Abstract
Due to the advances in oncological therapy, the life expectancy of patients with malignant tumours and the incidence of pathological fractures have increased over the last decades. Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in patient’s survival and postoperative complications after the treatment of pathological fractures of the long bones. Eighty-eight patients with 96 pathological fractures of the long bones were analysed retrospectively. Seventy-five patients with 83 fractures received surgical treatment. The operative treatments used were intramedullary fixation, gliding screws, plate osteosynthesis or arthroplasty. Five patients were still alive at the end of data collection at a median time of 42.5 months, and 16.2% survived 1 year, 7% 2 years and 4% more than 3 years postoperatively. All surgically treated patients had a reduction of local pain and were able to walk after the operation. The overall rate of complications was 8%. Early palliative treatment of pathological fractures of the long bones is indicated in most patients in the advanced stage of metastatic disease. The low complication rate, reduction of local pain and early mobilisation justify the surgical stabilisation of fractures in this cohort of patients.
Résumé
En raison des progrés des thérapies oncologiques l’espérance de vie et la fréquences des fractures pathologiques ont augmentées chez les patients porteurs de tumeurs malignes. Les fractures pathologiques des os long sont une complication de la maladie métastatique et l’efficacité des différentes techniques de traitement chirurgical ne sont pas clairement définies. Le but de cette étude était d’évaluer les différences en terme de survie et de complications selon le traitement. C’est une étude rétrospective de 88 patients avec 96 fractures pathologiques traitées par clou centro-médullaire, vissage, plaque vissée ou arthroplasty. Cinq patients étaient encore en vie à la fin de l’étude avec une médiane de 42,5 mois; 16,2, 7 et 4% avaient survécu respectivement 1, 2 ou 3 ans ou plus. Tous les patients traités chirurgicalement avaient des capacités de déambulation et une réduction de leurs douleurs après l’opération. Le taux global de complications était de 8%. Le traitement palliatif précoce des fractures pathologiques des os longs est indiqué chez la plupart des patients à un stade avancé de la maladie métastatique. Le faible taux de complications, la réduction des douleurs et la mobilisation précoce justifient la stabilisation chirurgicale chez ces patients.
Similar content being viewed by others
References
Algan SM, Horowitz SM (1996) Surgical treatement of pathologic hip lesions in patients with metastatic disease. Clin Orthop 332:223–231
Assal M, Zanone X, Peter RE (2000) Osteosynthesis of metastatic lesions of the proximal femur with a solid femoral nail and interlocking spiral blade inserted without reaming. J Orthop Trauma 14:394–397
Barwood SA, Wilson JL, Molnar PR, Choong PF (2000) The incidence of cardiorespiratory and vascular dysfunction following intramedullary nail fixation of femoral metastasis. Acta Orthop Scand 71:147–152
Bauer HC, Wedin R (1995) Survival after surgery for spinal and extremity metastases: prognostication in 241 patients. Acta Orthop Scand 66:143–146
Böhm P, Huber J (2002) The surgical treatment of bony metastases of the spine and limbs. J Bone Joint Surg 84B:521–529
Bridle SH, Patel AD, Probe RA et al (1991) Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg 73B:330
Clarke HD, Damron TA, Sim FH (1998) Head and neck replacement endoprostheses for pathologic proximal femoral lesion. Clin Orthop 353:210–217
Cole AS, Hill GA, Theologis TN, Gibbons CLM, Willett K (2000) Femoral nailing for metastatic disease of the femur: a comparison of reamed and unreamed femoral nailing. Injury 31:25–31
Coleman RE (1997) Skeletal complications of malignancy. Cancer 80:1588–1594
Coley BL, Higinbotham NL (1950) Diagnosis and treatment of metastatic lesions in bone. AAOS Instr Cours Lect 7:18–25
Colyer RA (1986) Surgical stabilization of pathological neoplastic fractures. In: Hickey RC, Clark RL (eds) Current problems in cancer. Chicago: Year Book Medical Publishers 118–168
Demirel M, Turhan E, Dereboy F, Ozturk A (2005) Interlocking nailing of humeral shaft fractures. A retrospective study of 114 patients. Indian J Med Sci 59:436–442
Franck WM, Olivieri M, Jannasch O, Hennig FF (2002) An expandable nailing system for the management of pathological humerus fractures. Ach Orthop Trauma Surg 122:400–405
Goldhagen PR, Conner DR, Schwarze D, et al (1994) A prospective comparative study of the compression hip screw and the gamma nail. J Orthop Surg 8:367
Hage WD, Aboulafia AJ, Aboulafia DM (2000) Incidence, location and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am 31:515–528
Heinz TH, Stoick W, Vecsei V (1989) Behandlung und Ergebnisse von pathologischen Frakturen. Unfallchirurg 92:477–485
Katzer A, Meenen NM, Grabbe F, Rueger JM (2002) Surgery of skeletal metastases. Arch Orthop Trauma Surg 122:251–258
Koskinen EV, Nieminen RA (1973) Surgical treatment of metastatic pathological fracture of major long bones. Acta Orthop Scand 44:539–549
Krebs H (1987) Management of pathologic fractures of long bones in malignant disease. Acta Orthop Trauma Surg 92:133–137
Landis S, Murray T, Bolden S, Wingo P (1998) Cancer statistics. CA Cancer J Clin 48:6–29
Leung KS, So WS, Shen WY, et al (1992) Gamma nails and dynamic hip screws for pertrochanteric fractures: A randomised prospective study in elderly patients. J Bone Joint Surg 74B:345
Mc Laughin JR, Harris WH (1996) Revision of the femoral component of a total hip arthroplasty with the calcar-replacement femoral component. J Bone Joint Surg 78A:331–339
Schatzker J, Ha’eri GB (1979) Methylmethacrylate as an adjnct in the internal fixation of pathologic fractures. Can J Surg 2:179–182
Ward WG, Holsenbeck S, Dorey FJ, Spang J, Howe D (2003) Metastatic disease of the femur: surgical treatment. Clin Orthop 415:230–244
Wedin R, Bauer HC, Wersäll P (1999) Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop 358:128–139
Wedin R, Bauer HC (2005) Surgical treatment of skeletal metastatic lesions of the proximal femur. Endoprosthesis or reconstruction nail? J Bone Joint Surg 87B:1653–1657
Weikert DR, Schwart HS (1991) Intramedullary nailing for impending pathological subtrochanteric fractures. J Bone Joint Surg 73B:668–670
Windhager R, Ritschl P, Rokus U, Kickinger W, Braun O, Kotz R (1989) The incidence of recurrence of intra and extralesional operated metastases of long tubular bones. Z Orthop Ihre Grenzgeb 127:402–405
Yazawa Y, Frassica FJ, Chao EY, Pritchard DJ, Sim FH, Shives TC (1990) Metastatic bone disease. Clin Orthop 251:213–219
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sarahrudi, K., Hora, K., Heinz, T. et al. Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients. International Orthopaedics (SICOT) 30, 519–524 (2006). https://doi.org/10.1007/s00264-006-0205-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-006-0205-9