Osteolytic metastasis can result in pathological fracture. A local control of the metastasis, using thermal ablation technique, can be useful at the early stage to avoid any growth of the tumor that could lead to skeletal related events. A prophylactic consolidation is also required in association. For this purpose, cementoplasty alone is not sufficient in the proximal femur and a percutaneous osteosynthesis must be performed in addition.

Objectives:

• To acquire the right technique of the radiofrequency ablation procedure: material and ablation protocol.
• To know to assess the position of the needle during the puncture using 3D acquisition with a flat panel detector.
• To know how to perform a percutaneous osteosynthesis of the femoral neck.
• To know how to prepare the bone cement.

• 3D acquisitions   15:42 / 28:32 / 07:23 / 23:04 / 00:22
• Assessment of the needle position with 3D   07:54
• Cannulated screw and screw driver   17:06
• Cement preparation   32:46
• Drill   21:20 / 15:00
• General anesthesia and femoral block   40:14 / 00:07
• Injector set   32:46
• Insertion of the cannulated screw   29:50 / 24:06 / 17:48
• Insertion of the cementoplasty needle   31:31
• Insertion of the coaxial needle  03:48
• Insertion of the guide pins   27:00 / 20:00 / 14:45
• Measurement of the cannulated screw to be inserted   23:30 / 16:05 / 29:20
• Planification of the guide pins position   19:35 / 28:50 / 14:00 / 26:07
• Planification of the needle trajectory   00:39
• Presentation of the radiofrequency generator   06:44
• Presentation of the radiofrequency needle   01:29
• Radiofrequency ablation   09:05
• Radiofrequency needle   03:48

Equipment:

• RFA electrode-needle ( Cool-tip® 20/2 cm, Covidien, Mansfield, USA )
• 13G cementoplasty needle ( Osteo-Site®, Cook, Bjaeverskov, Denmark )
• 8G needle ( Transpedicular Introducer®, Laurane, Westbrook, USA 
• 11G cementoplasty needle ( Osteo-Site®, Cook, Bjaeverskov, Denmark )
• Vertebroplasty bone cement ( Opacity®, ViC en Bigorre, France )
• Injector Set for cementoplasty ( Osteo-Force®, Cook, Bjaeverskov, Denmark )
   

Cementoplasty of metastases of the proximal femur: is it a safe palliative option?

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J Vasc Interv Radiol. 2012 Oct;23(10):1311-6. doi: 10.1016/j.jvir.2012.06.027. Epub 2012 Aug 21.

Percutaneous stabilization of impending pathological fracture of the proximal femur.

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Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures (1989).

Mirels H.

Clin Orthop Relat Res. 2003 Oct;(415 Suppl): S4-13.

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Van der Linden YM, Dijkstra PD, Kroon HM, Lok JJ, Noordijk EM, Leer JW, Marijnen CA.

J Bone Joint Surg Br. 2004 May;86(4):566-73. Review