Metastatic fractures of long bones

Korkala, O; Karaharju, Erkki

doi:10.1007/bf00179706

Cited by 18 publications

(13 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The long-term survival of patients after their first pathological fracture of a long bone has more than tripled for the most common cancers during the past 25 years, 8,21 and survival in our study was high compared with those undertaken in the 1970s and 1980s. 14,19,[22][23][24][25][26][27][28][29] In two Swedish studies which described patients treated surgically between 1986 and 1995, the one-year survival rate (0.3) was in the same range as that for three years in our group. 30,31 In many studies, patients with solitary bony metastases survived significantly longer than those with multiple lesions.…”

Section: Discussionmentioning

confidence: 84%

The surgical treatment of bony metastases of the spine and limbs

Böhm

Huber

2002

The Journal of Bone and Joint Surgery

177

View full text Add to dashboard Cite

The skeleton is the most common site to be affected by metastatic cancer. The place of surgical treatment and of different techniques of reconstruction has not been clearly defined. We have studied the rate of survival of 94 patients and the results of the surgical treatment of 91 metastases of the limbs and pelvis, and 18 of the spine. Variables included the different primary tumours, the metastatic load at the time of operation, the surgical margin, and the different techniques of reconstruction. The survival rate was 0.54 at one year and 0.27 at three years. Absence of visceral metastases and of a pathological fracture, a time interval of more than three years between the diagnosis of cancer and that of the first skeletal metastasis, thyroid carcinoma, prostate carcinoma, renal-cell carcinoma, breast cancer, and plasmacytoma were positive variables with regard to survival. The metastatic load of the skeleton and the surgical margin were not of significant influence. In tumours of the limbs and pelvis, the local failure rate was 0% after biological reconstruction (10), 3.6% after cemented or uncemented osteosynthesis (28) and 1.8% after prosthetic replacement (53). The local failure rate after stabilisation of the spine (18) was 16.6%. There was local recurrence in seven patients (6.4%), and in four of these the primary tumour was a renal-cell carcinoma. The local recurrence rate was 0% after extralesional (24) and 8.2% after intralesional resection (85). Improvements in the oncological management of patients with primary and metastatic disease have resulted in an increased survival rate. In order to avoid additional surgery, it is essential to consider the expected time of survival of the reconstruction and, in bony metastases with a potentially poor response to radiotherapy, the surgical margin.

show abstract

Section: Discussionmentioning

confidence: 84%

The surgical treatment of bony metastases of the spine and limbs

Böhm

Huber

2002

The Journal of Bone and Joint Surgery

177

View full text Add to dashboard Cite

show abstract

“…We used cement in conjunction with rod fixation for a number of reasons. These included strengthening the residual bone, enhancing fixation of the rod along its whole length not just at its ends, thus providing rotational stability [ 8 , 11 , 12 ], and also for the thermonecrotic effect of cement on tumor cells as the cement cures [ 11 ]. The need for cross bolting is obviated, minimizing the creation of new defects and thus weaknesses in the remaining bone.…”

Section: Discussionmentioning

confidence: 99%

Outcome of surgical management of bony metastases to the humerus and shoulder girdle: a retrospective analysis of 93 patients

Thai

Kitagawa

Choong

2006

Int Semin Surg Oncol

View full text Add to dashboard Cite

BackgroundMetastatic disease to the shoulder girdle is a challenging problem because of the potential for pain, pathologic fracture and loss of function of that limb. Management of the bone disease centers around palliation, prevention of further complications and the preservation of residual function. A variety of surgical options exist for managing metastatic disease to the shoulder girdle and our experience with over 90 patients is reported. We focus on a preferred technique of combining rigid intramedullary nailing with cementation.MethodsPatients with metastatic disease to the shoulder girdle were accrued over a 9 year period from 1996 to 2004. 93 patients were identified with 96 operations being performed. The median age was 63 years (range 33 – 89) and 54% were female. The commonest primary tumor to metastasize was breast, and the proximal and midshaft humerus was involved in 84% of cases. The median survival time was 8 months and at last review 82% of patients had died of their diseaseResultsOperations performed were intramedullary nailing (n = 51), resection with or without prosthetic reconstruction (n = 34) or plate osteosynthesis (n = 9). The site of the metastasis was a guide to the most appropriate operation. Amputations (n = 2) were not done as the primary procedure.Median post operative hospitalization ranged from 3 to 6 days depending on the type of operation performed. Our preferred technique for diaphyseal lesions (intramedullary nailing plus cementation) achieved excellent results in terms of pain relief, functional restoration and minimal complications. Functional restriction was most notable for proximal humeral prostheses (35% of patients).ConclusionSurgical treatment of metastases to the shoulder girdle can be successful, allowing prompt relief of pain and return to prehospital level of care. Proximal and midshaft humeral metastases are easily amenable to resection and reconstruction or intramedullary nailing with cementation. Relief of pain and preservation of function occurs for the majority of patients.

show abstract

“…We believe however that cement, used mostly with plates (seven out of eight plates and two out of 10 IM nails) has an important role in minimizing fixation failure. This goes along with many other studies that showed benefits to cementing [18,[21][22][23][24]. In Table 2, we listed the publications and patient's characteristics on metastatic humeral fractures available in the literature.…”

Section: Discussionmentioning

confidence: 97%

Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions

Ricard

Stavropoulos²,

Nooh

et al. 2021

Cureus

View full text Add to dashboard Cite

In the event of surgical management of metastases to the humeral shaft, intramedullary nailing (IMN) is often preferred to plate osteosynthesis (PO) fixation despite a lack of consensus. In this study, we hypothesized that plate osteosynthesis will be associated with better functional and pain outcomes, thus better quality of life. Eighteen patients with the diagnosis of humeral shaft metastatic fracture or impending fracture were extracted from a prospective database of 140 metastatic patients collected across three hospitals over a five-year period. Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), Quality of Life (QOL) and Brief Pain Inventory (BPI) score were gathered during the year following the surgery. Statistical analysis was performed to compare the mean score differences between the two surgical options at baseline and five follow-up visits. Both treatment options were associated with an increase in functional outcomes based on both MSTS and TESS, and a decrease in pain level. However, no significant difference was found in quality of life and between the two treatment modalities. Thus, based on our results, a similar improvement in functional status and pain level can be achieved surgically by either intramedullary nailing or plating osteosynthesis.

show abstract

Metastatic fractures of long bones

Cited by 18 publications

References 11 publications

The surgical treatment of bony metastases of the spine and limbs

The surgical treatment of bony metastases of the spine and limbs

Outcome of surgical management of bony metastases to the humerus and shoulder girdle: a retrospective analysis of 93 patients

Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions

Contact Info

Product

Resources

About