The Use of Locking Compression Plate for Stabilization of Existing and Impending Pathologic Fractures at Long Bones with Metastatic Cancer

Ah Reum Jo; Sung Taek Jung; Young-Woo Chung; Young Min Lee

doi:10.4055/jkoa.2016.51.3.183

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Jo, Jung, Chung, and Lee: The Use of Locking Compression Plate for Stabilization of Existing and Impending Pathologic Fractures at Long Bones with Metastatic Cancer

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(3): 183-190.

Published online: 22 June 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.3.183

The Use of Locking Compression Plate for Stabilization of Existing and Impending Pathologic Fractures at Long Bones with Metastatic Cancer

Ah Reum Jo, M.D., Sung Taek Jung, M.D., Ph.D., Young-Woo Chung, M.D., Young Min Lee, M.D.

Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Korea.

Correspondence to: Sung Taek Jung, M.D., Ph.D. Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. TEL: +82-62-220-6336, FAX: +82-62-227-1640, stjung@chonnam.ac.kr

Received 23 October 2015 Revised 4 January 2016 Accepted 12 January 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the results and the advantages of the operative treatment of metastatic pathologic fractures in long bones using locking compression plates.

Materials and Methods

Twenty-five patients (28 cases) who underwent open reduction and internal fixation with a locking compression plate with or without cement augmentation for pathologic fractures in long bones resulting from metastatic cancer between 2004 and 2013 were reviewed retrospectively. Mean age at the time of surgery was 62.8 years. Pathologic fractures occurred in 11 cases in the humerus, 11 cases in the femur, and 6 cases in the tibia. Functional analysis of Musculoskeletal Tumor Society (MSTS) scores, functional restoration condition of patients with upper extremity involvements, and interval to wheelchair ambulation in patients with lower extremity involvements was performed. Pain relief (visual analogue scale, VAS) and operation time, postoperative satisfaction with individuals, and complications were evaluated.

Results

Mean operation time was 81.3 minutes and mean MSTS scores were 19.8. Mean time from operation to wheelchair ambulation was 3.3 days. Mean VAS improved from 8.1 preoperatively to 2.9 at 1 week postoperatively. Most patients reported that they were more than 'satisfied' One transient radial nerve palsy and one late complication of screw breakage and reduction loss had occurred at postoperative 3 months.

Conclusion

Internal fixation with a locking compression plate in metastatic pathologic fractures can be an effective treatment option in the meta or diaphyseal area of long bones.

Keywords: metastatic pathologic fractures, metastatic impeding fractures, locking compression plate

Figures and Tables

Figure 1

Patients' survival during follow-up.

Figure 2

A 42-year-old male with metastatic lung cancer. (A) Preoperative plain radiograph of the right distal femur shows a pathologic fracture with an osteolytic lesion. (B) The distal femur pathologic fracture was stabilized by locking compression plate with cement augmentation. (C) Plain radiograph shows loss of reduction and failure of the internal fixation after postoperative 3 months. (D) Revision of the screws with breakage was performed with additional anterior plate fixation.

Figure 3

A 70-year-old male with multiple myeloma. (A) Preoperative plain radiograph of the right proximal humerus shows an osteolytic lesion with impending fracture. (B) Coronal T2 weighted image magnetive resonance imaging shows high signal intensity with heterogeneous enhancement. (C) Prophylactic internal fixation was performed with a locking compression plate and bone cement augmentation.

Table 1

Patient Demographics

Values are presented as median (range) or number only.

Table 2

Bony Union Depending on the Primary Type of Tumor

Values are presented as mean±standard deviation.

Notes

This work was supported with clinical research in the Chonnam National University Hospital (CRI10063-1).

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. Body JJ. New developments for treatment and prevention of bone metastases. Curr Opin Oncol. 2011; 23:338–342.

2. DeVita VT, Lawrence TS, Rosenberg SA. DeVita, Hellman, and Rosenberg's cancer: principles & practice of oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins;2011.

3. Bickels J, Kollender Y, Wittig JC, Cohen N, Meller I, Malawer MM. Vacuum-assisted wound closure after resection of musculoskeletal tumors. Clin Orthop Relat Res. 2005; 441:346–350.

4. Siegel HJ, Lopez-Ben R, Mann JP, Ponce BA. 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.

5. Berrettoni BA, Carter JR. Mechanisms of cancer metastasis to bone. J Bone Joint Surg Am. 1986; 68:308–312.

6. Frassica FJ, Frassica DA. Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res. 2003; 415 Suppl. S212–S218.

7. Ward WG, Holsenbeck S, Dorey FJ, Spang J, Howe D. Metastatic disease of the femur: surgical treatment. Clin Orthop Relat Res. 2003; 415 Suppl. S230–S244.

8. Bickels J, Kollender Y, Wittig JC, Meller I, Malawer MM. Function after resection of humeral metastases: analysis of 59 consecutive patients. Clin Orthop Relat Res. 2005; 437:201–208.

9. Jung ST, Ghert MA, Harrelson JM, Scully SP. Treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop Relat Res. 2003; 409:223–231.

10. Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am. 1999; 81:1538–1544.

11. Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998; 80:618–630.

12. Bouma WH, Mulder JH, Hop WC. The influence of intramedullary nailing upon the development of metastases in the treatment of an impending pathological fracture: an experimental study. Clin Exp Metastasis. 1983; 1:205–212.

13. Anglen J, Kyle RF, Marsh JL, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg. 2009; 17:465–472.

14. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; 286:241–246.

15. Harrington KD. Orthopedic surgical management of skeletal complications of malignancy. Cancer. 1997; 80:8 Suppl. 1614–1627.

16. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004; 12:205–212.

17. Sharma H, Bhagat S, McCaul J, Macdonald D, Rana B, Naik M. Intramedullary nailing for pathological femoral fractures. J Orthop Surg (Hong Kong). 2007; 15:291–294.

18. Moholkar K, Mohan R, Grigoris P. The long gamma nail for stabilisation of existing and impending pathological fractures of the femur: an analysis of 48 cases. Acta Orthop Belg. 2004; 70:429–434.

19. Heinz T, Stoik W, Vécsei V. Treatment and results of pathologic fractures. A collaborative study from 1965 to 1985 of 16 Austrian hospitals. Unfallchirurg. 1989; 92:477–485.

20. Douglass HO Jr, Shukla SK, Mindell E. Treatment of pathological fractures of long bones excluding those due to breast cancer. J Bone Joint Surg Am. 1976; 58:1055–1061.

21. Lancaster JM, Koman LA, Gristina AG, et al. Pathologic fractures of the humerus. South Med J. 1988; 81:52–55.

22. Vail TP, Harrelson JM. Treatment of pathologic fracture of the humerus. Clin Orthop Relat Res. 1991; 268:197–202.

23. Friedl W. Indication, management and results of surgical therapy for pathological fractures in patients with bone metastases. Eur J Surg Oncol. 1990; 16:380–396.

24. Yazawa Y, Frassica FJ, Chao EY, Pritchard DJ, Sim FH, Shives TC. Metastatic bone disease. A study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin Orthop Relat Res. 1990; 251:213–219.

25. Habermann ET, Sachs R, Stern RE, Hirsh DM, Anderson WJ Jr. The pathology and treatment of metastatic disease of the femur. Clin Orthop Relat Res. 1982; 169:70–82.

26. Bickels J, Dadia S, Lidar Z. Surgical management of metastatic bone disease. J Bone Joint Surg Am. 2009; 91:1503–1516.

27. Kontakis GM, Tossounidis T, Weiss K, Pape HC, Giannoudis PV. Fat embolism: special situations bilateral femoral fractures and pathologic femoral fractures. Injury. 2006; 37:Suppl 4. S19–S24.

28. Alvi HM, Damron TA. Prophylactic stabilization for bone metastases, myeloma, or lymphoma: do we need to protect the entire bone? Clin Orthop Relat Res. 2013; 471:706–714.

29. Bahk WJ, Rhee SK, Kang YK, Lee AH, Park JM, Chung YG. Gastric cancer acrometastases to all digits of one hand following closed intramedullary nailing. Skeletal Radiol. 2006; 35:529–532.

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