This study evaluates the effects of three surgical procedures in the treatment of pronation deformities of the forearm in cerebral palsy patients; namely the transposition of pronator teres to extensor carpi radialis brevis muscle; and rerouting of the pronator teres muscle with or without pronator quadratus muscle myotomy. Sixty-one patients, 48 male/13 female, with a mean age of 17 years (5–41 years) were treated between 1971 and 2011. Pronator teres transposition was performed in 10, pronator rerouting in 35, and pronator rereouting with pronator quadratus myotomy in 16 patients. Ranges of motion, and assessments using the Quick Dash, Mayo Scoring, and Functional Classification system of upper extremity, were made before and after surgery. Mean follow-up was 17.5 years (3–41 years). All three procedures led to significantly improved ranges of motion and upper limb function, with good/excellent results in 80 % of patients. Mean active supination improved from 10 ° (0–60 °) to 85 ° (30–90 °) (p < 0.001). There were significant improvements in Functional Classification system for the upper extremity scores (p < 0.003), Mean Quick Dash Scores improved from 58.41 (38.63–79.54) to 44.59 (27.27–68.18), and mean MEPS improved from 68 (30–85) to 84 (60–100) following surgery. All three techniques had statistically improved MEPS following surgery (p < 0.001); only the pronator teres muscle rerouting with pronator quadratus myotomy showed an improved Functional Classification system for the upper extremity score (p < 0.05); and only the pronator teres rerouting procedure showed an improved Quick Dash score (p < 0.05). There were no statistically significant differences in outcomes between different ages groups, and no significant differences between isolated pronator teres muscle rerouting were compared with those undergoing simultaneous treatment of carpal flexion and thumb adduction deformities (p > 0.05). Surgery is very effective in the management of pronation deformities of the forearm in patients with cerebral palsy. Isolated pronator teres rerouting is probably the most effective and simple technique. Adjunctive pronator quadratus myotomy does not lead to an improvement in the results and requires an additional surgical approach. There should be no age restriction to surgery, as all age groups appear to benefit from similar improvements in range of motion and upper limb function.

Background: The purpose of this study was to collect all available randomized controlled trials (RCT) on the treatment of open tibial fractures with an external fixator (EF) and intramedullary nailing (IMN) for meta-analysis to provide reliable evidence-based data for clinical decision-making. Material and methods: The systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and AMSTAR (Assessing the Methodological Quality of Systematic Review). An electronic search of PubMed, Cochrane Library, and Web of Science was performed until 1 March 2023 to identify RCTs which compared either IMN or EF to fix the open tibial fracture. Outcome measures were: postoperative superficial and deep infection, time to union, delayed union, malunion, nonunion and hardware failure. In addition, pain and health-related quality of life were evaluated after 3 and 12 months of follow-up. Results: Sixteen publications comprising 1011 patients were included in the meta-analysis. The pooled results suggested that the IMN technique had a lower postoperative superficial infection and malunion rate (RR = 3.56, 95%CI = 2.56–4.95 and RR = 1.96, 95%CI = 1.12–3.44, respectively), but higher hardware failure occurrence in contrast to EF (RR = 0.30; 95%CI = 0.13–0.69). No significant differences were found in the union time, delayed union or nonunion rate, and postoperative deep infection rate between the treatments. Lower levels of pain were found in the EF group (RR = 0.05, 95%CI = 0.02–0.17, p < 0.001). A difference in quality of life favoring IMN after 3 months was found (RR = −0.04, 95%CI = −0.05–0.03, p < 0.001), however, no statistical difference was found after 12 months (RR = 0.03, 95%CI = −0.05–0.11, p = 0.44). Conclusions: Meta-analysis presented reduced incidence rates of superficial infection, malunion, and health-related quality of life 3 months after treatment in IMN. However, EF led to a significant reduction in pain and incidence rate of hardware failure. Postoperative deep infection, delayed union, nonunion and health-related quality of life 12 months following therapy were similar between groups. More high-quality RCTs should be conducted to provide reliable evidence-based data for clinical decision-making.

Introduction. The most common cause of pathological fractures are skeletal metastases. Ten percent of patients with diagnosed skeletal metastases will sustain a pathological fracture. Skeletal metastases can be treated by non-surgical methods, including analgesics, bisphosphonates, and radiotherapy, with the primary goal of relieving pain and slowing down tumor growth. Surgical treatment is indicated for impending or existing fractures. It includes stabilization with internal fixation using various nails, plates, and screws with or without osteoplasty, and endoprosthetic joint replacement, especially in lesions around major joints - hip, knee, and shoulder. Material and Methods. The study included patients operatively treated at the Institute of orthopedics "Banjica" and pathohistologically analyzed at the Institute of pathology in Belgrade during the period from February 2021 to January 2022. Inclusion criteria were an existing or impending pathological fracture of long bones, operative treatment with tissue sampling, and the consequent pathohistological diagnosis of metastatic carcinoma. Patients with biopsy-proven processes other than metastatic carcinomas were excluded from the study. The total number of patients included in the study was 69. Results. The mean age of patients at the pathological fracture occurrence was 67.7 (ranging from 42 to 88). Malignant diseases diagnosed were: breast cancer 36.1%, lung cancer 24.5%, kidney cancer 14.5%, prostate cancer 13.1%, colorectal cancer 2.9%, other cancer (8.9%). The radiological presentation was in the form of lysis in 75.4% and in blastic form in 24.6%. Operative treatment included arthroplasty in 53.6% of patients and stabilization with nail or plate in 46.4%. Conclusion. Pathological fractures represent the final outcome of tumor activity in a bone and cause significant suffering in patients expressed through severe pain and often immobility, which accelerates all the pathological processes and leads to death. Joint methods of contemporary chemotherapy, radiotherapy, and surgery enabled a significant life quality improvement and extension in these patients.

Identifying risk factors for fracture occurrence in breast cancer (BC) skeletal metastases (SM) may guide the management of such bone deposits. There is sparse evidence regarding receptor status in SM and their relationship to fracture occurrence. Our study aimed to determine the relationship between estrogen (ER), progesterone (PR) and HER2 receptor status and Ki-67 index and fracture occurrence in SM of BC. Exactly 152 samples of SM of BC obtained from individual patients were evaluated. The status of the aforementioned receptors and Ki67 index were determined in SMs samples. Their expression was compared between SM that did and did not develop a fracture. Ninety-one cases sustained a pathological fracture at the SM site, and 61 did not. Patients who sustained a pathological fracture had a higher rate of PR positivity at their SMs as compared to those with no fracture. There was no significant difference between the two groups concerning ER, HER2+ or Ki67 status. SMs secondary to BC with a fracture are more likely to be PR positive than those with no fracture. Determining the receptor status in SMs may identify high-risk groups for fracture occurrence, and determining the PR status may also guide surgical and hormonal therapy.

Breast cancer is the leading cause of cancer-related deaths among women worldwide. While significant progress has been made in the prophylaxis, diagnosis, and management of breast cancer, around 90% of deaths occur due to metastatic disease, which is still incurable. The bone has been identified as one of the predominant metastatic sites, accounting for around 80% of patients with metastatic breast cancer. The paper aims to summarize the hallmarks of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) influence on breast cancer bone metastases development and their further biological and clinical behavior. Various clinicopathological characteristics have been identified as risk factors for the development of metastases. In particular, the status of ER, PR and HER2 is crucial for making clinical decisions as an important tool for predicting the spread of breast cancer and choosing a therapeutic protocol. Patients with any hormone receptor-positive status, particularly those with ER+, PR+/HER2-, are more likely to develop bone-only-metastatic (BOM), whereas those with hormone receptor-negative status, especially those with so-called triple-negative (HR-/HER2-) or HER2+ breast cancer, have a predilection for visceral metastases. The paper highlights that while bone metastases of breast cancer are much less investigated than primary tumors, more studies are needed to understand the complex, multi-step process involved in the development and behavior of bone metastases.

Background/Objectives: Understanding the biological factors that drive the behavior and clinical presentation of breast cancer (BC) skeletal metastases (SM) is critical for improving diagnostic accuracy and guiding treatment strategies. However, evidence regarding the immunohistochemical (IHC) profiles of SM and their association with radiographic characteristics and clinical features remains limited. This study aimed to evaluate the relationship between estrogen receptor (ER), progesterone receptor (PR), HER2 receptor status, and Ki-67 proliferation index with the radiographic presentation of SM in patients with BC. Methods: A total of 185 SM samples from individual BC patients were analyzed. IHC expressions of ER, PR, HER2, and Ki-67 were determined for each sample. Clinical and radiological data were retrieved from medical records. IHC profiles were compared between metastases demonstrating purely lytic versus mixed radiographic patterns. Results: Of the 185 cases, 66 exhibited a lytic pattern, and 119 demonstrated a mixed pattern. Lytic metastases showed a significantly higher rate of HER2 positivity compared with mixed lesions. The Ki-67 index was also significantly higher in lytic metastases, with a cutoff value of 25 yielding a sensitivity of 92.98% and specificity of 89.84% (positive likelihood ratio 9.16; negative likelihood ratio 0.08). No significant differences were observed between groups in ER or PR expression. Conclusions: SM from BC with a lytic radiographic presentation are more likely to exhibit HER2 positivity and a Ki-67 index above 25. Assessing the IHC status of SM may help identify patients at elevated risk for skeletal complications, including pathological fracture, and may support more tailored surgical and systemic treatment planning.