Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures.

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.