Israel Medical Association Journal

Background: Multiple myeloma (MM) affects the long bones in 25% of patients. The advent of positron-emission tomography/computed tomography (PET/CT) scanners offers the possibility of both metabolic and radiographic information and may help determine fracture risk. To the best of our knowledge, no published study correlates these two factors with long bone fractures.

Objective: To evaluate the impact of PET/CT on fracture risk assessment in multiple myeloma patients.

Methods: We identified all bone marrow biopsy proven multiple myeloma patients from 1 January 2010 to 31 January 2015 at a single institution. We prospectively followed patients with long bone lesions using PET/CT scan images.

Results: We identified 119 patients (59 males/60 females) with 256 long bone lesions. Mean age at diagnosis was 58 years. The majority of lesions were in the femur (n=150, 59%) and humerus (n=84, 33%); 13 lesions in 10 patients (8%) required surgery for impending (n=4) or actual fracture (n=9). Higher median SUVmax was measured for those with cortical involvement (8.05, range 0–50.8) vs. no involvement (5.0, range 2.1–18.1). SUVmax was found to be a predictor of cortical involvement (odds ratio = 1.17, P = 0.026). No significant correlation was found between SUVmax and pain or fracture (P = 0.43).

Conclusions: Improved medical treatment resulted improvement in 8% of patients with an actual or impending fracture. The orthopedic surgeons commonly use the Mirels classification for long bone fracture prediction. Adding PET/CT imaging to study in myeloma long bone lesions did not predict fracture risk directly but suggested it indirectly by cortical erosion.

Background: Fractures of the distal radius are the most common fractures in the upper extremity, and their incidence is increasing with the aging of the population. Despite anatomical reduction of the bones, many patients complain of residual pain. A reason for this may be ligament injury not addressed during surgery or conservative treatment. Radiographic measurements may allow assessment of ligament integrity but they may be population specific and differ among races.

Objectives: To assess radiographic wrist measurements in an Israeli population and to compare them to existing values.

Methods: Demographic data, previous diagnosis of osteoporosis, fracture classification, and radiologic measurements (radial height, radial inclination, ulnar variance, volar tilt, and d2/w2) were measured and compared.

Results: The study was comprised of 53 females and 27 males, mean age 64 years, with wrist radiographs following surgery. Of these, 13% were smokers and 38.5% had osteoporosis. According to the Arbeitsgemeinschaft für Osteosynthesefragen classification system, most of the fractures were comminuted and intra-articular. The mean values for all measurements did not differ significantly from values in the literature. The average d2/w2 ratio (describing the radiocarpal ligaments) was 0.42, significantly differing from this measurement in normal wrists as described in the literature, but similar to a population following surgery (P = 0.002).

Conclusions: Our population had more fragility fractures than other populations. Otherwise, our demographics and measurements did not differ from normal values described in the literature. This study supports the validity of any wrist radiographic study performed in our population.