Proximal femoral multiple myeloma pathological fractures, impending and actual fractures - a patient survival study
Oded Hershkovich1,2, Mojahed Sakhnini3, Gal Barkay3
1Department of Orthopedic Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv, Israel. oded.hershkovich@gmail.com.
Introduction:
The femur is a common site for Multiple Myeloma (MM) involvement. This study explores the impact of preventive surgery for anticipated femoral pathological fractures (IFF), based on Mirels classification, versus treatment of pathological femur fracture (PFF) on MM patient mortality and morbidity.
Methods:
Retrospective cohort of 33 patients undergoing surgery due to femoral MM involvement (2004-2015), 18 patients with PFF, 15 patients with IFF, followed up until deceased or to July 2016. Demographic data, oncological, pathological, radiation, surgical reports, outpatient clinical records, and imaging studies were studied. Exclusion criteria included patients who had surgery at other medical centers.
Results:
The mean age was 70.4 ± 13.6 and 62.6 ± 12.2 years (p = 0.1) in the PFF and the IFF cohorts, respectively, primarily women (55.6% and 46.7%, respectively). The average Mirels' score was 10.4 ± 1.2. Post-operative complications were observed in 25% of patients, with no difference between IFF & PFF. We did not find a difference in mortality between IFF and PFF cohorts (p = 0.59).
Conclusion:
The femur is commonly involved in MM. This study found that actual fractures, compared to imminent fractures, do not affect MM morbidity or mortality. Our study shows that proximal femoral MM behaves differently from proximal femoral metastatic disease regarding the impact of surgery on life span. Due to the fracture healing potential of MM, an IFF can probably be treated initially conservatively unless it progresses to an actual fracture needing surgery. Future, more extensive studies are required before revolutionizing the proximal femoral Multiple Myeloma-related involvement treatment paradigm.
Insights
Preventive surgery for anticipated femoral fractures in Multiple Myeloma (MM) patients did not significantly impact mortality or morbidity compared to treating actual pathological femur fractures (PFF). This suggests conservative management for imminent fractures may be viable.
Area of Science:
- Orthopedic Oncology
- Hematology
- Skeletal Metastasis Research
Background:
- The femur is a frequent site of Multiple Myeloma (MM) involvement.
- Skeletal-related events significantly impact MM patient morbidity and mortality.
- Surgical intervention is often considered for impending or actual pathological fractures.
Purpose of the Study:
- To compare the outcomes of preventive surgery for anticipated femoral pathological fractures (IFF) versus treatment of actual pathological femur fractures (PFF) in MM patients.
- To evaluate the impact of surgical approach on mortality and morbidity in MM patients with femoral involvement.
- To understand the unique behavior of proximal femoral MM compared to other metastatic bone diseases.
Main Methods:
- Retrospective cohort study of 33 MM patients with femoral involvement undergoing surgery between 2004 and 2015.
- Patients were categorized into IFF (n=15) and PFF (n=18) groups.
- Data analyzed included demographics, oncological, surgical, and imaging reports; follow-up until death or July 2016.
Main Results:
- No significant difference in post-operative complications or mortality was observed between the IFF and PFF cohorts (p=0.59).
- The average Mirels' score was 10.4 ± 1.2, indicating a high risk of fracture.
- Proximal femoral MM appears to have different surgical outcome implications compared to other metastatic bone diseases.
Conclusions:
- Surgical intervention for imminent femoral fractures in MM does not appear to alter patient mortality or morbidity compared to treating actual fractures.
- The fracture healing potential of MM suggests that conservative management may be appropriate for IFF unless progression to fracture occurs.
- Further extensive research is needed to refine treatment paradigms for proximal femoral MM-related involvement.
