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Osteosynthesis in Metastatic Disease of Long Bones

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Management of Bone Metastases

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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.

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References

  1. Healey JH, Brown HK. Complications of bone metastases: surgical management. Cancer. 2000;88(12 Suppl):2940–51.

    Article  CAS  PubMed  Google Scholar 

  2. Katzer A, Meenen NM, Grabbe F, Rueger JM. Surgery of skeletal metastases. Arch Orthop Trauma Surg. 2002;122(5):251–8. Epub 2001 Dec 4

    Article  PubMed  Google Scholar 

  3. Bickels J, Dadia S, Lidar Z. Surgical management of metastatic bone disease. J Bone Joint Surg Am. 2009;91:1503–16. Review

    Article  PubMed  Google Scholar 

  4. Capanna R, Campanacci DA. The treatment of metastases in the appendicular skeleton. J Bone Joint Surg Br. 2001;83(4):471–81.

    Article  CAS  PubMed  Google Scholar 

  5. Capanna R, Piccioli A, Di Martino A, Daolio PA, Ippolito V, Maccauro G, et al. Management of long bone metastases: recommendations from the Italian Orthopaedic Society bone metastasis study group. Expert Rev Anticancer Ther. 2014;14(10):1127–34.

    Article  CAS  PubMed  Google Scholar 

  6. Swanson KC, Pritchard DJ, Sim FH. Surgical treatment of metastatic disease of the femur. J Am Acad Orthop Surg. 2000;8(1):56–65.

    Article  CAS  PubMed  Google Scholar 

  7. Wegener B, Schlemmer M, Stemmler J, Jansson V, Dürr HR, Pietschmann MF. Analysis of orthopedic surgery of bone metastases in breast cancer patients. BMC Musculoskelet Disord. 2012;13:232.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ratasvuori M, Wedin R, Keller J, Nottrott M, Zaikova O, Bergh P, Kalen A, Nilsson J, Jonsson H, Laitinen M. Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol. 2013;22(2):132–8.

    Article  PubMed  Google Scholar 

  9. Hu YC, Lun DX, Wang H. Clinical features of neoplastic pathological fracture in long bones. Chin Med J. 2012;125(17):3127–32.

    PubMed  Google Scholar 

  10. Forsberg JA, Wedin R, Bauer HCF, Hansen BH, Laitinen M, Trovik CS, et al. External validation of the Bayesian Estimated Tools for Survival (BETS) models in patients with surgically treated skeletal metastases. BMC Cancer. 2012;12:493.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Conill C, Verger E, Salamero M. Performance status assessment in cancer patients. Cancer. 1990;65(8):1864–6.

    Article  CAS  PubMed  Google Scholar 

  12. Piccioli A, Spinelli MS, Forsberg JA, Wedin R, Healey JH, Ippolito V, et al. How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations. BMC Cancer. 2015;15:424.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Maccauro G, Muratori F, Liuzza F, Rossi B, Logroscino CA. Anterograde femoral nail for the treatment of femoral metastases. Eur J Orthop Surg Traumatol. 2008;18:509–13.

    Article  Google Scholar 

  14. Fidler M. Prophylactic internal fixation of secondary neoplastic deposits in long bones. Br Med J. 1973;1(5849):341–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Harrington KD. New trends in the management of lower extremity metastases. Clin Orthop. 1982;169:53–61.

    Google Scholar 

  16. Mirels H. Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop. 2003;415(Suppl):S4–13.

    Article  Google Scholar 

  17. Cheung FH. The practicing orthopedic surgeon’s guide to managing long bone metastases. Orthop Clin North Am. 2014;45(1):109–19.

    Article  PubMed  Google Scholar 

  18. Randall RL, Aoki SK, Olson PR, Bott SI. Complications of cemented long-stem hip arthroplasties in metastatic bone disease. Clin Orthop. 2006;443:287–95.

    Article  PubMed  Google Scholar 

  19. Sun S, Lang EV. Bone metastases from renal cell carcinoma: preoperative embolization. J Vasc Interv Radiol. 1998;9(2):263–9.

    Article  CAS  PubMed  Google Scholar 

  20. Layalle I, Flandroy P, Trotteur G, Dondelinger RF. Arterial embolization of bone metastases: is it worthwhile? J Belg Radiol. 1998;81(5):223–5.

    PubMed  CAS  Google Scholar 

  21. Jehn CF, Diel IJ, Overkamp F, Kurth A, Schaefer R, Miller K, et al. Management of metastatic bone disease algorithms for diagnostics and treatment. Anticancer Res. 2016;36(6):2631–7.

    PubMed  CAS  Google Scholar 

  22. Dijstra S, Wiggers T, van Geel BN, Boxma H. Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures. Eur J Surg. 1994;160(10):535–42.

    PubMed  CAS  Google Scholar 

  23. Jacofsky DJ, Frassica D, Frassica F. Metastatic disease to bone. Hosp Physician. 2004;39:21–8.

    Google Scholar 

  24. Sharma H, Bhagat S, McCaul J, Macdonald D, Rana B, Naik M. Intramedullary nailing for pathological femoral fractures. J Orthop Surg (Hong Kong). 2007;15(3):291–4.

    Article  CAS  Google Scholar 

  25. Tanaka T, Imanishi J, Charoenlap C, Choong PF. Intramedullary nailing has sufficient durability for metastatic femoral fractures. World J Surg Oncol. 2016;14:80.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ward WG, Holsenbeck S, Dorey FJ, Spang J, Howe D. Metastatic disease of the femur: surgical treatment. Clin Orthop. 2003;415(Suppl):S230–44.

    Article  Google Scholar 

  27. Sim FH. Metastatic bone disease of the pelvis and femur. Instr Course Lect. 1992;41:317–27.

    PubMed  CAS  Google Scholar 

  28. Chan D, Carter SR, Grimer RJ, Sneath RS. Endoprosthetic replacement for bony metastases. Ann R Coll Surg Engl. 1992;74(1):13–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  29. Nathan SS, Healey JH, Mellano D, Hoang B, Lewis I, Morris CD, et al. Survival in patients operated on for pathologic fracture: implications for end-of-life orthopedic care. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(25):6072–82.

    Article  Google Scholar 

  30. Harrington KD. Impending pathologic fractures from metastatic malignancy: evaluation and management. Instr Course Lect. 1986;35:357–81.

    PubMed  CAS  Google Scholar 

  31. Harrington KD, Sim FH, Enis JE, Johnston JO, Diok HM, Gristina AG. Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases. J Bone Joint Surg Am. 1976;58(8):1047–55.

    Article  CAS  PubMed  Google Scholar 

  32. Forsberg JA, Wedin R, Bauer H. Which implant is best after failed treatment for pathologic femur fractures? Clin Orthop. 2013;471(3):735–40.

    Article  PubMed  Google Scholar 

  33. Collis PN, Clegg TE, Seligson D. The invisible nail: a technique report of treatment of a pathological humerus fracture with a radiolucent intramedullary nail. Injury. 2011;42(4):424–6.

    Article  PubMed  Google Scholar 

  34. Zimel MN, Hwang S, Riedel ER, Healey JH. Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging. Skeletal Radiol. 2015;44(9):1317–25.

    Article  PubMed  Google Scholar 

  35. Gausepohl T, Pennig D, Heck S, Gick S, Vegt PA, Block JE. Effective management of bone fractures with the Illuminoss® photodynamic bone stabilization system: initial clinical experience from the European Union Registry. Orthop Rev (Pavia). 2017;9(1):6988.

    Article  Google Scholar 

  36. Townsend PW, Rosenthal HG, Smalley SR, Cozad SC, Hassanein RE. Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol Off J Am Soc Clin Oncol. 1994;12(11):2345–50.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Centro di Chirurgia Oncologica Ortopedica Istituto Ortopedico “Gaetano Pini”, Milan, Italy

    Primo Daolio, Eleonora Marini & Stefano Bastoni

  2. Clinica Ortopedica Policlinico Universitario, Padua, Italy

    Vincenzo Ippolito

  3. UOC Ortopedia, Ospedale Gubbio-Gualdo Tadino, Gubbio, Italy

    Barbara Rossi

Authors
  1. Primo Daolio
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  2. Vincenzo Ippolito
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  3. Barbara Rossi
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  4. Eleonora Marini
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  5. Stefano Bastoni
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Corresponding author

Correspondence to Primo Daolio .

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Editors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Vincenzo Denaro

  2. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Alberto Di Martino

  3. General Direction of Health Program, National Ministry of Health of Italy, Rome, Italy

    Andrea Piccioli

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Daolio, P., Ippolito, V., Rossi, B., Marini, E., Bastoni, S. (2019). Osteosynthesis in Metastatic Disease of Long Bones. In: Denaro, V., Di Martino, A., Piccioli, A. (eds) Management of Bone Metastases. Springer, Cham. https://doi.org/10.1007/978-3-319-73485-9_12

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  • DOI: https://doi.org/10.1007/978-3-319-73485-9_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-73484-2

  • Online ISBN: 978-3-319-73485-9

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