Background and purpose: Patients with advanced cancer may develop painful bone metastases, potentially resulting in pathological fractures. Adequate fracture risk assessment is of key importance to... Show moreBackground and purpose: Patients with advanced cancer may develop painful bone metastases, potentially resulting in pathological fractures. Adequate fracture risk assessment is of key importance to prevent fracturing and maintain mobility. This study aims to validate the clinical reliability of axial cortical involvement with a 30 mm threshold on conventional radiographs to assess fracture risk in femoral bone metastases.Materials and methods: All patients with bone metastases who received radiotherapy for pain included in two multicentre prospective studies were selected. Conventional radiographs obtained at a maximum of two months prior to radiotherapy were collected. Three experts independently measured lesions and scored radiographic characteristics. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were calculated.Results: Hundred patients were included with a median follow-up of 23.0 months (95%CI: 10.6-35.5). Two fractures occurred in lesions with axial cortical involvement <30 mm, and 12 in lesions >= 30 mm. Sensitivity, specificity, PPV and NPV of axial cortical involvement for predicting femoral fractures were 86%, 50%, 20% and 96%, respectively. Patients with lesions >= 30 mm had a 5.3 times higher fracture risk than patients with smaller lesions.Conclusion: Our validation study confirmed the use of 30 mm axial cortical involvement to assess fracture risk in femoral bone metastases. Until a more accurate and practically feasible method has been developed, this clinical parameter remains an easy method to assess femoral fracture risk to aid patients and clinicians to choose the optimal individual treatment modality. (C) 2019 Elsevier B.V. All rights reserved. Show less
Eggermont, F.; Derikx, L.C.; Verdonschot, N.; Geest, I.C.M. van der; Jong, M.A.A. de; Snyers, A.; ... ; Tanck, E. 2018
Objectives In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from... Show moreObjectives In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians.Methods A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separatelyfor the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians.Results In institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments.Conclusion FE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines. Show less
Demographic changes will result in a tidal wave of hip fractures in the growing group of frail octo- and nonagenarian citizens. These osteoporotic fractures are a major burden to the patients__... Show moreDemographic changes will result in a tidal wave of hip fractures in the growing group of frail octo- and nonagenarian citizens. These osteoporotic fractures are a major burden to the patients__ quality of life. Despite all preventive measures, predominantly focusing on osteoporosis medication, the total number of second, contralateral hip fractures has not declined over the past decades. Complications and institutionalization after surgery of these second hip fractures are increased and can be held responsible for a decrease in quality of life for these patients and high healthcare costs. In this thesis Elastomer femoroplasty (EF) is introduced as a new modality in the prevention of hip fracture surgey We found that in, in-vitro, cadaver, biomechanical experiments, EF prevents dislocation after fracture and after fracture-loading compared to untreated control femurs. These preventively treated hip fractures can be cyclically loaded with forces that well exceed the loads during normal gait. Elastomer Femoroplasty is a feasible and a readily available, minimal invasive technique to prevent second hip fracture surgery. It can be applied during ipsilateral hip fracture surgery and does not need a separate operation or anesthesia. Furermore, due to the nature of this surgical intervention, patient compliance after EF is 100%. Show less
