Management of Bone Metastases

Abstract

Orthopaedic surgeons involved in fracture management will occasionally encounter patients with pathological fractures secondary to metastatic bone disease. Advances in cancer treatment have prolonged life expectancy for most patients and increased the probability and prevalence of bone metastases. The diagnosis and treatment of metastatic bone lesions require multidisciplinary input from diagnostic and interventional radiologists, medical and radiation oncologists, pathologists, as well as pain specialists. If the bony lesion is solitary, a biopsy is always indicated to avoid inappropriate treatment of an unsuspected primary bone tumour. Bisphosphonates, arterial embolization, and radiotherapy constitute important adjuncts to surgical treatment. Stabilization and fixation of destructive bone lesions are the primary Orthopaedic goals to afford the patient significant pain relief and ability to bear weight on the affected bone. Because these pathological fractures seldom unite, load-bearing fixation devices are preferred to avoid failure of fixation. Acrylic bone cement may be used to provide immediate stability in lesions with large structural defects. Where there is widespread bony destruction, reconstruction with an endoprosthesis may be more ideal. Prompt and appropriate surgical management of bony metastases can be highly worthwhile and cost-effective by making patients mobile and independent from prolonged hospital care.