[The preoperative plan in orthopedics (case reports)]

Area of Science:

• Orthopaedic Surgery
• Bone Metabolism
• Oncology

Background:

• Modern orthopaedic surgery relies heavily on biomechanical principles and implant technology.
• The metabolic function of osseous tissue is frequently underestimated by surgeons.
• This oversight can lead to complications and misdiagnoses in patient care.

Observation:

• Case 1: A femoral fracture treated with Küntscher osteosynthesis was later found to be a pathological fracture due to osteosarcoma, missed initially due to lack of histological examination.
• Case 2: Challenges were encountered in creating adequate space for femoral component implantation, potentially related to bone quality.
• Case 3: Rapid weight loss in an overweight patient led to osteoporosis, raising questions about pre-endoprosthesis weight reduction protocols without metabolic assessment.

Findings:

• Failure to consider bone's metabolic role can result in delayed diagnosis of conditions like osteosarcoma.
• Improper assessment of bone health can complicate implant procedures, such as total hip or knee replacements.
• Metabolic changes, like osteoporosis post-weight loss, require careful consideration before major orthopaedic interventions.

Implications:

• Integrating metabolic evaluation into orthopaedic practice may improve diagnostic accuracy and surgical planning.
• A comprehensive approach considering both biomechanics and bone metabolism is crucial for optimizing patient outcomes.
• Future orthopaedic treatments could benefit from a deeper understanding and application of osseous tissue's metabolic functions.