Metastatic disease of bone and treatment of pathological fractures

The importance of early, secure, internal fixation in the management of pathologic fractures, especially if bone stock has been severely compromised, is clearly recognized by the orthopedic surgeon. There is virtually no place for denying surgical treatment to the majority of these cases, because it would most probably leave them in a painful, bedridden state. The risks of operative intervention and the use of methylmethacrylate along with fixation devices are justified when analyzing the end results of relief of pain, ambulatory activity, and restoration of function, as well as psychologic benefits. The use of radiotherapy and chemotherapy along with surgery has greatly enhanced the management of this disabled patient population. Fracture healing can take place in the presence of extensive destructive lesions. Survival rates are improving and earlier recognition of skeletal metastasis by newer technology, including bone scanning and computerized axial tomography, is helpful in the overall management of these patients. The goals of treatment can be achieved by proper planning and a multidisciplinary approach to the patient with metastatic skeletal disease.