1. Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures.
- Author
-
Dijstra S, Wiggers T, van Geel BN, and Boxma H
- Subjects
- Adult, Aged, Aged, 80 and over, Bone Cements, Bone Nails, Bone Neoplasms complications, Bone Neoplasms mortality, Bone Neoplasms secondary, Bone Plates, Female, Femoral Fractures etiology, Femoral Fractures mortality, Femoral Neoplasms complications, Femoral Neoplasms mortality, Femoral Neoplasms secondary, Femoral Neoplasms surgery, Fracture Fixation, Intramedullary adverse effects, Fractures, Spontaneous etiology, Fractures, Spontaneous mortality, Humans, Humeral Fractures etiology, Humeral Fractures mortality, Male, Middle Aged, Pain epidemiology, Pain etiology, Pain Management, Postoperative Complications epidemiology, Prosthesis Failure, Retrospective Studies, Survival Rate, Tibial Fractures etiology, Tibial Fractures mortality, Time Factors, Treatment Outcome, Bone Neoplasms surgery, Femoral Fractures surgery, Fracture Fixation, Intramedullary methods, Fractures, Spontaneous surgery, Humeral Fractures surgery, Humerus, Tibia, Tibial Fractures surgery
- Abstract
Objective: Analysis of short-term and long-term complications after cemented osteosynthesis for pathological fractures., Design: Retrospective study., Setting: South Municipal Hospital and the Daniël den Hoed Cancer Centre, Rotterdam, The Netherlands., Subjects: 199 patients consecutive surgically treated between 1978 to 1990 for 233 fractures (161 actual and 72 impending) caused by metastatic lesions of the femur, humerus and tibia., Interventions: Local resection of the tumour was followed by endoprostheses (n = 52) and by internal plate osteosynthesis (n = 167); 14 fractures were treated with intramedullary nails. Bone cement was added in 211 cases (91%)., Main Outcome Measures: Pain relief, mobilisation, complications., Results: Pain relief was achieved in about 90%. 145 (76%) who were treated for fractures of the lower extremity were able to walk again. There were 13 local complications: 26 (11%) implanted devices failed (cumulative probability 40%, after 60 months). In 11 cases the fixation failed after 7 weeks. The failure rate was 16% in the subtrochanteric region treated with an angled blade (probability 70% after four years). The patients' survival rate was 55% after six months and 20% at two years., Conclusion: Despite the poor life expectancy, our results indicate that hemiarthroplasty or osteosynthesis with bone cement for treatment of pathological (impending) fractures is a safe way to restore limb function and to improve quality of life.
- Published
- 1994