11/14/2023 0 Comments Pathological fracture presenceThe cortical destruction is a measure for estimating the fracture risk. In daily practice, bi-planar conventional radiographs of the whole affected long bone are mandatory to evaluate the extent of the cortical destruction of the involved bone lesion and whether other adjacent bone lesions are present. What is the local status of the involved bone? If PET-CT is unavailable, then an additional CT of the thorax/abdomen should be considered to analyse visceral dissemination. 9 Additionally, PET-CT provides information on other (visceral) disease localisations. Currently the use of PET-CT is accelerating due to its increased accessibility and superior sensitivity and specificity to bone scintigraphy. 8 In the past, the principal examination to assess the bone dissemination status was a total-body bone scintigraphy (technetium-99m or fluoride-18 scan). Especially for kidney and breast cancer patients, it is hypothesised that a more aggressive local treatment in the case of oligometastases might improve survival. 7 Defining a difference between oligometastases and diffuse metastases throughout the skeleton is a relatively new concept. Solitary lesions can, in some cases (such as primary kidney cancer or bone sarcoma), be treated with curative, albeit generally palliative, intent. Bone dissemination can be grouped into three categories: solitary lesion, oligometastases (between two and four bone metastases), or diffuse. The presence of other disease localisations influences the treatment strategy. This review discusses the local management of (impending) pathological fractures of the long bones, with focus on surgical treatment strategies. 5 Pathological fractures of the femur, 75% of which present in the proximal part, are roughly 3.5 times as common as fractures of the humerus. 4 In the long bones, pain is the most common symptom, followed by impending or actual pathological fractures in 10%-25% of patients. Over half of patients experience clinical symptoms for which treatment is required, 3 of whom only a minority are surgically treated. Longer survival unfortunately gives each patient more time to develop metastases.īone metastases of the long bones may lead to pain, pathological fractures, immobility, decreased functioning, and hypercalcaemia. Due to constantly improving treatments, the duration of the palliative phase is prolonged. 1 Two-thirds of all patients dying of cancer reportedly develop bone metastases 2 however, a modern, image-based study would probably present an even higher number. Keywords: bone metastasis long bone pathological fractures diagnosis survival surgery radiotherapyīone metastases arise most commonly in patients suffering from breast, prostate, kidney or lung cancer. Treatment of pathological fractures of the long bones. Adjuvant cement should be considered in large lesions for better stabilisation.Ĭite this article: Willeumier JJ, van der Linden YM, van de Sande MAJ, Dijkstra PDS. The choice of modality depends on the localisation, extent of involved bone, and expected survival. Main surgical treatment options consist of plate fixation, intramedullary nails and (endo) prosthesis. The role of post-operative radiotherapy remains unclear. Radiotherapy is the primary treatment for symptomatic lesions without risk of fracturing. Treatment strategies are strongly based on the risk of the fracture and expected survival.ĭiagnostic work-up consists of CT and biopsy for diagnosis of the primary tumour, bone scan or PET-CT for dissemination status, patient history and blood test for evaluation of general health, and biplanar radiograph or CT for evaluation of the involved bone.Ī bone lesion with an axial cortical involvement of >30 mm has a high risk of fracturing and should be stabilised surgically.Įxpected survival should be based on primary tumour type, performance score, and presence of visceral and cerebral metastases. Local treatment consists of radiotherapy or surgery. Bone metastases of the long bones often lead to pain and pathological fractures.
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