Management of Pathologic Fractures Around the Hip: Part 1–Femur

Abstract

Evaluation and management of suspected pathologic fractures, secondary to metastatic disease, require a comprehensive understanding of the underlying disease process and a multidisciplinary treatment approach. Recognition of a pathologic fracture can be challenging, and the diagnosis today remains often missed, but is necessary for appropriate care. The incidence of cancer in the United States is on the rise, and with advances in medical and surgical care the prevalence of cancer is increasing as well. This will result in a similar trend of increased incidence and prevalence of metastatic disease requiring treatment from orthopaedic surgeons. The proximal femur is the most common location for metastatic lesions in the appendicular skeleton, and as such sees a disproportionate number of pathologic fractures. This site of injury is particularly challenging to manage due to the transmission of high forces through this region during ambulation. A combination of adjunct therapies and surgical intervention will maximize the outcomes for these patients. Obtaining a tissue diagnosis, especially in the setting of a solitary bone lesion, is a crucial and required early step in this process.

Proximal Femoral Replacement for Metastatic Bone Disease - A Case Series

“…Mirels criteria study showed fair to moderate agreement between authors when using the Mirels score to quantify the need for fixation in pathological and diseased bone. (7) We present four cases of metastasis to the proximal femur in patients managed with Proximal femoral replacements.…”