Indication, management and results of surgical therapy for pathological fractures in patients with bone metastases

The most important localized bone lesions to cause pathological fractures are metastases of various primary tumors. Among these, breast cancer represents about 2:3. The survival time of patients with pathological fractures is only 4 to 15 months, and therefore an immediate restoration of loading capacity and full function should be attempted. This, and immediate pain relief, can be achieved by operative stabilization of the fracture. To avoid postoperative local radiotherapy, the metastases should be resected completely with tumor-free margins. Biomechanical aspects of the different parts of the skeleton must also be considered to avoid mechanical failure of the osteosynthesis. Four different parts of the skeleton with different biomechanical characteristics (lower and upper extremity, spinal column and pelvis) must be considered. Only in patients with very advanced cancer and poor general condition, may intramedullary nailing be performed without resection of the metastasis, to obtain pain relief and partial restoration of the function of the extremity. When managing pathological fractures caused by metastases, good functional results can be obtained, with these principles in mind, when the general condition of the patient is moderately good at the time of operation. Joint and muscular preserving devices allow faster and easier rehabilitation, and postoperative morbidity is reduced. The devices used in the different parts of the skeleton are presented.