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Review Article| Volume 54, ISSUE 1, P47-57, January 2023

Fixation Principles for Pathologic Fractures in Metasatic Disease

Published:October 25, 2022DOI:https://doi.org/10.1016/j.ocl.2022.08.010

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      References

        • Biermann J.S.
        • Holt G.E.
        • Lewis V.O.
        • et al.
        Metastatic bone disease: diagnosis, evaluation, and treatment.
        J Bone Joint Surg Am. 2009; 91 (PMID: 19487533): 1518-1530
        • American Cancer Society
        Cancer facts & figures 2022.
        American Cancer Society, Atlanta (GA)2022
        • Jayarangaiah A.
        • Kemp A.K.
        • Theetha Kariyanna P.
        Bone metastasis.
        in: StatPearls [internet]. StatPearls Publishing, Treasure Island (FL)2022 (Available at:)
        • Rizzo S.E.
        • Kenan S.
        Pathologic fractures.
        in: StatPearls [internet]. StatPearls Publishing, Treasure Island (FL)2022 (Available at:)
        • Hernandez R.K.
        • Wade S.W.
        • Reich A.
        • et al.
        Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States.
        BMC Cancer. 2018; 18: 44
        • Nørgaard M.
        • Jensen A.Ø.
        • Jacobsen J.B.
        • et al.
        Skeletal related events, bone metastasis and survival of prostate cancer: a population based cohort study in Denmark (1999 to 2007).
        J Urol. 2010; 184: 162-167
        • Higinbotham N.L.
        • Marcove R.C.
        The management of pathological fractures.
        J Trauma. 1965; 5 (PMID: 5851126): 792-798
        • Jairam V.
        • Lee V.
        • Yu J.B.
        • et al.
        Nationwide Patterns of Pathologic Fractures Among Patients Hospitalized With Bone Metastases.
        Am J Clin Oncol. 2020; 43: 720-726
        • Oster G.
        • Lamerato L.
        • Glass A.G.
        • et al.
        Natural history of skeletal-related events in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems.
        Support Care Cancer. 2013; 21: 3279-3286
        • Saad F.
        • Lipton A.
        • Cook R.
        • et al.
        Pathologic fractures correlate with reduced survival in patients with malignant bone disease.
        Cancer. 2007; 110: 1860-1867
        • El Abiad J.M.
        • Raad M.
        • Puvanesarajah V.
        • et al.
        Prophylactic Versus Postfracture Stabilization for Metastatic Lesions of the Long Bones: A Comparison of 30-day Postoperative Outcomes.
        J Am Acad Orthop Surg. 2019; 27: e709-e716
        • Blank A.T.
        • Lerman D.M.
        • Patel N.M.
        • et al.
        Is Prophylactic Intervention More Cost-effective Than the Treatment of Pathologic Fractures in Metastatic Bone Disease?.
        Clin Orthop Relat Res. 2016; 474: 1563-1570
        • Arvinius C.
        • Parra J.L.
        • Mateo L.S.
        • et al.
        Benefits of early intramedullary nailing in femoral metastases.
        Int Orthop. 2014; 38: 129-132
        • Ward W.G.
        • Holsenbeck S.
        • Dorey F.J.
        • et al.
        Metastatic disease of the femur: surgical treatment.
        Clin Orthop Relat Res. 2003; 415 Suppl: S230-S244
        • Philipp T.C.
        • Mikula J.D.
        • Doung Y.C.
        • et al.
        Is There an Association Between Prophylactic Femur Stabilization and Survival in Patients with Metastatic Bone Disease?.
        Clin Orthop Relat Res. 2020; 478: 540-546
        • Mosher Z.A.
        • Patel H.
        • Ewing M.A.
        • et al.
        Early Clinical and Economic Outcomes of Prophylactic and Acute Pathologic Fracture Treatment.
        J Oncol Pract. 2019; 15: e132-e140
      1. GBD 2019 Fracture Collaborators. Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019.
        Lancet Healthy Longev. 2021; 2: e580-e592
        • Kaneko T.S.
        • Pejcic M.R.
        • Tehranzadeh J.
        • et al.
        Relationships between material properties and CT scan data of cortical bone with and without metastatic lesions.
        Med Eng Phys. 2003; 25: 445-454
        • Sekita A.
        • Matsugaki A.
        • Nakano T.
        Disruption of collagen/apatite alignment impairs bone mechanical function in osteoblastic metastasis induced by prostate cancer.
        Bone. 2017; 97: 83-93
        • Pacheco R.
        • Stock H.
        Effects of radiation on bone.
        Curr Osteoporos Rep. 2013; 11: 299-304
        • Gainor B.J.
        • Buchert P.
        Fracture healing in metastatic bone disease.
        Clin Orthop Relat Res. 1983; 178: 297-302
        • Adams S.C.
        • Potter B.K.
        • Mahmood Z.
        • et al.
        Consequences and prevention of inadvertent internal fixation of primary osseous sarcomas.
        Clin Orthop Relat Res. 2009; 467: 519-525
        • Peabody T.
        The rodded metastasis is a sarcoma: strategies to prevent inadvertent surgical procedures on primary bone malignancies.
        Instr Course Lect. 2004; 53: 657-661
        • Spence G.M.
        • Dunning M.T.
        • Cannon S.R.
        • et al.
        The hazard of retrograde nailing in pathological fractures: three cases involving primary musculoskeletal malignancy.
        Injury. 2002; 33: 533-538
        • Mankin H.J.
        • Mankin C.J.
        • Simon M.A.
        The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society.
        J Bone Joint Surg Am. 1996; 78: 656-663
      2. Mankin HJ, Lange TA, Spanier SS (2006) THE CLASSIC: The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. Clin Orthop Relat Res 450:4–10

        • Bickels J.
        • Jelinek J.S.
        • Shmookler B.M.
        • et al.
        Biopsy of musculoskeletal tumors. Current concepts.
        Clin Orthop Relat Res. 1999; 368: 212-219
        • Traina F.
        • Errani C.
        • Toscano A.
        • et al.
        Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection.
        J Bone Joint Surg Am. 2015; 97: e7
        • Kasraeian S.
        • Allison D.C.
        • Ahlmann E.R.
        • et al.
        A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses.
        Clin Orthop Relat Res. 2010; 468: 2992-3002
        • Pohlig F.
        • Kirchhoff C.
        • Lenze U.
        • et al.
        Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study.
        Eur J Med Res. 2012; 17: 29
        • Adams S.C.
        • Potter B.K.
        • Pitcher D.J.
        • et al.
        Office-based core needle biopsy of bone and soft tissue malignancies: an accurate alternative to open biopsy with infrequent complications.
        Clin Orthop Relat Res. 2010; 468: 2774-2780
        • Scolaro J.A.
        • Lackman R.D.
        Surgical management of metastatic long bone fractures: principles and techniques.
        J Am Acad Orthop Surg. 2014; 22 (PMID: 24486755): 90-100
        • Arpornsuksant P.
        • Morris C.D.
        • Forsberg J.A.
        • et al.
        What Factors Are Associated With Local Metastatic Lesion Progression After Intramedullary Nail Stabilization?.
        Clin Orthop Relat Res. 2022; 480: 932-945
        • Tejwani N.C.
        • Guerado E.
        Improving fixation of the osteoporotic fracture: the role of locked plating.
        J Orthop Trauma. 2011; 25: S56-S60
        • Virkus W.W.
        • Miller B.J.
        • Chye P.C.
        • et al.
        The use of locking plates in orthopedic oncology reconstructions.
        Orthopedics. 2008; 31: 438
        • Gregory J.J.
        • Ockendon M.
        • Cribb G.L.
        • et al.
        The outcome of locking plate fixation for the treatment of periarticular metastases.
        Acta Orthop Belg. 2011; 77: 362-370
        • Umer M.
        • Abbas K.
        • Khan S.
        • et al.
        Locking compression plate in musculoskeletal oncology ‘a friend in need.
        Clin Orthop Surg. 2013; 5: 321-326
        • Cameron H.U.
        • Jacob R.
        • Macnab I.
        • et al.
        Use of polymethylmethacrylate to enhance screw fixation in bone.
        J Bone Joint Surg Am. 1975; 57 (PMID: 1150708): 655-656
        • Wittenberg R.H.
        • Lee K.S.
        • Shea M.
        • et al.
        Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength.
        Clin Orthop Relat Res. 1993; 296 (PMID: 8222439): 278-287
        • Siegel H.J.
        • Lopez-Ben R.
        • Mann J.P.
        • et al.
        Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement.
        J Bone Joint Surg Br. 2010; 92: 707-712
        • Willeumier J.J.
        • van der Linden Y.M.
        • van de Sande M.A.J.
        • et al.
        Treatment of pathological fractures of the long bones.
        Open Rev. 2017; 1 (PMID: 28461940; PMCID: PMC5367617): 136-145
        • Kistler B.J.
        • Damron T.A.
        Latest Developments in Surgical and Minimally Invasive Treatment of Metastatic Bone Disease.
        Curr Surg Rep. 2014; 2: 49
        • Auran R.L.
        • Martin J.R.
        • Duran M.D.
        • et al.
        Management of Metastatic Disease in Long Bones.
        J Orthop Trauma. 2022; https://doi.org/10.1097/BOT.0000000000002360
        • Wang A.S.
        • Armstrong E.J.
        • Armstrong A.W.
        Corticosteroids and wound healing: clinical considerations in the perioperative period.
        Am J Surg. 2013; 206: 410-417
        • Elias A.W.
        • Kasi P.M.
        • Stauffer J.A.
        • et al.
        The Feasibility and Safety of Surgery in Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Study.
        Front Oncol. 2017; 7: 121
        • Seim L.A.
        • Irizarry-Alvarado J.M.
        Perioperative Management of Female Hormone Medications.
        Curr Clin Pharmacol. 2017; 12: 188-193
        • Gross C.E.
        • Frank R.M.
        • Hsu A.R.
        • et al.
        External beam radiation therapy for orthopaedic pathology.
        J Am Acad Orthop Surg. 2015; 23: 243-252
        • Lutz S.
        • Balboni T.
        • Jones J.
        • et al.
        Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline.
        Pract Radiat Oncol. 2017; 7: 4-12
        • Lin J.T.
        • Lane J.M.
        Bisphosphonates.
        J Am Acad Orthop Surg. 2003; 11: 1-4
        • Wong R.
        • Wiffen P.J.
        Bisphosphonates for the relief of pain secondary to bone metastases.
        Cochrane Database Syst Rev. 2002; 2002: CD002068
        • Al Farii H.
        • Frazer A.
        • Farahdel L.
        • et al.
        Bisphosphonates Versus Denosumab for Prevention of Pathological Fracture in Advanced Cancers With Bone Metastasis: A Meta-analysis of Randomized Controlled Trials.
        J Am Acad Orthop Surg Glob Res Rev. 2020; 4: e2000045
        • Wolanczyk M.J.
        • Fakhrian K.
        • Adamietz I.A.
        Radiotherapy, Bisphosphonates and Surgical Stabilization of Complete or Impending Pathologic Fractures in Patients with Metastatic Bone Disease.
        J Cancer. 2016; 7: 121-124
        • Barton D.W.
        • Smith C.T.
        • Piple A.S.
        • et al.
        Timing of Bisphosphonate Initiation After Fracture: What Does the Data Really Say?.
        Geriatr Orthop Surg Rehabil. 2020; 11 (2151459320980369)
        • Pazionis T.J.
        • Papanastassiou I.D.
        • Maybody M.
        • et al.
        Embolization of hypervascular bone metastases reduces intraoperative blood loss: a case-control study.
        Clin Orthop Relat Res. 2014; 472: 3179-3187
        • Geraets S.E.W.
        • Bos P.K.
        • van der Stok J.
        Preoperative embolization in surgical treatment of long bone metastasis: a systematic literature revi.
        efort Open Rev. 2020; 5: 17-25
        • Healey J.H.
        • Brown H.K.
        Complications of bone metastases: surgical management.
        Cancer. 2000; 88: 2940-2951
        • Higuchi T.
        • Yamamoto N.
        • Hayashi K.
        • et al.
        The Efficacy of Wide Resection for Musculoskeletal Metastatic Lesions of Renal Cell Carcinoma.
        Anticancer Res. 2018; 38: 577-582
        • Coleman R.E.
        Metastatic bone disease: clinical features, pathophysiology and treatment strategies.
        Cancer Treat Rev. 2001; 27: 165-176
        • Willeumier J.J.
        • Kaynak M.
        • van der Zwaal P.
        • et al.
        What Factors Are Associated With Implant Breakage and Revision After Intramedullary Nailing for Femoral Metastases?.
        Clin Orthop Relat Res. 2018; 476: 1823-1833
        • Elhammali A.
        • Milgrom S.A.
        • Amini B.
        • et al.
        Postoperative Radiotherapy for Multiple Myeloma of Long Bones: Should the Entire Rod Be Treated?.
        Clin Lymphoma Myeloma Leuk. 2019; 19: e465-e469
        • Gao H.
        • Liu Z.
        • Wang B.
        • et al.
        Clinical and functional comparison of endoprosthetic replacement with intramedullary nailing for treating proximal femur metastasis.
        Chin J Cancer Res. 2016; 28: 209-214
        • Anatone A.J.
        • Danford N.C.
        • Jang E.S.
        • et al.
        Risk Factors for Surgical Site Infection in Orthopaedic Oncology.
        J Am Acad Orthop Surg. 2020; 28: e923-e928
        • Morris C.D.
        • Sepkowitz K.
        • Fonshell C.
        • et al.
        Prospective identification of risk factors for wound infection after lower extremity oncologic surgery.
        Ann Surg Oncol. 2003; 10: 778-782
        • Donati D.
        • Biscaglia R.
        The use of antibiotic-impregnated cement in infected reconstructions after resection for bone tumours.
        J Bone Joint Surg Br. 1998; 80: 1045-1050
        • Racano A.
        • Pazionis T.
        • Farrokhyar F.
        • et al.
        High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review.
        Clin Orthop Relat Res. 2013; 471: 2017-2027
        • Ghert M.
        • Schneider P.
        • Guyatt G.
        • et al.
        • Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Investigators
        Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Randomized Clinical Trial.
        JAMA Oncol. 2022; 8: 345-353
        • Grover S.P.
        • Hisada Y.M.
        • Kasthuri R.S.
        • et al.
        Cancer Therapy-Associated Thrombosis.
        Arterioscler Thromb Vasc Biol. 2021; 41: 1291-1305
        • Nijziel M.R.
        • van Oerle R.
        • Hillen H.F.
        • et al.
        From Trousseau to angiogenesis: the link between the haemostatic system and cancer.
        Neth J Med. 2006; 64 (PMID: 17179570): 403-410
        • Groot O.Q.
        • Ogink P.T.
        • Janssen S.J.
        • et al.
        High Risk of Venous Thromboembolism After Surgery for Long Bone Metastases: A Retrospective Study of 682 Patients.
        Clin Orthop Relat Res. 2018; 476: 2052-2061
        • Mioc M.L.
        • Prejbeanu R.
        • Vermesan D.
        • et al.
        Deep vein thrombosis following the treatment of lower limb pathologic bone –ractures - a comparative study.
        BMC Musculoskelet Disord. 2018; 19: 213
        • Oppelt P.
        • Betbadal A.
        • Nayak L.
        Approach to chemotherapy-associated thrombosis.
        Vasc Med. 2015; 20: 153-161
        • Key N.S.
        • Khorana A.A.
        • Kuderer N.M.
        • et al.
        Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update.
        J Clin Oncol. 2020; 38: 496-520
      3. The ICM-VTE Oncology Delegates∗ Recommendations from the ICM-VTE: Oncology.
        J Bone Joint Surg. 2022; 104: 232-237
        • Aguilera X.
        • Martinez-Zapata M.J.
        • Bosch A.
        • et al.
        Efficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial.
        J Bone Joint Surg Am. 2013; 95: 2001-2007
        • Chang C.H.
        • Chang Y.
        • Chen D.W.
        • et al.
        Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty.
        Clin Orthop Relat Res. 2014; 472: 1552-1557
        • Whiting D.R.
        • Gillette B.P.
        • Duncan C.
        • et al.
        Preliminary results suggest tranexamic acid is safe and effective in arthroplasty patients with severe comorbidities.
        Clin Orthop Relat Res. 2014; 472: 66-72
        • Sabbag O.D.
        • Abdel M.P.
        • Amundson A.W.
        • et al.
        Tranexamic Acid Was Safe in Arthroplasty Patients With a History of Venous Thromboembolism: A Matched Outcome Study.
        J Arthroplasty. 2017; 32: S246-S250
        • Haase D.R.
        • Templeton K.J.
        • Rosenthal H.G.
        • et al.
        Tranexamic Acid in Patients With Cancer Undergoing Endoprosthetic Reconstruction: A Retrospective Review.
        J Am Acad Orthop Surg. 2020; 28: 248-255
        • Schwarzkopf E.
        • Sachdev R.
        • Flynn J.
        • et al.
        Occurrence, risk factors, and outcomes of bone cement implantation syndrome after hemi and total hip arthroplasty in cancer patients.
        J Surg Oncol. 2019; 120: 1008-1015
        • Hines C.B.
        Understanding Bone Cement Implantation Syndrome.
        AANA J. 2018; 86: 433-441
        • Rudloff M.I.
        • Smith W.R.
        Intramedullary nailing of the femur: current concepts concerning reaming.
        J Orthop Trauma. 2009; 23: S12-S17
        • Donaldson A.J.
        • Thomson H.E.
        • Harper N.J.
        • et al.
        Bone cement implantation syndrome.
        Br J Anaesth. 2009; 102: 12-22
        • Hall J.A.
        • McKee M.D.
        • Vicente M.R.
        • et al.
        Prospective Randomized Clinical Trial Investigating the Effect of the Reamer-Irrigator-Aspirator on the Volume of Embolic Load and Respiratory Function During Intramedullary Nailing of Femoral Shaft Fractures.
        J Orthop Trauma. 2017; 31: 200-204
        • Roth S.E.
        • Rebello M.M.
        • Kreder H.
        • et al.
        Pressurization of the metastatic femur during prophylactic intramedullary nail fixation.
        J Trauma. 2004; 57: 333-339
        • Kendal J.K.
        • Heard B.J.
        • Abbott A.G.
        • et al.
        Does surgical technique influence the burden of lung metastases in patients with pathologic long bone fractures?.
        BMC Musculoskelet Disord. 2022; 23: 102