Format

Send to

Choose Destination
See comment in PubMed Commons below
Clin Orthop Relat Res. 2013 Mar;471(3):706-14. doi: 10.1007/s11999-012-2656-1. Epub 2012 Oct 27.

Prophylactic stabilization for bone metastases, myeloma, or lymphoma: do we need to protect the entire bone?

Author information

1
Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Abstract

BACKGROUND:

The current operative standard of care for disseminated malignant bone disease suggests stabilizing the entire bone to avoid the need for subsequent operative intervention but risks of doing so include complications related to embolic phenomena.

QUESTIONS/PURPOSES:

We questioned whether progression and reoperation occur with enough frequency to justify additional risks of longer intramedullary devices.

METHODS:

A retrospective chart review was done for 96 patients with metastases, myeloma, or lymphoma who had undergone stabilization or arthroplasty of impending or actual femoral or humeral pathologic fractures using an approach favoring intramedullary fixation devices and long-stem arthroplasty. Incidence of progressive bone disease, reoperation, and complications associated with fixation and arthroplasty devices in instrumented femurs or humeri was determined.

RESULTS:

At minimum 0 months followup (mean, 11 months; range, 0-72 months), 80% of patients had died. Eleven of 96 patients (12%) experienced local bony disease progression; eight had local progression at the original site, two had progression at originally recognized discretely separate lesions, and one had a new lesion develop in the bone that originally was surgically treated. Six subjects (6.3%) required repeat operative intervention for symptomatic failure. Twelve (12.5%) patients experienced physiologic nonfatal complications potentially attributable to embolic phenomena from long intramedullary implants.

CONCLUSIONS:

Because most patients in this series were treated with the intent to protect the bone with long intramedullary implants when possible, the reoperation rate may be lower than if the entire bone had not been protected. However, the low incidence of disease progression apart from originally identified lesions (one of 96) was considerably lower than the physiologic complication rate (12 of 96) potentially attributable to long intramedullary implants.

LEVEL OF EVIDENCE:

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

PMID:
23104043
PMCID:
PMC3563787
DOI:
10.1007/s11999-012-2656-1
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Springer Icon for PubMed Central
    Loading ...
    Support Center