Metastatic fractures of long limb bones

Abstract

The diagnosis of pathological fracture should be considered routinely in patients with long limb-bone fractures. Investigations must be performed to establish the diagnosis of pathological fracture then to determine that the bone lesion is a metastasis. In over 85% of cases, the clinical evaluation combined with a detailed analysis of the radiographs is sufficient to determine that the fracture occurred at a tumour site. Aetiological investigations establish that the tumour is a metastasis. In some patients, the diagnosis of metastatic cancer antedates the fracture. When this is not the case, a diagnostic strategy should be devised, with first- to third-line investigations. When these fail to provide the definitive diagnosis, a surgical biopsy should be performed. The primaries most often responsible for metastatic bone disease are those of the breast, lung, kidney, prostate, and thyroid gland. However, the survival gains provided by newly introduced treatments translate into an increased frequency of bone metastases from other cancers. The optimal treatment of a pathological fracture is preventive. The Mirels score is helpful for determining whether preventive measures are indicated. When selecting a treatment for a pathological fracture, important considerations are the type of tumour, availability of effective adjuvant treatments, and general health of the patient. Metastatic fractures are best managed by a multidisciplinary team. The emergent treatment should start with optimisation of the patient's general condition, in particular by identifying and treating metabolic disorders (e.g., hypercalcaemia) and haematological disorders. Treatment decisions also depend on the above-listed general factors, location of the tumour, and size of the bony defect. Prosthetic reconstruction is preferred for epiphyseal fractures and internal fixation for diaphyseal fractures.

Pathologic fractures of the distal femur: Current concepts and treatment options

“…In other situations, resection and reconstruction with a tumour prosthesis is advised. Concerning the use of LPO as described by Anract et al we do not completely agree, for union should rarely be expected. Therefore, in our own instructional review, we recommend locking plate fixation with adjuvant PMMA if the bone stock is sufficient for adequate grip of the screws, irrespective of any expected union.…”

Bone metastasis as the first symptom of tumors: role of an immunohistochemistry study in establishing primary tumor

“…Bone metastasis is the most frequent neoplasm of bone tissue, occurring predominantly in the axial skeleton and proximal limbs. 1 , 2 It affects individuals of different age groups; in the present sample, age ranged from 28 to 87 years, with no predilection for gender (55% of women and 45% of men).…”

“…Carcinoma metastases are the most frequent neoplasm in bone tissue, affecting mainly the axial skeleton (skull, ribs, spine, and pelvis) and the proximal limbs (humerus and femur), rarely occurring beyond the elbow or knee. 1 , 2 , 3 , 4 , 5 , 6…”

“…The main primary sites of bone metastases are the breasts, lungs, prostate, thyroid, and kidney. 1 , 2 , 6 Bone involvement of these neoplasms usually suggests disseminated disease, and other organs are probably then involved. 3 …”

Uzun kemik diyafizer metastazları

“…Bu durumda böbrek fonksiyonları takip edilmelidir. [20] Açık küretaj yapılıp yapılmaması ameliyattan önce değerlendirilmelidir. Açık küretajın avantajları, anatomik bölgedeki tümör dokusunun azaltılarak radyoterapiye cevabın artırılması ve tespit kalitesinin çimento ile güçlendirilerek hastanın erken fonksiyon kazanabilmesidir.…”