rss_2.0Romanian Journal of Orthopaedic Surgery and Traumatology FeedSciendo RSS Feed for Romanian Journal of Orthopaedic Surgery and Traumatology Journal of Orthopaedic Surgery and Traumatology Feed use of osteoclast inhibitors in metastatic breast cancer<abstract> <title style='display:none'>Abstract</title> <p>Introduction: In most patients, metastatic breast cancer (MBC) is incurable. Consequently, the goal in this setting is life prolongation and quality of life improvement, although possible long-term effects of anticancer treatment need to be considered. Bone is the most common site of metastasis in breast cancer and its complex management includes minimizing the risk of skeletal-related events (SRE), maximizing pain control, stabilizing or even restoring function, preventing spinal cord compression, hypercalcemia of malignancy and fractures and reducing the need for radiotherapy and orthopedic surgery.</p> <p>Aim: The present paper aims to compare the efficacy and safety of zoledronic acid (and other bisphosphonates) with denosumab in the management of bone metastases in breast cancer patients.</p> <p>Materials and methods: In this article, required information was collected through literature review and keyword query using the PRISMA 2020 guideline.</p> <p>Conclusions: In the metastatic setting, it appears that denosumab is indeed superior to zoledronic acid in delaying and preventing skeletal related events, except for spinal cord compression and risk of surgery, and equally efficient in treatment of already present bone pain and hypercalcemia of malignancy, with similar adverse effects, overall survival and disease progression.</p> </abstract>ARTICLEtrue and soft tissue pathology, the importance of the systematic approach ossificans in a 29 years old athletic female<abstract> <title style='display:none'>Abstract</title> <p>Myositis ossificans (MO) is a rare group of diseases in which heterotopic ossification occurs in muscles, tendons, nerves, or even subcutaneous fat. MO can occur in patients of all ages, but usually appears in young adults who practice sports or have a history of mechanical trauma, burns, infections or drug abuse.</p> <p>The article highlights the case of a 29-year-old athletic female who noticed, by random palpation, a small lump in her left biceps, near the radial insertion. The lump was not painful and noticeable with the naked eye.</p> <p>Rest and NSAIDs were recommended and all went well for about 3 months.</p> <p>However, after almost a week from that moment, the pain was excruciating, inflammation extend on the arm and forearm, she could not extend her arm anymore and its circumference was 30 cm from 24 initially.</p> <p>A biopsy was performed and the result was calcified fibrous tissue with suggestive aspect of myositis ossificans. Surgery was planned with reconstruction of the biceps tendon in mind.</p> <p>After surgery, the elbow was splinted at 90 degrees for two weeks, then dynamic splinting was performed with increasingly wider range of motion until full recovery was achieved.</p> <p>MO is a rare disease that involves many differential diagnoses, some of which are deadly and each with its own particularities, different imaging aspects and different treatments.</p> </abstract>ARTICLEtrue to choose the bone modifying treatment for early stage and locally advanced breast cancer?<abstract> <title style='display:none'>Abstract</title> <p>Introduction: Breast cancer continues to be the most frequent malignancy in women worldwide. Considerable advances in oncology over the years have led to decreased mortality in early stage (EBC) and locally advanced (ABC) breast cancer, but this has raised concerns about possible long-term effects of anticancer treatment nonetheless.</p> <p>Purpose: The present paper aims to describe the efficacy and safety of osteoclast inhibitors, both as antiresorptive agents, reducing osteoporosis and fracture risk, and as adjuvant anticancer agents, potentially improving disease-related outcomes in patients with early stage and locally advanced breast cancer.</p> <p>Materials and methods: In this article, literature sources were selected and evaluated using the PRISMA 2020 guideline.</p> <p>Conclusions: Bisphosphonates are recommended for early stage and advanced breast cancer patients, either premenopausal or postmenopausal, with osteoporosis. Denosumab may also be used for postmenopausal women. Bisphosphonates also showed a statistically significant benefit for overall survival in postmenopausal women only. However, denosumab is not presently used for indications other than prevention or treatment of osteoporosis.</p> </abstract>ARTICLEtrue expression and molecular aspects in osteoarthritis of the knee - review of literature<abstract> <title style='display:none'>Abstract</title> <p>Gonarthrosis is one of the main causes of pain and limitation of physical activity in elderly patients. The diagnosis is established based on the clinical and radiological examination, and the treatment consists of non-surgical measures. The final stage of gonarthrosis is treated surgically and consists of total knee arthroplasty.</p> <p>The molecular study in gonarthrosis aims to identify patients with early stages of arthrosis, with reversible potential, who can benefit from etiological treatment and non-pharmacological measures to slow down the evolution of the disease or even reversibility. Total knee arthroplasty is a surgical intervention with the role of reducing the symptoms and restoring the functionality of the affected joint.</p> <p>Total knee arthroplasty remains the surgical intervention of choice in the case of patients in the final stage of the evolution of the disease with very good functional outcome.</p> </abstract>ARTICLEtrue cancer and musculoskeletal implications - potential mechanism of dissemination<abstract> <title style='display:none'>Abstract</title> <p>The purpose of this article was to analyze bone metastases as being the most common site of recurrence of breast cancer. Bone metastases secondary to breast cancer have a negative impact on patient survival, mobility and quality of life. In addition, the clinical complications of bone cancer metastases of breast cancer are associated with a significant financial burden for the individual and society.</p> <p>This article summarized the implications of breast cancer musculoskeletal metastases based on clinical application in an emergency hospital, including patient workup, procedural strategy and techniques.</p> </abstract>ARTICLEtrue hysterectomy for locally advanced cervical cancer with Para-Aortic lymphadenectomy: case presentation<abstract> <title style='display:none'>Abstract</title> <p>Pelvic lymphadenectomy with radical hysterectomy is the basic treatment in locally advanced cervical cancer, but, for carefully selected cases, this intervention can be extended and high Para-Aortic lymphadenectomy can be performed to the site of emergence of the renal arteries. The mortality of the procedure has decreased significantly since the 1900s when it was introduced by Wertheim, while the 5-year DFS reached rates of over 90%.</p> </abstract>ARTICLEtrue rehabilitation of a patient with CRPS type I after tibial plateau fracture and sprain of the ankle: A case report and Literature review<abstract> <title style='display:none'>Abstract</title> <p>Complex regional pain syndrome is a clinical syndrome characterized by chronic, severe, neuropathic pain, which is associated with sensory, trophic, and autonomic disorders and decreased range of motion of the affected joint. Symptoms begin at a variable interval, at least 6 weeks after a traumatic event or after surgery. The evolution of symptoms is unpredictable, as they can range from complete and self-limiting resolution to significant chronic pain with decreasing limb function and quality of life. Depending on the absence or presence of a well-identified neural lesion, types I and II of CRPS can be observed. Because it is a relatively rare condition, it can be overlooked due to the limited experience that doctors have with this one.</p> <p>A 61-year-old male patient presented with severe pain 9/10 on the Visual Analogue Scale (VAS) and a significant decrease in mobility after suffering a traumatic fracture with a left tibial plateau fracture 4 months before, which required orthopedic treatment with a plate and screws, and a left ankle sprain. Previously, the patient presented to several emergency services where he received anti-inflammatory and analgesic treatment with gradual aggravation of pain and impaired mobility of the left lower limb, walking being possible only on two axillary crutches. The patient received treatment that combined drug therapy with medical rehabilitation exercises and physical therapy agents, with a favorable evolution. At the time of discharge, the pain was 5/10 on the VAS scale and the patient could move with a single Canadian crutch.</p> </abstract>ARTICLEtrue pain management in total hip and knee arthroplasty grafts versus synthetic bone substitutes in the treatment of benign bone tumors<abstract> <title style='display:none'>Abstract</title> <p>Benign bone tumors represent an important chapter in the pathology of the musculoskeletal system, most commonly affecting young people under the age of 30. The most common benign bone tumors diagnosed in orthopedic surgery are: osteochondroma, osteoid osteoma, osteoblastoma, giant cell tumor, bone aneurysmal cyst, and fibrous dysplasia. An important feature is the lack of secondary determinations.</p> <p>Depending on the type and the location of the benign bone tumors, treatment can be non-surgical or surgical.</p> <p>Patients included in the study were between 25 and 55 years old with an average age of 40.</p> <p>In both cases, the radiological image remains the routine investigation in the periodic postoperative control.</p> <p>The purpose of this study was to compare the surgical treatment (curettage-filling) with synthetic bone substitute, compared to autograft in patients with benign bone tumors.</p> </abstract>ARTICLEtrue metastatic pattern in vulvar cancer<abstract> <title style='display:none'>Abstract</title> <p>Vulvar cancer is a rare malignancy of the genital tract, the fourth most common type in this category. The most common form of the clinical appearance is long-lasting pruritus, a lump or mass on the vulva. Despite its histological type, in most cases, invasive vulvar cancer metastasizes primarily through the lymphatic system. Bone metastases related to gynecological cancers are rare, often underdiagnosed, and have a very poor prognosis. The most common site of metastasis in vulvar cancer is the lung, which is affected in about 45%, followed closely by the liver and brain. Bone metastases are present in about 10% to a quarter of cases. The most common places are the spine, pelvic bone, ribs, skull, limb bones and sternum. The only characteristic of the bone microenvironment is its high sensitivity to endocrine status, as vulvar cancer affects postmenopausal women. Thus, the theory of the protective role of estrogen on bone density and bone metastases remains an open door for future protection and treatment strategies.</p> </abstract>ARTICLEtrue table saw hand injury-case report<abstract> <title style='display:none'>Abstract</title> <p>Currently, Romania lacks a tradition of trade schools. This is due to the lack of awareness on the importance of this educational structure. Such multiple trades have been learned by simple observation from one individual to another. The importance of security measures has been taken for granted if not ignored. The number of traumas produced in wood processing has decreased rapidly due to the appearance of wood processing robots, the human factor being reduced only to their programming. The cases that arrive in the emergency departments are in a major percentage from the rural area, where the wood processing is done in the household without an adequate training and without going through a learning process. Hand injuries represent a great part of the Emergency Department presentations, and because of their fundamental functional use in daily life, repair of such lesions should be done with utmost care. Wounds of the hand typically have different degrees of severity depending on the mechanism of injury. Hand trauma probably represents the most frequent pathology of a plastic surgery ER and it should be handled with utmost care because of the fundamental function in the daily routine. The present article presents the therapeutic conduct of a complex case, multiple wounds with bone exposure, digital nerve sectioning and destruction of the flexor system of several fingers.</p> </abstract>ARTICLEtrue Era - Adapting treatment and education in the Orthopedics and Traumatology Department - review<abstract> <title style='display:none'>Abstract</title> <p>Coronavirus disease (COVID-19) is a pandemic-level health disaster with more than 220 million verified cases and more than 4.6 million confirmed fatalities globally as of September 2021. Since its initial detection in 2019, the virus has spread rapidly around the world. In many parts of the world, the present status of health systems has resulted in a decline in elective procedures.</p> <p>Physician shortages have been clearly reported in nations that have previously been infected with the virus. Experienced and young physicians were similarly recruited to work on the front lines in medical wards and intensive care units outside of their specializations. As a result, hospitals have made significant modifications to their care systems, such as updating general wards to include ICU capabilities, postponing, and canceling elective procedures, and rethinking the duties of healthcare personnel.</p> <p>Residents and fellows in training in orthopedic surgery have not been immune to these developments. As a result of many hospitals discontinuing elective procedures, orthopedic case volume has decreased significantly. Numerous educational activities must be implemented to provide workers with the knowledge and skills essential to protect themselves and their families from infection and to care for COVID-19 patients.</p> </abstract>ARTICLEtrue management of bone metastasis located in the proximal femur-review of literature<abstract> <title style='display:none'>Abstract</title> <p>Neoplasms are the second leading cause of death worldwide. The increase in diagnostic possibilities and development of new treatments has led to an increase in life expectancy among cancer patients.</p> <p>The proximal region of the femur is a favorite site for bone metastases, these lesions being accompanied by increased mortality and morbidity.</p> <p>The methods of treatment for metastatic bone disease can be surgical or non-surgical.</p> <p>Bone metastases and pathological bone fractures in the proximal femur are most commonly located in the intertrochanteric or subtrochanteric region. Patients with bone metastases at this level most often require osteosynthesis with a centromedullary nail, but also plates and screws or dynamic hip screw can be used.</p> <p>Bone metastases located in the femoral neck or femoral head can be treated surgically by hemiarthroplasty (HA) or total hip arthroplasty (THA). Both HA and THA have been shown to be successful surgeries in patients with bone metastases.</p> <p>In patients with multiple bone metastases located in the head or neck of the femur and trochanteric region, but with increased life expectancy, resection and reconstruction using endoprostheses is a viable solution.</p> <p>Given the complexity of oncological pathologies, the therapeutic decision in the case of a patient with secondary bone determinations must be established by a multidisciplinary team comprising the oncologist, orthopedic surgeon, pathologist, anesthetist, and radiotherapist.</p> <p>Surgical treatment of symptomatic bone metastases that cause pain and functional impotence with limited patient mobility increases survival and quality of life regardless of the type of surgery and the implant chosen.</p> </abstract>ARTICLEtrue review of surgical management options for total knee arthroplasty in the rheumatoid knee<abstract> <title style='display:none'>Abstract</title> <p>Rheumatoid arthritis (RA) represents a condition that can erode cartilage and damage joints, leading to inflammation and loss of movement, characterized by inflammatory synovitis. While the widespread use of potent disease-modifying medications has increased opportunities for RA patients, orthopedic surgery and complete joint arthroplasty remain an important option in end-stage joint treatment. The knee is one of the most frequently affected joints in chronic rheumatoid arthritis patients. The severity of RA ranges from a moderate illness to a serious, rapidly progressing, destructive version, gradually leading to incessant pain and joint deformity. Despite recent advances in biological agents and therapeutic modalities in the field of rheumatology, certain patients with RA, who ultimately undergo joint surgery, tend to experience progressive joint damage. Though, TKA can be performed in these patients, increased complications and poorer outcomes may result after total knee arthroplasty, because of the particularities given by RA. They are associated with extended operating time, specifically resulting in increased infection, blood loss and deep vein thrombosis. However, because RA patients present additional risk factors for complications, certain critical preoperative examination and surgical aspects need to be considered in order to maximize TKA outcomes in this subgroup of patients.</p> </abstract>ARTICLEtrue granular cell tumor of the arm – case report<abstract> <title style='display:none'>Abstract</title> <p>Granular cell tumor (GCT) is a rare form of soft tissue cancer that is usually benign. Its malignant evolution is encountered in less than 2% of cases, having a more rapid and unfavorable evolution. Clinical presentation betraying malignant features could be increased tumor size, rapid growth, deep localization, and female gender.</p> <p>This paper presents the case of a 52-year-old patient with a hard, rapidly evolving tumor in the left arm. The diagnosis of granular cell tumor was made based on histopathological examination using the Fanburg and Smith criteria to differentiate the formation as malignant, but with certainty this was subsequently confirmed by the existence of a metastasis. Surgical excision was performed and the evolution was favorable.</p> <p>Evolution and treatment differ depending on the benign or malignant form, but surgical treatment with wide local excision is recommended. This may be followed by chemotherapy or radiotherapy, and follow-up of patients for the rest of their lives is mandatory.</p> </abstract>ARTICLEtrue management of blunt splenic injuries beyond safety conditions A short narrative review<abstract> <title style='display:none'>Abstract</title> <p>Although the introduction of specific guidelines regarding the acute management of trauma patients have resolved many inconsistencies in the acute treatment pathways, grey areas are still preventing consensus and unitary standards of care. The treatment of splenic injuries has seen a notable shift from splenectomy only in the early 20th century to mainly non-operative contemporary approaches. However, there is no current agreement on the optimum timing of switching from conservative to operative decisions, raising the legitimate question of whether some patients are put at risk by waiting too much or other patients are deprived of a necessary organ by not waiting enough.</p> <p>This paper focuses on the non-operative paradigms of blunt splenic injuries and their immediate and long-term clinical implications presented as a short narrative review. It presents the historical perspective on the treatment of splenic injuries, the role of surgery and selective angioembolisation and their repercussions on the immunological functions of the spleen.</p> </abstract>ARTICLEtrue an old pigmented lesion becomes serious: the problematic diagnosis of low-grade skin malignancies – Bednar tumor with fibrosarcomatous transformation<abstract> <title style='display:none'>Abstract</title> <p>Bednar tumor is a rare cutaneous neoplasm, regarded as a variant of dermatofibrosarcoma protuberans with melanotic colonization and it usually affects young and middle-aged adults or children. This lesion is considered a low-grade malignant tumor, which can be associated with multiple local recurrences after surgical excision. Although a rare phenomenon, these lesions may undergo fibrosarcomatous transformation, which implies a poorer prognosis of the disease, as the tumor has a more locally aggressive behavior and patients might also develop distant metastases.</p> <p>We present the case of a 53-year-old female patient, with no significant medical history, who presented with a subcutaneous nodule on her upper back, for which a wide surgical excision was performed. The gross examination of the specimen showed a solitary protuberant grey-white nodule with a bluish shade and flecked with pigment. The microscopic examination revealed a malignant proliferation with a predominantly fascicular growth pattern, composed of spindle cells with highly pleomorphic nuclei and high mitotic rate, as well as the presence of dendritic cells with abundant melanin. Upon immunohistochemical analysis, the proliferation showed negative staining for CD 34 and AE 1/3, whereas the scattered dendritic cells stained positive with S100 protein. Ki 67 was positive in 15% of the tumor cells and the absence of p53 expression was noted. Thus, the diagnosis of Bednar tumor with fibrosarcomatous transformation was established.</p> <p>The aim of this paper was to gain further knowledge about the histopathological and immunohistochemical features, as well as about the treatment of Bednar tumor, especially considering its rarity.</p> </abstract>ARTICLEtrue marketing strategies in Romania analgesia in primary bone tumors<abstract> <title style='display:none'>Abstract</title> <p>Introduction: A worrying increase in the number of bone tumors that appear at younger ages justifies the efforts aimed at optimizing perioperative management practices in orthopedic tumor surgery. Pain control is critical in the prognosis and postoperative outcome of these procedures.</p> <p>Material and methods: Our study included a group of 11 patients diagnosed with bone malignancies. These patients were hospitalized in the Orthopedic Clinic of the University Emergency Hospital Bucharest. Under our supervision, they underwent surgical treatment of the tumor under combined general anesthesia and epidural anesthesia for the pelvic limb, and general anesthesia only for the upper limb. We performed perioperative pain management with multimodal analgesia (continuous epidural analgesia with ropivacaine 0,2% and fentanyl 2 mcg/ml in association with systemic analgesics). Following this procedure, we measured the intensity of the postoperative pain at intervals of 48 hours and one week after surgery and compared with preoperative pain intensity using the visual analogue pain scale (VAS).</p> <p>Results: Multimodal analgesia (epidural analgesia associated with systemic analgesics – paracetamol, COX2 inhibitor, gabapentinoids) was performed well in the postoperative pain of the tumor prosthesis, with a significant decrease in VAS from a mean value of 7.63 preoperatively to an average of 3 in the first 48 hours postoperatively. After the removal of the epidural catheter, which also coincided with patient mobilization, the level of pain registered a slight increase to a mean value of 3.23.</p> <p>Conclusions: Multimodal analgesia is currently considered the gold standard in perioperative pain management. The use of multimodal analgesia during perioperative period in patients with bone tumors has been shown to decrease the length of hospital stay, improve surgical outcome, reduce the number of systemic complications, and improve the long-term prognosis of the patient. Efficacy of analgesia correlates with tumor site and vascularization.</p> </abstract>ARTICLEtrue