Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients

Sarahrudi, Kambiz; Hora, K.; Heinz, Thomas; Millington, Steven; Vécsei, V.

doi:10.1007/s00264-006-0205-9

Cited by 48 publications

(37 citation statements)

References 29 publications

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“…Patients undergoing fixation of pathological fractures benefit from these procedures in terms of mobility and reduction in local pain [18]. Prevention of fracture by prophylactic fixation offers both technical and patient related benefits.…”

Section: Discussionmentioning

confidence: 99%

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

Niocaill

Quinlan

Stapleton

et al. 2010

International Orthopaedics (SICOT)

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Metastatic bone disease is increasing in association with ever-improving medical management of osteophylic malignant conditions. The precise timing of surgical intervention for secondary lesions in long bones can be difficult to determine. This paper aims to evaluate a classic scoring system. All radiographs were examined twice by three orthopaedic oncologists and scored according to the Mirels' scoring system. The Kappa statistic was used for the purpose of statistical analysis. The results show agreement between observers (κ=0.35-0.61) for overall scores at the two time intervals. Inter-observer agreement was also seen with subset analysis of size (κ=0.27-0.60), site (κ=0.77-1.0) and nature of the lesion (κ=0.55-0.81). Similarly, low levels of intra-observer variability were noted for each of the three surgeons (κ=0.34, 0.39, and 0.78, respectively). These results indicate a reliable, repeatable assessment of bony metastases. We continue to advocate its use in the management of patients with long bone metastases.

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Section: Discussionmentioning

confidence: 99%

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

Niocaill

Quinlan

Stapleton

et al. 2010

International Orthopaedics (SICOT)

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“…Surgical treatment options for pathological fracture in malignant bone sarcomas range from reconstructive surgery to amputation [20]. Limb salvage has become a popular alternative to amputation for the treatment of malignant bone tumours and can improve functional outcome [23][24][25]. Within this setting it is of pivotal interest whether limb salvage has any effect on the long-term survival of patients, and few studies have specifically compared the outcome of limb salvage versus amputation [1,2,5,13,16,22,27].…”

Section: Introductionmentioning

confidence: 99%

The impact of pathological fractures on therapy outcome in patients with primary malignant bone tumours

Moradi

Zahlten-Hinguranage

Lehner

et al. 2009

International Orthopaedics (SICOT)

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The primary objective of this study was to investigate the implications of pathological fractures on therapy outcome in patients with primary malignant bone tumours and to determine whether limb salvage can be safely performed. A retrospective analysis of 447 patients with primary malignant bone tumours, treated between 1985 and 2005, was performed. Multivariate Cox regression analysis was used to investigate the influence of pathological fractures and further independent variables on survival rate. In 52 of the 447 patients, the primary malignant bone tumour was complicated by a pathological fracture. These fractures were more common in malignant fibrous histiocytoma (MFH) of the bone and in the tumour stages IIa/b and III. Ablative surgery was performed in ten patients and limb salvage surgery in 42 patients. The mortality risk for patients with pathological fractures was significantly increased by a factor of 1.82 (p=0.015), and overall duration of survival was significantly lower in the fracture group, with a median of 6.2 years (p<0.00001). In univariate and multivariate analysis, fracture, higher tumour stages and resection margins remained a significant predictor of worse survival. Overall survival, rate of local recurrence and distant metastases were not affected by the type of surgical treatment selected; there was no difference between the patients who underwent limb salvage and those who underwent an amputation. Pathological fracture in patients with primary malignant bone tumours is a predictor of worse survival and significantly increases mortality risk. Reconstructive surgery did not influence the survival rate, showing that limb salvage therapy is safe when adequate resection margins are achieved.

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“…Implant failure rates regarding proximal femur pathological fractures vary vastly in different literatures, ranging from 0-23% (5,12,28,29). A study by Manoso et al (28) reported the most favorable results that no infections, dislocations or reoperations were observed in a 6-year retrospective study with 13 cancer patients with proximal femur metastasis treated with proximal femur replacement.…”

Section: Msts-93 Score ----------------------------------------------mentioning

confidence: 99%

“…Surgical modalities are widely regarded as effective, most of which include endoprosthetic reconstruction (EPR) (1,3,7,8,(10)(11)(12)(13), intramedullary nailing (IMN) and open reduction-internal fixation (4,5,9,10,14). Although these surgical strategies are usually palliative, consensus of the optimal surgical procedure has not been reached.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement

Xiong

Shi

et al. 2017

mol clin onc

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Abstract. Endoprosthetic replacement (EPR) and intramedullary nailing (IMN) are the two most commonly applied surgical methods used to treat proximal metastatic lesions; however, indication of the above procedures remains controversial. The aim of the present study was to evaluate the clinical, functional and oncological outcomes of patients who underwent EPR compared to IMN for the treatment of proximal femur metastases to investigate the surgical indication for patients. The records of patients (n=88) with pathological fractures secondary to metastatic tumors of the proximal femur admitted between January 2005 and December 2014 to West China Hospital, Sichuan University (Chengdu, China) were retrospectively studied. A total of 57 patients were treated with EPR (34 males and 23 females; mean age, 62.5 years) and 31 patients were stabilized with IMN (19 males and 12 females; mean age, 60.2 years). Patients were analyzed regarding surgery time, blood loss, hospital stay, Musculoskeletal Tumor Society (MSTS) score, survival, recurrence and complications. The median follow-up period was 12.9 (range, 3-98) months. The median survival time in EPR was 10.0 months and 7.5 months in IMN. The surgery time was 142.6±22.7 min in the EPR group and 98.7±19.5 min in the IMN group (P=0.001). Significantly less blood loss was observed in the IMN group (345.2±66.4 ml) than in the EPR group (631.5±103.6 ml; P=0.001). The median hospital stay in the EPR group was 8 (quartile range, 7-9) days and 5 (quartile range, 5-6) days in the IMN group (P=0.001). Local recurrence rate was 10.5% (6/57) in the EPR group and 25.8% (8/31) in the IMN group (P=0.074). The complication rates were 10.5% (6/57) in the EPR group and 29.0% (9/31) in the IMN group (P=0.038). MSTS-93 score was higher in IMN compared with EPR at 6 weeks postoperatively (P=0.001), while the EPR group demonstrated a higher score at 6 months postoperatively (P=0.001). EPR has the advantage of better functional outcomes and higher life quality in the long term, with lower complication rates in treating metastatic lesions of the proximal femur with pathological fractures. EPR is recommended for patients with relatively good general condition and prognosis. IMN is best indicated when the patient's life expectancy is extremely limited.

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Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients

Cited by 48 publications

References 29 publications

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

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

The impact of pathological fractures on therapy outcome in patients with primary malignant bone tumours

Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement

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