Successful treatment of pathologic femoral shaft fracture associated with large arteriovenous malformations using a 3-dimensional external fixator and teriparatide: a case report
Successful treatment of pathologic femoral shaft fracture associated with large arteriovenous malformations using a 3-dimensional external fixator and teriparatide: a case report
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DOI：
10.1186/s12893-019-0498-4
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发表时间：
2019-04-05
期刊：
影响因子：
1.9
通讯作者：
Tsuchiya, Hiroyuki
中科院分区：
文献类型：
--
作者：
Takeuchi, Akihiko;Matsubara, Hidenori;Tsuchiya, Hiroyuki
背景动静脉畸形（AVM）是一种罕见的先天性血管病变，早期静止，晚期扩张，最终浸润和破坏局部软组织和骨骼。四肢是一个常见的位置。据报告，AVM累及骨的发生率高达31%。然而，关于AVM相关病理性骨折的治疗报道很少。特立帕肽是一种重组甲状旁腺激素（PTH）类似物，由PTH的1-34片段组成。最近，一些报道显示了特立哌酮改善骨折愈合的能力。在这里，我们提出了一个病例病理性股骨干骨折与大动静脉畸形，成功地治疗外固定和teripartization.Case presentationA 68岁的日本女性，以前诊断为有大动静脉畸形，持续右股骨干骨折由于下降。入院时，她出现右大腿大面积肿胀和静脉曲张。右大腿X线平片显示股骨干骨折伴骨质侵蚀和软组织钙化。我们计划在供血动脉栓塞后进行闭合复位和单侧外固定器髓内钉固定。然而，使用骨折台闭合复位是困难的。当我们尝试切开复位时，皮下组织切开后发生大量出血（1000 mL）。最后，我们仔细地应用了泰勒空间框架。初次手术后15个月，骨折移位得到成功纠正，并通过teriparbazole治疗获得骨愈合。患者能够行走使用1 cane.ConclusionWe提出的第一份报告的病理性骨折与大AVM，实现骨性愈合使用三维外固定器和teriparterum。
BackgroundArteriovenous malformations (AVMs) are rare congenital vascular lesions associated with early quiescence, late expansion, and, ultimately, infiltration and destruction of local soft tissue and bone. The extremities are a common location. Incidence of bony involvement by AVM has been reported as high as 31%. However, there are few reports on management of pathologic fracture associated with AVM. Teriparatide is a recombinant parathyroid hormone (PTH) analogue consisting of the 1-34 fragment of PTH. Recently, some reports have shown the ability of teriparatide to improve fracture healing. Here, we present a case of pathologic femoral shaft fracture associated with large AVMs that was treated successfully by external fixation and teriparatide.Case presentationA 68-year-old Japanese woman, previously diagnosed as having large AVMs, sustained a right femoral shaft fracture due to a fall. At the time of admission, she presented with massive swelling and venous varicosities of the right thigh. Plain radiography of the right thigh revealed femoral shaft fracture with bony erosion and calcification of soft tissue. We planned closed reduction and intramedullary nailing with a unilateral external fixator following embolization of the feeding artery. However, closed reduction using the fracture table was difficult. When we attempted open reduction, massive bleeding (1000mL) after incision of subcutaneous tissue occurred. Finally, we carefully applied a Taylor Spatial Frame. Fracture displacement was corrected successfully and bony union was obtained with administration of teriparatide 15months after the initial surgery. The patient is able to walk using 1 cane.ConclusionWe present the first report of pathologic fracture associated with large AVMs that achieved bony union using a 3-dimensional external fixator and teriparatide.