Fracture healing in metastatic bone disease.

In 123 cancer patients with metastatic disease, 129 pathologic fractures of long bones were assessed to determine the rate of osseous union. Bony healing was observed in 67% of malignant fractures from multiple myeloma, in 44% of fractures secondary to metastatic hypernephroma, and in 37% of neoplastic fractures from breast carcinoma. No patient with a pathologic fracture secondary to lung carcinoma demonstrated bony repair, and none of these patients lived for more than six months after fracture. The overall fracture healing rate for the entire study population was 35%. In the group that survived longer than six months, 74% of fractures united. A life expectancy of longer than six months was the primary factor determining osseous healing in all patients. A total radiotherapy dose of 3000 rad or less did not inhibit callus formation. Internal fixation improved the rate of fracture union by 23% as compared with cast immobilization.