Abstract
We report a radiographic review of 54 consecutive patients with 24 impending and 30 actual pathological fractures due to metastatic bone lesions in the subtrochanteric femoral region. In an attempt to develop criteria for metastatic lesions at risk of fracturing, the following variables based on anteroposterior and lateral X-rays were considered: appearance of the lesion, width of the lesion, ratio between width of the lesion and bone width, length of the lesion, length of cortex involvement, proportion of transverse cortical bone destroyed and local pain. Nearly all (99%) of the lesions were radiographically classified as lytic. In 27 cases (50%) they were radiographically unmeasurable. Maximal longitudinal cortical destruction showed a difference between patients with an actual or impending fracture. Prophylactic internal fixation of pathological subtrochanteric fractures due to metastatic lesions has to be considered in cases of increasing pain. If the conventional X-ray can not be evaluated, a computed tomography (CT) scan has to be considered.
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Beals RK, Lawton GD, Snell WE (1971) Prophylactic internal fixation of the femur in metastatic breast cancer. Cancer 28:1350–1354
Habermann ET, Sachs R, Stern RE, Kirsch DM, Anderson WG (1982) The pathology and treatment of metastatic disease of the femur. Clin Orthop 169:70–82
Albright JA, Gillspie TE, Butaud TR (1980) Treatment of bone metastases. Semin Oncol 7:418–434
Malawer M, Delaney TF (1989) Treatment of metastatic cancer of the bone. In: Devita VTJ (ed) Cancer: principles and practices of oncology. Lippincott, New York, pp 2298–2315
Zickel RE, Mouradian WH (1976) Intramedullary fixation of pathological fractures and lesions of the subrochanteric region of the femur. J Bone Joint Surg [Am] 58:1061–1066
Menck H, Schulze S, Larsen E (1988) Metastasis size in pathologic femoral fractures. Acta Orthop Scand 59:151–154
Yazawa Y, Frassica FJ, Chao EXS, Pritchard DJ, Sim FH, Shives TC (1990) Metastatic bone disease. Clin Orthop 251:213–219
Dijkstra PDS, Wiggers T, Geel AN van, Boxma H (1994) Treatment of impending and actual pathological fractures in patients with bone metastases of the long bones. Eur J Surg 160:535–542
Harrington KD (1982) New trends in the management of the lower extremity metastases. Clin Orthop 169:53–61
Fidler M (1973) Prophylactic internal fixation of secondary neoplastic deposits in long bones. B Med J 1:341–343
Keene JS, Sellinger SD, McBeath AA, Engber WD (1986) Metastatic breast cancer in the femur. Clin Orthop 203:282–288
Hipp JA, McBroom RJ, Cheal EJ, Hayes WC (1989) Structural consequences of endosteal metastatic lesions in long bones. J Orthop Res 7:828–837
Mirels H (1989) Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 14:513–525
Cheal EJ, Hipp JA, Hayes WC (1993) Evaluation of finite element analysis for prediction of the strength reduction due to metastatic lesions in the femoral neck. J Biomech 26:251–264
Bunting R, Lamont-Havers W, Schweon D, Kliman A (1985) Pathologic fracture risk in rehabilitation of patients with bony metastases. Clin Orthop 192:222–227
Griesmann H, Schüttemeyer W (1947) Weitere Erfahrungen mit der Marknagelung nach Küntscher an der Chirurgischen Universitätsklinik Kiel. Chirurg 17–18:316–333
Parrish FF, Murray JA (1970) Surgical treatment for secondary neoplastic fractures. A retrospective study of ninety-six patients. J Bone Joint Surg [Am] 52:665–686
Miller F, Whitehill R (1984) Carcinoma of the breast metastatic to the skeleton. Clin Orthop 184:121–127
Fidler M (1981) Incidence of fracture through metastases in long bones. Acta Orthop Scand 52:623–627
Bremner RA, Jelliffe AM (1958) The management of pathological fracture of the major long bones from metastatic cancer. J Bone Joint Surg [Br] 40:652
Frankel VH, Burstein AH (1965) Load capacity of tubular bone. In: Kenedi RM (ed) Biomechanics and related bio-engineering topics. Pergamonn Press, Oxford, pp 381–396
Clark CR, Morgan C, Sonstegard DA, Matthews LS (1977) The effect of biopsy hole shape and size on bone strength. J Bone Joint Surg [Am] 59:213–217
McBroom RJ, Cheal EJ, Hayes WC (1988) Strength reductions from metastatic cortical defects in long bones. J Orthop Res 6:369–378
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Dijkstra, P.D.S., Oudkerk, M. & Wiggers, T. Prediction of pathological subtrochanteric fractures due to metastatic lesions. Arch Orthop Trauma Surg 116, 221–224 (1997). https://doi.org/10.1007/BF00393714
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DOI: https://doi.org/10.1007/BF00393714