title: Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases.
abstract: OBJECTIVE
  To review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures.
  
  
  METHODS
  Between May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57-75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment.
  
  
  RESULTS
  Four pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1-4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2-3 months; one case could not be followed due to early post-procedural oncologic mortality.
  
  
  CONCLUSIONS
  Percutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.
authors.affiliation: Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France. juliengarnon@gmail.com.
authors.forename: Julien
authors.initials: J
authors.lastname: Garnon
authors.affiliation: Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Koch
authors.affiliation: Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Nitin
authors.initials: N
authors.lastname: Ramamurthy
authors.affiliation: Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Caudrelier
authors.affiliation: ICube, University of Strasbourg, Strasbourg, France.
authors.forename: Pramod
authors.initials: P
authors.lastname: Rao
authors.affiliation: Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Georgia
authors.initials: G
authors.lastname: Tsoumakidou
authors.affiliation: Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Roberto Luigi
authors.initials: RL
authors.lastname: Cazzato
authors.affiliation: Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Afshin
authors.initials: A
authors.lastname: Gangi
mesh_terms: D000368:Aged; D001863:Bone Screws; D005471:Fluoroscopy / Q000379:methods; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012782:Shoulder / Q000000981:diagnostic imaging* / Q000601:surgery*; D000070599:Shoulder Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Pathological fracture; Percutaneous osteosynthesis; Screw fixation; Shoulder girdle