Surgical treatment for pathologic fracture

Abstract

One of the reasons for initiating this project was the suspicion of a high failure rate in the surgical treatment for pathologic fracture. If a reoperation is a disappointment for an otherwise healthy patient, it is often a disaster for a gravely ill patient. The main aim of this thesis was to draw attention to this important clinical problem and the fact that principles of fracture treatment are different for pathologic and traumatic fractures. Bone metastasis is a dreaded complication in malignant disease. The precise incidence is unknown. It has been estimated that half of all patients with malignant disease will acquire metastases and half of these will arise in the skeleton. With 40,000 new cases of malignant disease in Sweden each year approximately 10,000 patients will develop skeletal metastases. However, skeletal metastases may be asymptomatic and the incidence of clinically signi cant skeletal metastases is lower. Bone metastases per se are seldom responsible for cancer mortality but often dramatically affect quality of life by causing pain, pathologic fracture, hypercalcemia, anemia and paraparesis. These complications often occur during the last months of life; however, some patients will survive for many years. It would be of clinical importance if this subgroup of patients could be identi ed since long-term survival has implications for the choice of treatment. During recent years, more attention has been directed towards improved palliative care for cancer patients with skeletal metastases. Radiotherapy remains the mainstay for painful skeletal metastases, but treatment with hormone therapy, chemotherapy and bisphosphonates are also important treatment modalities. The application of surgical treatment for pathologic fracture has increased dramatically. At our Department, the yearly number of patients operated for pathologic fracture or paraparesis has tripled during the last decade. Home based care of terminally ill patients requires an active palliative management of pathologic frac

Cytotoxic effects of zoledronic acid-loaded hydroxyapatite and bone cement in malignant tumors

“…However, complications of local recurrence and subsequent osteolysis persisted. Tumor-associated osteolysis precipitates the development of pathological fractures and causes loosening of previously placed devices for internal fixation of pathological fractures (5)(6)(7). Previously, the prognosis of patients with bone metastases has improved through the development of effective adjuvant or neoadjuvant chemotherapy regimens.…”

In Brief: Classifications in Brief

“…These metastatic lesions and other destructive processes affecting bones such as myeloma and lymphoma, predispose the bone to an impending fracture [16]. Such a high-risk lesion can be treated with radiotherapy, drugs (bisphosphonates), and surgery [20]. Surgery usually is reserved for lesions at the highest risk of fracture or intractable pain.…”

Enfermedad metastásica ósea: Diagnóstico y tratamiento

“…El diagnóstico histológico de metásta-sis es sencillo, no así el reconocimiento del órgano origen, al que no se llega en todos los casos 17 . Encontrar tejido epitelial neoplásico en el interior de un hueso no puede significar otra cosa que la presencia de una metástasis.…”