Percutaneous osteosynthesis in the pelvis in cancer patients

Abstract

Purpose: Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. We report our experience in cancer patients.

Material/methods: We retrospectively reviewed all cases of percutaneous osteosynthesis (PO) of the pelvic ring and proximal femur performed in our hospital. PO were performed for fracture palliation or for osteolytic metastases consolidation. Screws were inserted under CT- or cone-beam CT- guidance and general anaesthesia. Patients were followed-up with pelvic-CT and medical consultation at 1 month, then every 3 months. For fractures, the goal was pain palliation and for osteolytic metastases, pathologic fracture prevention.

Results: Between February 2010 and August 2014, 64 cancer patients were treated with PO. Twenty-one patients had PO alone for 33 painful fractures (13 bone-insufficiency, 20 pathologic fractures). The pain was significantly improved at 1 month (VAS score = 20/100 vs. 80/100). In addition, 43 cancer patients were preventively consolidated using PO plus cementoplasty for 45 impending pathologic fractures (10 iliac crests, 35 proximal femurs). For the iliac crests, no fracture occurred (median-FU = 75 days). For the proximal femurs, 2 pathological fractures occurred (fracture rate = 5.7 %, median-FU = 205 days).

Conclusion: PO is a new tool in the therapeutic arsenal of interventional radiologists for bone pain management.

Key points: • Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. • CT- or CBCT-guidance results in high technical success rates for screw placement. • This minimally invasive technique avoids extensive surgical exposure in bone cancer patients. • Osteosynthesis provides pain relief for bone-insufficiency fractures and for pathologic fractures. • Osteosynthesis plus cementoplasty provide prophylactic consolidation of impending pathological fractures.

Keywords: Bone screws; Femur; Fracture fixation; Osteosynthesis; Pelvis; Screw fixation.