We evaluated the clinical results of treatment for bone metastases in the extremities associated with pathological fracture.
Thirty-four patients (11 men and 23 women, mean age 62 years) were treated at our institution between August 2006 and July 2011. The site of the primary tumor was the kidney in 4 patients, lung in 5 patients, breast in 14 patients, and other sites in 11 patients. Pathological fractures were found in the humerus in 5 patients, femur in 23 patients, and tibia in 2 patients. Surgical treatment was performed in 28 cases.
Pathological fracture of the femur was treated by resection and prosthetic replacement in 12 cases. The remaining fractures of the femur were stabilized using locking nails (n=6) or plates (n=5). Humeral lesions were stabilized using locking nails (n=3) or plates (n=2). Pathological fractures of the tibia were stabilized using plates (n=2). Postoperative performance status (PS) of the patients with pathological fractures recovered to that before the trauma in almost all patients. Postoperative complications occurred in 6 cases, including temporary palsy of the radial nerve in 2 patients, deep infection in 1 patient, plate breakage in 1 patient, and periprosthetic femoral fractures in 2 patients.
The average survival after fracture was 10.5 months for patients who underwent surgery and 3.5 months for patients who were treated conservatively. These figures suggest that patient selection for treatment should be based on prognosis.