Narrow Results

We present two cases of pathologic fractures extended to the metacarpal head related with enchondromas at the metacarpal neck treated by surgery. The timing of surgery varied between the two cases. The first was operated without delay, using tumor curettage and β-TCP (tricalcium phosphate) packing in the cavity, followed by internal fixation of the fracture using a screw and Kirshner wires. In the second case, tumor curettage and β-TCP packing was performed after fracture union. Favorable clinical outcomes were obtained for both cases.

We report a 94-year-old patient with a fractured radius that was being managed conservatively. At 2 months, an abscess was observed overlying the fracture site. An MRI scan was done and samples obtained for microbiological and pathological analyses. The patient was diagnosed with tuberculous osteomyelitis. Surgical debridement of the fracture site was performed, and the bone defect was filled with bone cement impregnated with gentamicin and rifampicin. Anti-tuberculosis therapy was administered for 9 months and the patient made an uneventful recovery. Early diagnosis and correct medical treatment depend on sound evidence of tuberculous osteomyelitis. Surgical debridement is essential if abscesses are present in the bone.

Level of Evidence: Level V (Therapeutic)

The management and treatment of orthopedic emergencies that develop in patients with cancer is diverse and often complex. Although treatment algorithms exist, treatment must be tailored to each patient. For the two most common orthopedic emergencies encountered, namely pathologic fracture and spinal cord compression, the primary goals of treatment in both cases are pain relief and early restoration of function. Surgical stabilization of a pathologic fracture and surgical fixation with decompression of a spinal cord compression is often performed to improve the patient's quality of life. In less commonly seen orthopedic emergencies, such as abscesses, necrotizing fasciitis, and acute compartment syndrome, aggressive surgical intervention is warranted, to prevent the compounding complications that may arise if inadequately treated. However, the patient's life expectancy must be considered when planning any type of treatment, since the disease stage may be advanced at the time the patient presents with an orthopedic oncologic emergency. In terminally ill patients, orthopedic surgical treatment should only be considered if there is reasonable evidence that an intervention will improve the patient's quality of life.