Journal List > J Korean Bone Joint Tumor Soc > v.16(2) > 1051979

Seo and Jung: Metastatic Pathologic Fractures in Lower Extremities Treated with the Locking Plate

Abstract

Purpose

The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates.

Materials and Methods

Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss.

Results

Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml).

Conclusion

Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.

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Figure 1.
A 70-year-old man with a fracture of the distal femur secondary to metastasis of lung cancer. (A) Anteroposterior (AP) radiograph of the distal femur shows a displaced pathologic fracture. (B) The patient underwent an open reduction and internal fixation using a locking plate with cement augmentation.
jkbjts-16-80f1.tif
Figure 2.
An 81-year-old man with thyroid cancer showing a pathologic fracture of the femoral mid-shaft. (A) Preoperative radiograph shows an osteolytic lesion of the femoral shaft. (B) Coronal plane of preoperative CT scan demonstrates a cortical discontinuity around the lesion of the femoral shaft. (C) A minimally invasive plate osteosynthesis was performed with a locking plate.
jkbjts-16-80f2.tif
Figure 3.
A 58-year-old man with a pathologic fracture of the distal femur due to lung cancer. (A) AP radiograph shows an osteolytic lesion of the distal femur with a pathologic fracture. (B) The distal femur with a pathologic fracture was stabilized by using locking plate with cement augmentation. (C) AP and lateral radiograph obtained 3 months after internal fixation shows loss of reduction and failure of the internal fixation.
jkbjts-16-80f3.tif
Table 1.
Demographic Data of Patients with an Impeding or Pathologic Fracture of the Lower Extremity Caused by Metastatic Cancer
Cases Gender Age (year) Primary tumor Metastases Pathologic fracture site Operation name Survival after fracture (day) Interval from operation to ambulation (day) Preoperative VAS (points) Postoperative VAS (points) Postoperative blood loss (ml) Operation time (minute)
1 M 81 Thyroid Multiple (skeleton, Lymph nodes) Femur mid-shaft ORIF with LCP 84 1 8 3 260 70
2 M 61 Lung Multiple (skeleton) Proximal femur ORIF with LCP 14 No 8 3 200 65
3 M 61 Lung Multiple (skeleton) Proximal tibia ORIF with LCP & cementing 14 No 8 2 315 80
4 M 70 Stomach Multiple (Skeleton, Brain) Distal tibia ORIF with LCP & cementing 32 3 7 4 130 65
5 M 70 Lung Multiple (Skeleton, Lymph nodes) Distal femur ORIF with LCP & cementing 44 2 9 3 320 85
6 M 58 Lung Multiple (Skeleton, Brain) Distal femur ORIF with LCP & cementing 220 6 9 2 200 90
7 M 50 Lung Multiple (Skeleton, Brain) Distal femur ORIF with LCP & cementing 378 4 8 2 300 95
8 F 58 Thyroid Multiple (Skeleton) Proximal femur ORIF with LCP & cementing 38 4 7 4 225 105
9 M 60 Lung Multiple (Skeleton) Mid-shaft femur ORIF with LCP & cementing 65 2 8 2 255 105
10 F 66 Stomach Multiple (Skeleton) Proximal tibia ORIF with LCP & cementing 149 2 8 3 230 100
11 F 56 Kidney Multiple (Skeleton) Proximal tibia ORIF with LCP 241 5 9 3 295 95
12 M 57 Lung Multiple (Skeleton, Brain) Mid-shaft femur ORIF with LCP & cementing 74 3 7 2 265 95
13 M 62 Lung Multiple (Skeleton) Proximal tibia ORIF with LCP 107 3 9 2 210 100
ORIF, open reduction and internal fixation; LCP, locking compression plate.

One patient (2 cases) died due to aggravation of underlying chronic obstructive pulmonary disease and interstitial pneumonia at 14 days postoperatively.

Table 2.
Results Compared with Intramedullary Nailing for the Treatment of Pathologic Fractures
Authors Cases Operation time (minute) Blood loss (ml) Ambulation (day) Complications (numbers)
Sharma et al.26) 21 140 900 3 Superficial wound infection (2)
        Pneumonia (2)
        Loss of reduction (1)
Moholkar et al.27) 48 98 400 7 Chest infection (4)
        Urinary track infection (2)
        Superficial wound infection (2)
        Deep wound infection (1)
        Renal failure (1)
        Death (2)
Present study 13 88.4 246.5 3.2 Screw breakage (1)

Weight bearing ambulation,

Of the 42 patients, 69% were ambulatory by one week in their study.

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