2 articles
Bone lesions remain a serious, unresolved issue in patients with multiple myeloma. The management of myeloma-related bone disease involves a multimodal approach, including chemotherapy, bone antiresorptive agents (bisphosphonates), radiotherapy, pharmacological pain management, minimally invasive percutaneous orthopedic procedures, and invasive surgical interventions.
A bibliographic search was conducted using databases such as PubMed, Hinari, SpringerLink, the National Center for Biotechnology Information, and Medline. Articles published between 2000 and 2025 were selected using the following keywords: “bone lesions in multiple myeloma” in combination with terms such as “conservative treatment,” “surgical treatment,” “orthopedic surgery,” and “minimally invasive techniques” to maximize the search yield. Based on the established search criteria, a total of 286 full-text articles were identified. The final bibliography includes 42 relevant sources, deemed representative of the literature published on the topic of this review article.
Bisphosphonates or denosumab should be considered the standard of care for the treatment of bone disease in patients with multiple myeloma. Cement augmentation (polymethylmethacrylate) is effective in managing painful vertebral compression fractures (percutaneous vertebroplasty, balloon-assisted percutaneous kyphoplasty). Radiotherapy is recommended for uncontrolled pain in cases of spinal cord compression or pathological fractures of long bones, especially in patients who show no response or minimal response to systemic treatment for multiple myeloma. Surgery should be used to prevent and repair pathological fractures of long bones, spinal instability, and spinal cord compression caused by bony fragments. Postoperative radiotherapy should be considered, particularly for long bone fractures, to achieve local disease control and prevent implant failure.
The current concept in the management of patients with multiple myeloma and bone lesions is based on developing an individualized approach that takes into account anatomical, biological, radiological, and social factors. The selection of surgical techniques must be tailored to each patient, based on general medical condition, quality of life and life expectancy, prior response to chemotherapy, fracture location, number, size and distribution of bone lesions, extent of bone invasion, neurological status, and patient expectations.
Despite advances in non-operative and surgical management, calcaneal fractures remain severe injuries with relatively poor clinical outcomes. These fractures predominantly affect young, active individuals and are often associated with long-term sequelae, permanent disability, a considerable reduction in quality of life, and a substantial economic impact due to work incapacity and rehabilitation needs.
This study is a narrative literature review. A bibliographic search was conducted using PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases. Articles published from 1990 to 2024 were selected based on keyword combinations such as “calcaneal fracture,” “comminuted calcaneal fracture,” “orthopedic treatment”, “surgical treatment,” “minimally invasive treatment,” “osteosynthesis,” “locking plate,” and “locked intramedullary nail.” After processing information from these databases according to the search criteria, 225 full-text articles were identified. The final bibliography includes 56 relevant sources, which were considered representative of the materials published on the topic of this synthesis article.
Surgical treatment using open reduction and internal fixation for displaced intra-articular calcaneal fractures was superior to non-surgical treatment in restoring Bohler’s angle, achieving more stable calcaneal height and width, improving functional recovery, reducing the number of patients requiring orthopedic footwear, and enabling return to pre-injury activities, though it carries a high risk of complications. The minimally invasive approach via the sinus tarsi and the extended lateral L-shaped approach are equally effective for treating Sanders type II and III fractures in terms of restoring anatomical structures, radiological outcomes, and functional recovery. However, the sinus tarsi approach is effective in reducing wound complication rates (3.6–6.3% vs. 13.5–31.2%, respectively; p < 0.05), pain syndrome rates, time to surgery (p < 0.0001), surgery duration (p < 0.05), and hospital stay duration. Therefore, the minimal incision approach is a good alternative to the extended lateral L-shaped approach.
The current concept in managing calcaneal fractures involves developing an individualized treatment plan based on the patient’s characteristics and functional requirements, comorbidities, fracture type, and associated injuries, as well as the surgeon’s experience with the selected surgical technique.