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Stop, Think, Stage, Then Act

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Management of Bone Metastases

Abstract

The treatment of pathologic fractures should be the final stage of a concise pathway including diagnostics, imaging, and survival prediction. If the treatment of a pathologic fracture is rushed, this can lead to severe and needless complications. Several important pitfalls should be avoided:

  • The cause of a pathologic fracture or the origin of a solitary lesion should be known. Without a final diagnosis, a new solitary lesion should always be regarded as primary tumour.

  • One should be cautious of a spontaneous fracture or of a fracture after minimal trauma, since there can be an underlying pathology.

  • It is important to realise that a pathologic fracture does not heal like a traumatic fracture. This must be considered when deciding on the treatment strategy.

  • Pain is not a firm prognostic factor for the risk of an impending fracture. More than one lesion can be present in a bone, so complete imaging is essential.

  • The treatment strategy should depend in great part on the expected survival. The aim of the treatment should be to give the patient a stable limb in a single operation. The extent of the surgery and the implant should thus be in balance with the expected survival, preventing overtreatment and unnecessary complications.

Therefore, it is important to “stop, think, stage, then act”.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands

    J. J. Willeumier, C. W. P. G. van der Wal, R. J. P. van der Wal, P. D. S. Dijkstra & M. A. J. van de Sande

Authors
  1. J. J. Willeumier
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  2. C. W. P. G. van der Wal
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  3. R. J. P. van der Wal
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  4. P. D. S. Dijkstra
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  5. M. A. J. van de Sande
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Corresponding author

Correspondence to J. J. Willeumier .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Vincenzo Denaro

  2. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Alberto Di Martino

  3. General Direction of Health Program, National Ministry of Health of Italy, Rome, Italy

    Andrea Piccioli

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Willeumier, J.J., van der Wal, C.W.P.G., van der Wal, R.J.P., Dijkstra, P.D.S., van de Sande, M.A.J. (2019). Stop, Think, Stage, Then Act. In: Denaro, V., Di Martino, A., Piccioli, A. (eds) Management of Bone Metastases. Springer, Cham. https://doi.org/10.1007/978-3-319-73485-9_20

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  • DOI: https://doi.org/10.1007/978-3-319-73485-9_20

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  • Online ISBN: 978-3-319-73485-9

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