title: Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus.
abstract: OBJECTIVE
  To review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.
  
  
  METHODS
  Thirty-two consecutive patients (mean age 67.5 years; range 33-86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.
  
  
  RESULTS
  Thirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.
  
  
  CONCLUSIONS
  PIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS, 1, place de l' Hôpital, 67000, Strasbourg, France. gigicazzato@hotmail.it.
authors.forename: Roberto Luigi
authors.initials: RL
authors.lastname: Cazzato
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS, 1, place de l' Hôpital, 67000, Strasbourg, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Koch
authors.affiliation: Department of Radiology, Institut Bergonié, 229, Cours de l'Argonne, 33000, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Buy
authors.affiliation: Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: Nitin
authors.initials: N
authors.lastname: Ramamurthy
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS, 1, place de l' Hôpital, 67000, Strasbourg, France.
authors.forename: Georgia
authors.initials: G
authors.lastname: Tsoumakidou
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS, 1, place de l' Hôpital, 67000, Strasbourg, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Caudrelier
authors.affiliation: Department of Radiology, Institut Bergonié, 229, Cours de l'Argonne, 33000, Bordeaux, France.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Catena
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS, 1, place de l' Hôpital, 67000, Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Garnon
authors.affiliation: Department of Radiology, Institut Bergonié, 229, Cours de l'Argonne, 33000, Bordeaux, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Palussiere
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS, 1, place de l' Hôpital, 67000, Strasbourg, France.
authors.forename: Afshin
authors.initials: A
authors.lastname: Gangi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D001863:Bone Screws; D060826:Cementoplasty; D054893:Cone-Beam Computed Tomography; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D005598:Fractures, Spontaneous / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Bone; Fractures; Screw fixation