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Osteosynthesis in Metastatic Disease of Long Bones

  • Primo Daolio
  • Vincenzo Ippolito
  • Barbara Rossi
  • Eleonora Marini
  • Stefano Bastoni
Chapter

Abstract

Prompt evaluation and effective treatment of long bone metastasis are a priority in the management of cancer patients. The main goals are to achieve local tumor control, pain relief, prevention and treatment of fractures, and maintenance of patient independence and quality of life.

Prognosis estimate, cross-sectional extent of bone destruction, and anatomic site of the bone lesion are clinical and radiographic features used by orthopedic surgeons in the decision-making process.

Treatment principles are the same regardless of the skeletal location. A construct should ideally provide enough stability to allow immediate full weight-bearing with enough durability to last the patients expected lifetime. Adequate mechanical stabilization by intramedullary interlocking nailing or plating and screws may address the vast majority of lesions of long bone diaphyseal and meta-diaphyseal portion in the presence of an adequate proximal and distal bone stock for fixation.

However, there are many additional aspects to consider in this setting as the need for biopsy, the evaluation of the extent of bone destruction and stability of the implant, dedicated and specific instruments for tumor surgery, the risk of perioperative bleeding and consideration to preoperative selective arterial embolization, cancer sensitivity and timing of postoperative radiation, possible tumor curettage, and use of local adjuvant and cement to improve tumor control and mechanical strength of the construct.

Keywords

Long bones metastasis Impending fracture Pathological fracture Intramedullary nailing Plating 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Primo Daolio
    • 1
  • Vincenzo Ippolito
    • 2
  • Barbara Rossi
    • 3
  • Eleonora Marini
    • 1
  • Stefano Bastoni
    • 1
  1. 1.Centro di Chirurgia Oncologica Ortopedica Istituto Ortopedico “Gaetano Pini”MilanItaly
  2. 2.Clinica Ortopedica Policlinico UniversitarioPaduaItaly
  3. 3.UOC Ortopedia, Ospedale Gubbio-Gualdo TadinoGubbioItaly

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