Early surgical treatment of secondary bone lesions excluding the spine
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The treatment of secondary bone lesions remains controversial. The purpose of this study is to demonstrate the advantage of early surgical treatment with a functional outcome. Our series consists of 66 cases, including 11 cases where there were two operations, that is 77 prophylactic or fracture treatments, on metastatic bone lesions or secondary myelomas. Operations were only on long bones (56 femurs, 19 humeri, 1 clavicle and 1 fibula). There were 11 prophylactic operations on the femur with 4 Ender pins, 4 open reductions and 3 total hip prostheses, including one using an allograft. In the case of fractures, we carried out 12 closed reductions, 9 open reductions, and 24 hip artroplasties of which 6 were “special tumour” total prostheses, 3 using an allograft. As for the humerus, 10 retrograde fasciculated Hacketal osteosyntheses were carried out, of which 7 were prophylactic and 10 were fracture cases. Likewise we carried out 2 arthroplasties cemented using allograft for pathological fractures of the upper extremity of the femur. Our own departmental grading system enabled us to evaluate the results. For femurs, we obtained 46% good early results for pain and 38% of the total for function. The average survival period for those patients operated on for prophylaxil was 14 months. For those operated on for fracture it was no more than 5 months. For humeri, good results were 58% of the total for pain, and 62% for function. The average survival period for those patients operated on for promylaxis was 17 months. It was just 7 months for those operated on for fracture.
The main aim of surgical treatment of secondary bony lesions is to relieve the pain of the patient, but also, if possible, to preserve and even restore function. This treatment is fundamental in handling cancer patients. Our series of 77 consecutive cases demonstrates that both the functional analgesic results and the survival of patients are clearly better where there is prophylactic surgery. These encouraging results should teach us to thoroughly investigate in order to firstly diagnose secondary lesions early, and then to treat them before the onset of fractures and their complications.
Key wordsBone metastases Surgical treatment Preventive treatment
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