Orthopedic treatment of metastatic bone fracture from hepatocellular carcinoma

We report on a 73-year-old female patient with a small hepatocellular carcinoma, which was detected by ultrasonography in September 1993. She was treated by ethanol injection and repeated courses of transcatheter arterial embolization for local recurrence. Five years after the initial treatment of the primary hepatocellular carcinoma in 1998, a solitary metastatic tumor from hepatocellular carcinoma was detected in the middle of the left humerus by fluorine-18-fluoro-2-deoxy-D glucose positron emission tomography and technetium-99m methylene diphosphonate bone scintigraphy. About one year later, bone fracture occurred at the site of metastatic lesion in spite of local radiation therapy. Reconstruction by three enderpines relieved the fracture-associated pain and improved the quality of life. The patient continued to enjoy a good quality of life without pain until death by liver failure in September 2000.