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excellent mechanical resistance and still represent an option when approaching a pathologic or impending fracture of long bones ( 14 , 15 , 16 , 17 ). However, titanium nails show some limits, especially during the follow-up of patients. First, titanium
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, 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 ). Surgical treatment In GSD, surgery is mainly used to treat complications. The orthopedic surgeon is involved in case of pathological fracture, impending
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comparison of different features eventually led to the definition provided by the ASBMR in 2010. 7 This is very helpful in cases of complete fracture, but impending fractures must also be diagnosed and treated before they become complete. Recognizing
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, pain is the most common symptom, followed by impending or actual pathological fractures in 10%-25% of patients. 5 Pathological fractures of the femur, 75% of which present in the proximal part, are roughly 3.5 times as common as fractures of the
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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treatment method ( Tables 1 and 2 ). Table 1 Surgical treatment of lower limb metastatic disease of the bone. Anatomical location Single metastasis (fractured or not) Multiple metastases Any type of metastasis Impending
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nailing. Fracture characteristics and patterns in which IMN has been found to be superior are pathological and impending fractures, segmental lesions and fractures in osteopenic bone ( Table 1 ). 11 , 12 A simple middle third transverse fracture is
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and oncologists to establish the correct diagnosis and plan the most favourable treatment accordingly. Our own protocol is presented in Figure 1 . Fig. 1 Diagnostic algorithm at impending fracture (known primary tumour). In cases of an
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impending crash by stretching out their leg in an attempt to right the motorcycle and catch themselves. The foot may impact first causing a hyperdorsiflexion, external rotation injury. Milder forms of these injuries can present as simple fracture
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with impending or actual pathological fractures. 5 Those impending or actual pathological fractures regularly require surgical treatment in order to prevent or stabilize fractures. Surgical procedures used to stabilize impending or actual
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( 14 ). From the 1970s to the 1980s, HRA, consisting of a metal femoral head with a polyethylene acetabulum, became popular. However, the early failure rate was very high due to various causes, including femoral neck fracture, femoral prosthesis
