acrylic acid (AA) • Activator of the polymerization: benzoyl peroxide • Radiopacifiers: barium sulfate, zirconium dioxide, tantalum, and tungsten |
Liquid phase composition | • Methyl methacrylate monomer • Activator of the polymerization: N-N-dimethyl-p-toluidine (DMPT) • Inhibitor of polymerization during storage: hydroquinone (HQ) |
Bending modulus Bending strength Compressive strength | • 2600–3500 MPa • 46–76 MPa • 70–111 MPa |
Osteosynthesis
Selection of the consolidative technique
Spine
Pelvic area
Long bones
1 point | 2 points | 3 points | |
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Lesion Aspect | Blastic | Mixed | Lytic |
Cortical Involvement | < 1/3 | 1/3–2/3 | > 2/3 |
Site | Upper limb | Lower limb | Trochanteric region |
Pain | +/− | Moderate | Mechanic |