Browse > Article
http://dx.doi.org/10.5292/jkbjts.2010.16.2.80

Metastatic Pathologic Fractures in Lower Extremities Treated with the Locking Plate  

Seo, Chang-Young (Department of Orthopedic Surgery, Chonnam National University Medical School)
Jung, Sung-Taek (Department of Orthopedic Surgery, Chonnam National University Medical School)
Publication Information
The Journal of the Korean bone and joint tumor society / v.16, no.2, 2010 , pp. 80-86 More about this Journal
Abstract
Purpose: The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates. Materials and Methods: Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss. Results: Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml). Conclusion: Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.
Keywords
pathologic fracture; metastatic cancer; locking plate;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Bashore CJ, Temple HT. Management of metastatic lesions of the humerus. Orthop Clin North Am. 2000;31:597-609.   DOI   ScienceOn
2 Cole AS, Hill GA, Theologis TN, et al. Femoral nailing for metastatic disease of the femur: a comparison of reamed and unreamed femoral nailing. Injury. 2000;31:25-31.   DOI   ScienceOn
3 Sharma H, Bhagat S, McCaul J, Macdonald D, Rana B, Naik M. Intramedullary nailing for pathological femoral fractures. J Orthop Surg (Hong Kong). 2007;15:291-4.   DOI
4 Moholkar K, Mohan R, Grigoris P. The Long Gamma Nail for stabilization of existing and impending pathological fractures of the femur: an analysis of 48 cases. Acta Orthop Belg. 2004;70:429-34.
5 Friedl W. Indication, management and results of surgical therapy for pathological fractures in patients with bone metastases. Eur J Surg Oncol. 1990;16:380-96.
6 Friedl W, Mieck U, Fritz T. Surgical therapy of bone metastases of the upper and lower extremity. Chirurg. 1992;63:897-911.
7 Anglen J, Kyle RF, Marsh JL, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg. 2009;17:465-72.   DOI
8 Graupe F, Heitmann C, Becker M, et al. Palliative surgical treatment of bone metastases. Improved quality of life by early intervention? Dtsch Med Wochenschr. 1996;121:393-7.   DOI   ScienceOn
9 Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998;80:618-30.   DOI
10 Brumback RJ, Toal TR Jr, Murphy-Zane MS, et al. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am. 1999;81:1538-44.   DOI
11 Hage WD, Aboulafia AJ, Aboulafia DM. Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am. 2000;31:515-28.   DOI   ScienceOn
12 Heinz T, Stoik W, Vecsei V. Treatment and results of pathologic fractures. A collaborative study from 1965 to 1985 of 16 Austrian hospitals. Unfallchirurg. 1989;92:477-85.
13 Barwood SA, Wilson JL, Molnar RR, et al. The incidence of acute cardiorespiratory and vascular dysfunction following intramedullary nail fixation of femoral metastasis. Acta Orthop Scand. 2000;71:147-52.   DOI
14 Harrington KD. Impending pathologic fractures from metastatic malignancy: evaluation and management. Instr Course Lect. 1986;35:357-81.
15 Varadhachary GR, Abbruzzese JL, Lenzi R. Diagnostic strategies for unknown primary cancer. Cancer. 2004;100:1776-85.   DOI   ScienceOn
16 Jung ST, Ghert MA, Harrelson JM, et al. Treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop. 2003;409:223-31.   DOI   ScienceOn
17 Kay PR. Cement augmentation of pathological fracture fixation. J Bone Joint Surg Br. 1989;71:702.
18 Mercadante S. Malignant bone pain: pathophysiology and treatment. Pain. 1997;69:1-18.   DOI   ScienceOn
19 Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80:1588-94.   DOI   ScienceOn
20 Dahlin DC, Unni KK. Bone tumours. 4th ed. Springfield, Illinois: Thomas; 1986.
21 Biermann JS, Holt GE, Lewis VO, Schwartz HS, Yaszemski MJ. Metastatic bone disease: diagnosis, evaluation, and treatment. Instr Course Lect. 2010;59:593-606.
22 Bauer HC. Controversies in the surgical management of skeletal metastases. J Bone Joint Surg Br. 2005;87:608-17.   DOI   ScienceOn
23 Frassica FJ, Frassica DA. Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res. 2003;415:S212-8.   DOI   ScienceOn
24 Ward WG, Holsenbeck S, Dorey FJ, et al. Metastatic disease of the femur: surgical treatment. Clin Orthop. 2003;415:S230-44.   DOI   ScienceOn
25 Bickels J, Kollender Y, Wittig JC, et al. Function after resection of humeral metastases: analysis of 59 consecutive patients. Clin Orthop. 2005;437:201-8.
26 Mundy GR. Mechanisms of bone metastasis. Cancer. 1997;80:1546-56.   DOI   ScienceOn
27 Siegel HJ, Lopez-Ben R, Mann JP, Ponce BA. Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement. J Bone Joint Surg Br. 2010;92:707-12.   DOI   ScienceOn