Pathological fractures due to metastases

The authors review the literature and report on the treatment of metastatic pathological fractures, on the basis of their own experience of 51 operations. They review the radiological and pathological aspects of the lesions, and the methods of investigation. They stress the need for close collaboration between oncologists, radiologists and orthopedic surgeons, and emphasize the role of surgical treatment in the restoration of function and the relief of pain, by stable synthesis of the affected part. The methods employed are those used in traumatology, together with arthroprosthetic replacement. The importance of ensuring a stable synthesis, for the patients' limited life expectancy, justifies the use of acrylic cement, which often establishes continuity that otherwise would not be attainable. The indications for operation are not related to prolonging life but only to improvement in the quality of remaining life as measured by absence of pain and recovery of function. The results should be assessed primarily from the patient's point of view, the aim being to restore his mode of living before the fracture occurred. This has psychological as well as functional value.