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Salvage of a femoral nonunion after primary non-Hodgkin's lymphoma of bone: a case report and literature review.

Xie XT, Gao YS, Zhang CQ - Med. Sci. Monit. (2011)

Bottom Line: No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation.Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.More cases have yet to be further investigated.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

ABSTRACT

Background: With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin's lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult.

Case report: We performed an operation using free vascularized fibular graft in combination with a locking plate on a 47-year-old female patient who had suffered from a three-year femoral nonunion after courses of radiochemotherapy for the treatment of primary non-Hodgkin's lymphoma of bone, a spontaneous femoral shaft fracture, an intramedullary nailing, and some nonoperative interventions in sequence. Primary union of the graft was obtained at 9 months without wound infection. No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation. Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.

Conclusions: Free vascularized fibular graft in combination with a locking plate can effectively enhance bone union in compromised bone and soft tissue milieu. More cases have yet to be further investigated.

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Related in: MedlinePlus

A radiograph is shown three years later, depicting the broken nail and fracture nonunion, with a segment of bone in the medial cortex.
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f3-medscimonit-17-11-cs138: A radiograph is shown three years later, depicting the broken nail and fracture nonunion, with a segment of bone in the medial cortex.

Mentions: The 47-year-old woman complaining of worsening pain in her right thigh for months was diagnosed with primary non-Hodgkin’s lymphoma of bone. Courses of chemotherapy and radiotherapy were administered, but the dose of irradiation was unknown. Months later, she heard a crack from her right femur and felt sudden pain when putting on trousers in the morning. She was sent to a local hospital, where she was diagnosed as having a pathological fracture in the right femoral shaft (Figure 1), which was then fixed with an intramedullary nail (Figure 2). The fracture, however, didn’t heal (Figure 3), despite some nonoperative interventions such as low-intensity pulsed ultrasound, and extracorporeal shock wave therapy. Three years later she was referred to our institution. Neither metastasis nor lymph node involvement was revealed through a thorough examination.


Salvage of a femoral nonunion after primary non-Hodgkin's lymphoma of bone: a case report and literature review.

Xie XT, Gao YS, Zhang CQ - Med. Sci. Monit. (2011)

A radiograph is shown three years later, depicting the broken nail and fracture nonunion, with a segment of bone in the medial cortex.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539489&req=5

f3-medscimonit-17-11-cs138: A radiograph is shown three years later, depicting the broken nail and fracture nonunion, with a segment of bone in the medial cortex.
Mentions: The 47-year-old woman complaining of worsening pain in her right thigh for months was diagnosed with primary non-Hodgkin’s lymphoma of bone. Courses of chemotherapy and radiotherapy were administered, but the dose of irradiation was unknown. Months later, she heard a crack from her right femur and felt sudden pain when putting on trousers in the morning. She was sent to a local hospital, where she was diagnosed as having a pathological fracture in the right femoral shaft (Figure 1), which was then fixed with an intramedullary nail (Figure 2). The fracture, however, didn’t heal (Figure 3), despite some nonoperative interventions such as low-intensity pulsed ultrasound, and extracorporeal shock wave therapy. Three years later she was referred to our institution. Neither metastasis nor lymph node involvement was revealed through a thorough examination.

Bottom Line: No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation.Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.More cases have yet to be further investigated.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

ABSTRACT

Background: With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin's lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult.

Case report: We performed an operation using free vascularized fibular graft in combination with a locking plate on a 47-year-old female patient who had suffered from a three-year femoral nonunion after courses of radiochemotherapy for the treatment of primary non-Hodgkin's lymphoma of bone, a spontaneous femoral shaft fracture, an intramedullary nailing, and some nonoperative interventions in sequence. Primary union of the graft was obtained at 9 months without wound infection. No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation. Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.

Conclusions: Free vascularized fibular graft in combination with a locking plate can effectively enhance bone union in compromised bone and soft tissue milieu. More cases have yet to be further investigated.

Show MeSH
Related in: MedlinePlus