Benjamin Ulmar

The Tokuhashi Score: Significant Predictive Value for the Life Expectancy of Patients With Breast Cancer With Spinal Metastases

Study Design. Retrospective study of 55 consecutive patients with spinal metastases secondary to breast cancer who underwent surgery. Objective. To evaluate the predictive value of the Tokuhashi score for life expectancy in patients with breast cancer with spinal metastases. Summary of Background Data. The score, composed of 6 parameters each rated from 0 to 2, has been proposed by Tokuhashi and colleagues for the prognostic assessment of patients with spinal metastases. Methods. A total of 55 patients surgically treated for vertebral metastases secondary to breast cancer were studied. The score was calculated for each patient and, according to Tokuhashi, the patients were divided into 3 groups with different life expectancy according to their total number of scoring points. In a second step, the grouping for prognosis was modified to get a better correlation of the predicted and definitive survival. Results. Applying the Tokuhashi score for the estimation of life expectancy of patients with breast cancer with vertebral metastases provided very reliable results. However, the original analysis by Tokuhashi showed a limited correlation between predicted and real survival for each prognostic group. Therefore, our patients were divided into modified prognostic groups regarding their total number of scoring points, leading to a higher significance of the predicted prognosis in each group (P < 0.0001), and a better correlation of the predicted and real survival. Conclusion. The modified Tokuhashi score assists in decision making based on reliable estimators of life expectancy in patients with spinal metastases secondary to breast cancer.

Prognosis Scores of Tokuhashi and Tomita for Patients With Spinal Metastases of Renal Cancer

BackgroundRetrospective evaluation of the prognosis scores of Tokuhashi and Tomita for life expectancy in 37 consecutive patients with spinal metastases secondary to renal cancer who underwent surgery. The score of Tokuhashi, composed of six parameters, each rated from zero to two, has been proposed in 1990 for the prognostic assessment of patients with spinal metastases. In 2001, Tomita et al. created another prognostic score, composed of three parameters, growth behaviour of the primary tumor (slow, moderate and rapid) and the evidence of visceral and bony metastases.MethodsThirty-seven patients, surgically treated for vertebral metastases secondary to renal cancer were studied. The scores according to Tokuhashi and Tomita were calculated for each patient.ResultsApplying the Tokuhashi Score for the estimation of life expectancy of renal cancer patients with vertebral metastases was found to provide very reliable results with a statistically high significance. The analysis according to Tomita showed no correlation between predicted and real survival. The statistical analysis did not show any significance.ConclusionFor surgical decisions in renal cancer patients with spinal metastases, the prognostic score of Tokuhashi appears to be much more valuable than the Tomita score.

Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up

BACKGROUND The LCP Distal Humerus Plate (DHP) system represents an angular stable fixation system consisting of 2 anatomically pre-shaped orthogonal plates intended for the treatment of fractures of the distal humerus. The purpose of this retrospective study was to evaluate the clinical and radiologic outcome after a minimum follow-up of 2 years after open reduction and fixation of distal humeral fractures with this device. METHODS Twenty-two consecutive patients with distal humeral fractures were treated with the DHP system between January 2004 and June 2006. Of these, 16 could be clinically and radiologically evaluated after a mean follow-up of 30.5 months. Follow-up included anteroposterior and lateral radiographs; assessment of range of motion; pain according to a VAS; Disabilities of the Arm, Shoulder and Hand score; and Mayo Elbow Performance Score. RESULTS All fractures showed satisfactory articular reduction. One patient showed preoperative sensory ulnar neuropathy, which recovered incompletely, and two patients showed sensory ulnar neuropathy postoperatively, requiring revision surgery in one patient. Mean range of motion was as follows: flexion, 129°; extension, -16°; pronation, 82°; and supination, 71°. The mean visual analog scale score was 1 point; the mean Disabilities of the Arm, Shoulder and Hand score, 23.3 points; and the mean Mayo Elbow Performance Score, 84.7 points. CONCLUSION The DHP system represents a valuable tool to perform internal fixation of complex fractures of the distal humerus. In contrast to conventional plating, we did not observe any case of secondary fracture displacement, even in elderly patients with potentially reduced bone mass. The multiple angular stable point fixation also of small distal fragments seems to be effective in the application of this system.

Classical and atypical location of adamantinomas--presentation of two cases.

Background: Adamantinomas are rare low-grade primary bone tumors of unknown histological origin. They typically develop in the diaphyses and metaphyses of long bones, prevalently the tibia. Case Reports: The cases of 2 female patients, one with localized swelling of the lateral metatarsals and one with pain of the tibia are being reported. The diagnostic work-up including biopsy verified an adamantinoma in both cases. In the younger patient, the tumor was located in the metatarsals 4 and 5, in the older patient in the left tibial diaphyses. In both patients, an en-bloc resection of the tumor with wide surgical margins was performed. Further follow-ups 73 and 36 months after surgery showed no local recurrence or metastatic spread. Conclusion: Adamantinomas of the short bones are rarely reported. In accordance to the literature, an en-bloc resection with wide surgical margins seems to reduce the risk of local recurrence and metastatic spread.

Interlocking Nailing Versus Interlocking Plating in Intra-articular Calcaneal Fractures A Biomechanical Study

Background: Open reduction and internal fixation with a plate is deemed to represent the gold standard of surgical treatment for displaced intra-articular calcaneal fractures. Standard plate fixation is usually placed through an extended lateral approach with high risk for wound complications. Minimally invasive techniques might avoid wound complications but provide limited construct stability. Therefore, 2 different types of locking nails were developed to allow for minimally invasive technique with sufficient stability. The aim of this study was to quantify primary stability of minimally invasive calcaneal interlocking nail systems in comparison to a variable-angle interlocking plate. Material and Methods: After quantitative CT analysis, a standardized Sanders type IIB fracture model was created in 21 fresh-frozen cadavers. For osteosynthesis, 2 different interlocking nail systems (C-Nail; Medin, Nov. Město n. Moravě, Czech Republic; Calcanail; FH Orthopedics SAS; Heimsbrunn, France) as well as a polyaxial interlocking plate (Rimbus; Intercus GmbH; Rudolstadt, Germany) were used. Biomechanical testing consisted of a dynamic load sequence (preload 20 N, 1000 N up to 2500 N, stepwise increase of 100 N every 100 cycles, 0.5 mm/s) and a load to failure sequence (max. load 5000 N, 0.5 mm/s). Interfragmentary movement was detected via a 3-D optical measurement system. Boehler angle was measured after osteosynthesis and after failure occurred. Results: No significant difference regarding load to failure, stiffness, Boehler angle, or interfragmentary motion was found between the different fixation systems. A significant difference was found with the dynamic failure testing sequence where 87.5% of the Calcanail implants failed in contrast to 14% of the C-Nail group (P < .01) and 66% of the Rimbus plate. The highest load to failure was observed for the C-Nail. Boehler angle showed physiologic range with all implants before and after the biomechanical tests. Conclusion: Both minimally invasive interlocking nail systems displayed a high primary stability that was not inferior to an interlocking plate. Clinical relevance: Based on our results, both interlocking nails appear to represent a viable option for treating displaced intra-articular calcaneal fractures.

Evaluation and Modification of the Tomita Score in 217 Patients with Vertebral Metastases

The Tomita prognosis score consists of the following 3 parameters: growth behavior, evidence of visceral metastases, and/or evidence of bony metastases. Methods: 217 consecutive patients, surgically treated for vertebral metastases of different entities, were studied retrospectively. The score according to Tomita was determined. Results: In the study group, the Tomita score showed significant results for the estimation of life expectancy of the different prognostic groups (p < 0.0001), but the analysis showed a low reliability, i.e. correlation between predicted prognosis and real survival. A modified division of the patients based on the total sum of points allowed a significant separation (p < 0.0001) of patients into 2 prognostic groups with a real survival of more or less than 12 months. Conclusion: In our study, the original Tomita score was not reliable to predict the life expectancy of cancer patients with spinal metastases. Our modification allows a significant differentiation of patients with spinal metastases with a prognosis of more or less than 12 months.

Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

Introduction. Vertebral compression fractures (VCFs) affect 20% of people over the age of 70 with increasing incidence. Kypho-/vertebroplasty as standard operative procedures are associated with limitations like cement leakage, limited reduction capabilities, and risk for adjacent fractures. To address these shortcomings, we introduce a new minimal invasive cementless VCF fixation technique. Methods. Four patients (72.3 years, range 70–76) with VCFs type AO/Müller A1.3 and concomitant osteoporosis were treated by minimal invasive transpedicular placement of two intervertebral mesh cages for fracture reduction and maintenance. Follow-up included functional/radiological assessment and clinical scores and averaged 27.7 months (24–28). Results. Endplate reduction was achieved in all cases (mean surgery time: 28.5 minutes). Kyphotic (KA) and Cobb angle revealed considerable improvements postoperatively (KA 14.5° to 10.7°/Cobb 10.1° to 8.3°). Slight loss of vertebral reduction (KA: 12.6°) and segment rekyphosis (Cobb: 10.7°) were observed for final follow-up. Pain improved from 8.8 to 2.8 (visual analogue scale). All cases showed signs of bony healing. No perioperative complications and no adjacent fractures occurred. Conclusion. Preliminary results in a small, selected patient collective indicate the ability of bony healing for osteoporotic VCFs. Cementless fixation using intravertebral titanium mesh cages revealed substantial pain relief, adequate reduction, and reduction maintenance without complications. Trial registration number is DRKS00005657, German Clinical Trials Register (DKRS).

Eosinophilic granuloma of the spine involving C1 and pulmonary infiltration in young children – Presentation of two cases with a follow-up over 10 years including review of the literature

Objectives The incidence of spinal eosinophilic granuloma in children is low. Methods Clinical case presentation of two children (♀ 18 months old, ♂ 16 months old) complaining of acute torticollis. Follow-up period was 11 years in the female patient and 13 years in the male patient. Results The diagnostics certified a spinal eosinophilic granuloma: the girl had a multilevel spinal disease including the atlas, the boy a thoracic and pulmonary manifestation. Both were treated with chemotherapy with good clinical results. Conclusions Overall, the above described is a very rare clinical entity. However, persisting torticollis in children should be clearly diagnosed.

Biomechanical analysis of anterior stabilization techniques for different partial and total vertebral corpectomy defect models.

Abstract Introduction: Restoration of the anterior spinal profile and regular load-bearing are the main goals in treating anterior spinal defects in cases of fracture. In large vertebral defects, the use of vertebral body replacements (VBRs) is common. For isolated anterior operations, VBRs are usually combined with antero-lateral angular stable or polyaxial plates. In preclinical biomechanical testing of spinal fracture stabilizations, complete corpectomies are often applied for fracture simulation. Complete corpectomies are reproducible and easily standardized but present a maximum instability not indicated for isolated anterior instrumentation. Therefore, this study investigates the stabilizing effect of VBRs and anterior plating systems on three different vertebral body defect models. Methods: Using 24 thoracolumbar spines, two different partial (PC 1+2) and one total corpectomy defect (CC) models were simulated and stabilized using different combinations of two VBRs and three different anterior plating systems. After anterior stabilization, range of motion (RoM) in the three main movement planes was evaluated. Results: RoM was significantly reduced in all three motion planes for both stabilized partial corpectomy defect models compared to the stabilized complete corpectomy model and the intact specimens. The stabilized complete corpectomy defect model did not reduce RoM in flexion/extension and axial rotation compared to the intact state. Conclusion: Both partial corpectomy models are suitable for biomechanical testing of isolated anterior stabilization. A complete corpectomy model is not suitable to test isolated anterior instrumentation, as this simulates a rotationally unstable fracture, where isolated anterior instrumentation is not indicated in clinical practice.