Abstract
The purpose of this study was to assess the referral system, clinical notes and radiographs of patients presenting with metastatic disease of long bones. The study demonstrated that 93% of oncologists did not use a reliable scoring system to assess risk of pathological fracture, and 60% felt an improvement in communication was required. Notes and radiographs were reviewed for 37 patients presenting with femoral metastatic lesions. Sixteen patients had a Mirels’ score of greater than 8. Four patients were referred for an orthopaedic opinion. Twelve patients with a score of greater than 8 were not referred; seven of these patients suffered a pathological fracture. Sixteen patients had a Mirels’ score of less than 8; none of these patients were referred for an orthopaedic opinion. No pathological fractures occurred. In conclusion, the majority of patients who score above 8 in the Mirels’ scoring system are at risk of fracture and do require prophylactic surgery. In keeping with the British Orthopaedic Association (BOA) guidelines, “Metastatic Bone Disease: A Guide to Good Practice”, we would recommend a multidisciplinary approach and the use of a recognised scoring system.
Résumé
Le but de cette étude est d’évaluer et de mettre en place un système de référence clinique et radiographique concernant les patients présentant des métastases des os longs. 93% des oncologistes n’utilisaient pas de scores fiables permettant d’évaluer le risque de fracture pathologique, néanmoins, 60% souhaitent avoir des informations plus importantes sur ce problème. Les observations cliniques et radiographiques de 37 patients présentant des métastases fémorales ont été revues pour cela. 16 patients avaient un score de Mirels supérieur à 8, 4 nécessitaient un avis orthopédique. 12 patients avaient un score supérieur à 8 et n’ont pas été évalués sur le plan orthopédique mais 7 sur 8 présentaient une fracture pathologique. 7 patients avaient un score de Mirels inférieur à 8 aucun de ces patients n’a nécessité un avis orthopédique et n’a présenté de fracture pathologique. En conclusion: la majorité des patients qui ont un score supérieur à 8 ont un risque de fractures et nécessitent une chirurgie prophylactique. En se reportant au référentiel de la BOA sur les métastases osseuses, un guide de bonnes pratiques doit être recommandé avec une approche multi disciplinaire et l’utilisation d’un système de classification reconnu.
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Appendices
Appendix 1
Appendix 2: Questionnaire
Metastatic disease in long bones
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1.
Do you treat patients with long bone metastatic lesions?
Yes/no
If yes: 0–5 per year
6–10 per year
>10 per year
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2.
What radiographic changes would concern you with regard to possible fracture?
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3.
What clinical features would concern you with regard to possible fracture?
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4.
Do you routinely use a scoring system for impending pathological fracture?
Yes/no
If yes, which scoring system do you use?
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5.
What could be done to improve links between orthopaedics and oncology?
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Thank you.
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Cumming, D., Cumming, J., Vince, A. et al. Metastatic bone disease: the requirement for improvement in a multidisciplinary approach. International Orthopaedics (SICOT) 33, 493–496 (2009). https://doi.org/10.1007/s00264-008-0556-5
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DOI: https://doi.org/10.1007/s00264-008-0556-5