Surgery for bone metastases

Pathological fractures of the femur: improvement of quality of life after surgical treatment

Radiotherapy and chemotherapy will result in an increase in the number of pathological fractures that occur, principally as a consequence of metastatic disease. These lesions are painful, especially at the level of the femur, and are apt to make invalids of the patient. If surgical intervention is applied as quickly as possible, (compound double-plate osteosynthesis or endoprosthesis), preferably before the lesion becomes a real fracture, the patient still has a chance of keeping a good, painless and well-functioning limb. This report concerns 40 patients with 48 pathological femoral fractures. Seventy-five percent of the lesions were localised at the level of the proximal extremity (femoral head or neck, trochanteric region, subtrochanteric region). Twenty cases were treated with an endoprosthesis, 28 by osteosynthesis; 4 patients died within the 1st month after surgery. In two of them, the data when considered post-facto were judged to show that any surgery would be too risky. Forty-five percent of patients survived for more than 1 year after operation. The average survival time of the whole group was slightly over 10 months. One patient is still going strong more than 35 months after surgery. Survival time was essentially dependent on the primary underlying malignant process. The results obtained have been more than reasonable: in 67% recovery of walking capacity, in 75% an effective fight against the pain.

Surgical treatment of pathologic fractures from metastatic tumors of long bones

Surgical treatment of 74 cases of impending and established metastatic pathologic fractures were analyzed. On the basis of various reports, the incidence of bone lesions, bone-seeking primary tumors, lesion sites, diagnostic techniques and possibilities, as well as indications for and methods of surgical treatment, are surveyed. Surgical intervention is only one aspect of the different components of general treatment in bone metastases. An aggressive surgical procedure yields very satisfactory results in most cases, compared with those of conservative treatment.