Functional outcome of pathologic fracture secondary to malignant disease in a rehabilitation hospital

Abstract

Fifty‐eight patients with 62 pathologic fractures secondary to metastatic disease were admitted to a rehabilitation hospital during a 5‐year period. Thirty‐four patients were discharged home, 7 were transferred to other facilities, and 17 died. The average hospital stay for the patients who went home (37 days) was only 3 days longer than for patients with nonpathologic fractures. No patient could transfer independently or ambulate at the time of admission, but 26 and 23, respectively, could do so by the time of discharge; 27 patients showed significant improvement in their ability to perform activities of daily living as measured by Kenny scores. All 11 patients who had hypercalcemia died. Eleven of 13 patients requiring parenteral narcotics died. Patients with pathologic fractures secondary to metastatic disease are excellent candidates for intensive rehabilitation programs, but hypercalcemia and administration of parenteral narcotics suggest a poor rehabilitation outcome.

Inter- and intra-observer variability associated with the use of the Mirels’ scoring system for metastatic bone lesions

“…Prevention of fracture by prophylactic fixation offers both technical and patient related benefits. In terms of operative procedures, a prophylactic fixation is considered to be of a lesser magnitude than having to fix an established pathological fracture [1,3,8,21]. Furthermore, in relation to the patient, prophylactic fixation has been associated with pain relief with resultant improvement in the quality of life and restoration of ambulation [19] as well as a low complication rate [7].…”

Update in Cancer Pain Syndromes

“…In these cases, the decision for surgical intervention should be based on the severity of and the symptoms associated with the fracture. 179 Radiation therapy after surgical repair is important for the patient to regain preoperative functional status. 180…”

Considerations for Exercise Prescription in Patients With Bone Metastases: A Comprehensive Narrative Review

“…In addition, lytic metastases (those that break down bone), common in myeloma or renal cell carcinoma, were more likely to develop into fractures in comparison with osteoblastic metastases (those that stimulate bone growth), common in prostate cancer. Although hypercalcemia and administration of parental narcotic suggest a poor rehabilitation outcome in those referred to rehabilitation after pathologic fracture, patients with pathologic fractures secondary to metastatic disease are considered excellent candidates for intensive exercise rehabilitation programs [50].…”