Management of pathologic fractures

Pérez, Carlos A.; Bradfield, John S.; Morgan, Harry C.

doi:10.1002/1097-0142(197203)29:3<684::aid-cncr2820290322>3.0.co;2-k

Cited by 40 publications

(15 citation statements)

References 12 publications

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“…Patients were categorised as referred if they were transferred via an external surgical department where surgical treatment of femoral fractures is routinely performed. In addition to a previously published functional score (excellent/good, fair, poor) [10], we created a score that focuses on mobility and walking aids (see Table 1). The Eastern Cooperative Oncology Group (ECOG) and the Karnofsky performance status (0-5) [11] were at least three, with no correlation to overall performance status; thus, they could not be applied in this retrospective analysis.…”

Section: Methodsmentioning

confidence: 99%

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Zacherl

Gruber

Glehr

et al. 2010

International Orthopaedics (SICOT)

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Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n=33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n=31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n=7) vs. the S group (n=3), with no statistically significant difference.Patients with surgery-related complications had a higher survival rate (p=0.049), as did patients with mechanical implant failure (p=0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

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Section: Methodsmentioning

confidence: 99%

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Zacherl

Gruber

Glehr

et al. 2010

International Orthopaedics (SICOT)

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“…The humerus constitutes the second most frequently involved site in the appendicular skeleton following the femur [24]. The metastatic lesions of the humerus account for 16% to 39% of cases with actual or impending pathological fractures of the long bones [7,19,25]. Pathological fractures of the humeral shaft usually occur late in the course of metastatic disease [9].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive treatment of pathological fractures of the humeral shaft

Ofluoğlu

Erol

Özgen

et al. 2008

International Orthopaedics (SICOT)

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Most patients with pathological fractures due to cancer metastasis have a limited life expectancy. Orthopaedic procedures, therefore, should be minimally invasive in order to avoid additional surgical morbidity. The purpose of this study was to analyse the results of minimally invasive approaches, including locked intramedullary nailing, followed by early postoperative radiation for pathological humeral shaft fractures. Twenty-four pathological fractures of the humerus diaphysis in 23 patients were treated with the prospective protocol, including antegrade unreamed intramedullary nailing and postoperative radiotherapy (20 Gy and five fractions). The patients and results of the surgery were evaluated by the Musculoskeletal Tumor Society upper extremity scoring system. All patients had a stable extremity, and the average function of 20 patients was 64% of the normal upper extremity function. Only one patient required revision surgery. The minimally invasive treatment of patients with pathological fractures of the humeral shaft with closed unreamed intramedullary nailing combined with adjuvant radiotherapy is an effective and safe procedure, even in seriously ill patients.Résumé Un grand nombre de patients avec des fractures pathologiques secondaires à des métastases ont une espérance de vie diminuée. Les traitements orthopédiques avec technique mini-invasive permettent de diminuer la morbidité chirurgicale. Le propos de cette étude est d'analyser les résultats d'une technique avec voie d'abord mini-invasive pour enclouage centro-médullaire verouillé suivi d'une irradiation post-opératoire pour des tumeurs de la diaphyse humérale. 24 fractures pathologiques de la diaphyse humérale sur 23 patients ont été traitées de façon prospective, le protocole incluant un clou centro-médullaire mis sans alésage par voie antérograde et une radiothérapie de 20 Gy en 5 séances. Les patients et les résultats de la chirurgie ont été évalués grâce au score de la Société des tumeurs musculo squelettiques. Tous les patients sont parfaitement stables avec une amélioration globale fonctionnelle chez 20% des patients, une fonction de l'extrémité supérieure normale dans 64%. Un seul patient a nécessité une reprise chirurgicale. La voie d'abord mini-invasive chez ces patients présentant des fractures pathologiques de la diaphyse humérale traités par enclouage centro-médul-laire sans alésage combiné à une radiothérapie adjuvante est un traitement qui permet d'avoir des résultats certains avec une bonne sécurité même chez des patients gravement atteints.

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“…10,11 Because of the poor conservative treatment results, operative stabilization has become the recommended therapy for pathologic fractures of long bones. 2,9,11,12 Surgical intervention is only for palliation and aims to achieve local tumor control, stability, and normal function of the affected extremity as quickly as possible. Failure to fulfill one of these criteria usually necessitates additional surgical interventions and impairment of an already limited quality of life.…”

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confidence: 99%