Surgical treatment of metastatic tumors of the long bones

BACKGROUND

With improvements in chemotherapy, endocrine therapy and radiotherapy, the development of a pathological fracture does not indicate a terminal stage for a neoplasm patient, since survival rates have increased over the years. A review has been undertaken of thirty-nine cases of long-bone metastases treated surgically at Taichung Veterans General Hospital in the past 11 years.

METHODS

Pathological fractures and impending fractures were managed with open reduction and internal fixation with different methods, dependent upon the lesion site. Methylmethacrylate was used to fill the bone defect and strengthen the internal fixation. Radiotherapy was given post-operatively to complying patients.

RESULTS

One patient died post-operatively. Eight cases were lost to post-operative follow-up. Four cases are still living. The remaining 26 cases survived for a median of 149 days (range 32-1220 days). Results in relief of pain and for restoration of limb function were good.

CONCLUSIONS

Since long bone metastases with pathological fracture predictably causes disability for patients, the authors recommend aggressive surgery to improve their quality of life.

[Treatment of proximal humeral tumor: a case report]

In management of malignancy of the proximal humerus, amputation or a complete flail limb both give poor functional results. The limb-salvage procedure with joint reconstruction preserves function in the elbow and hand, thereby improving the quality of remaining life for patient. Prosthetic humeral replacement may avert amputation and preserve a functional arm, but neither segmental modular proximal humeral prosthesis nor custom-made prosthesis is readily available here. Combining the Neer II shoulder prosthesis and Kuntscher's nail with acrylic cement can replace the proximal humerus with an adjustable length of stem within the humeral shaft. A piece of mesh is incorporated into the prosthesis, placed around the neck of the Neer II shoulder prosthesis, and sutured to the rotator cuff to prevent subluxation of the humeral head and preserve some function of the rotator cuff. The above prosthetic humeral replacement has been applied to one patient with a primary osteosarcoma. It preserved the function of the elbow and hand well. One year post-operatively, there was no dislocation or subluxation. Details of procedures used are given.