Screw Fixation in Metastatic Bone via the “Tripod” Method

A novel method for treating pelvic fractures in metastatic bone cancer patients is the subject of a new study from the Montefiore Health System in New York City.

The chief investigators are Montefiore’s orthopedic oncology surgeons and their study, “A Novel Tripod Percutaneous Reconstruction Technique in Periacetabular Lesions Caused by Metastatic Cancer,” appears in the February 19, 2020 edition of The Journal of Bone and Joint Surgery.

The “tripod” technique is one where surgeons place multiple screws through very small incisions thereby connecting the fractured pelvic bones and the pelvis. According to the team who studied this technique, the “tripod” technique, which refers to the configuration of screw placement, adequately supports the hip socket joint.

“This approach goes against the conventional notion that bone affected by cancer is too weak and needs to be completely replaced,” said lead author Rui Yang, M.D., an orthopedic surgeon at Montefiore, and an assistant professor, Albert Einstein College of Medicine. “Our study shows that using this technique means patients don’t need to undergo a longer, more aggressive surgery. They recover and go home quicker, have less pain, and most importantly, can resume therapies targeted at treating their cancer.”

“We are pleased to find this technique results in better outcomes for our patients,” said co-author David Geller, M.D., orthopedic oncologist and vice-chairman, Strategy and Innovation, Orthopaedic Surgery, Montefiore and associate professor of Orthopedic Surgery and Pediatrics, Albert Einstein College of Medicine. “And we are surprised to find that despite conventional wisdom, many of our patients heal their fractures and experience new bone growth.”

“Most of the patients in this study were able to get out of bed and bear weight on the same day as the surgery,” said Dr. Yang. “None of them needed a blood transfusion and there were no wound-healing issues. We hope that other surgeons will consider this approach so that patients have one less issue to deal with, while they undergo cancer treatment.”

Dr. Yang told OTW, “The most important thing for orthopaedic surgeons to know is that for patients with periacetabular metastatic lesions, the tripod technique offers a minimally invasive approach for pain control and functionality improvement, as compared to the modified total hip replacement as currently commonly practiced. It is safe and effective, as shown in our pilot study.”

“As with healthcare institutions throughout New York, we are dealing with COVID-19 patients and are strictly adhering to guidelines from the Centers for Disease Control and Prevention (CDC) and local public health agencies. As of now, all elective surgeries and procedures are cancelled to protect stocks of supplies, staffing and potential space for COVID-19 patients.”