The management of secondary neoplastic deposits in long bones by prophylactic internal fixation

Pathological fracture through a secondary neoplastic deposit is a distressing event. Prevention of such a fracture is clearly of considerable benefit. To determine which secondary deposits are liable to fracture the notes and X-rays of 57 patients with 91 secondary deposits were examined. Fractures are unlikely (2.4%) to develop where the deposit involves less than 50% of the cortex as seen on radiological examination, but 2 out of 3 deposits with over 50% involvement will fracture. As the benefits of internal fixation in those that would otherwise fracture are so great, it is recommended that all deposits involving over 50% of the cortex of a long bone should be treated by prophylactic internal fixation. The results of 26 patients treated by prophylactic internal fixation are summarized. Apart from fracture-prevention, the benefits of such internal fixation were found to be: pain relief, simple operation, rapid postoperative recovery, facilitation of administration of radiotherapy and maintenance of the independance of the patient. The possible effects on local and general tumour spread are not considered to be a contraindication to operation.