Scripties UMCG - Rijksuniversiteit Groningen
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Survival and complications after surgical treatment for (impending) pathological fractures of the lower extremities

(2017) Boer, R. (Rohan)

Introduction: The long bones of the lower extremities are a common site for (impending) pathological fractures due to bone metastasis (BM). Optimizing treatment is important as it strives to relieve symptoms and improve quality of life. This study aimed to analyse the survival and the complications rates of patients with (impending) pathological fractures due to BM and the outcomes of the different treatment strategies. Materials and methods: This retrospective study included all patients surgically treated for (impending) pathological fractures in the long bones of the lower extremities caused by BM from 1994 – 2016. The primary outcome was cumulative patient survival (CPS) at one and two years. The secondary outcome was cumulative implant survival (CIS) at one and two years. Lastly, the effects of the different therapies on survival and complication rates were analysed.
Results: A total of 137 patients were included. The CPS at one and two years was 32% and 19% respectively. Significantly higher CPS was seen at one and two years in those treated with impending pathological fractures (IPF) as opposed to complete pathological fractures (CPF) (p=0.03 and p=0.05). Additionally, those patients who underwent pre- and post-operative radiotherapy (RT) showed significantly higher CPS versus those who abstained from RT (p=0.03 and p=0.05). The CIS at one and two years was 89% and 76% respectively. A significantly higher CIS was observed at one year when treating IPF with respect to CPF (p=0.03). (Endo-)prosthesis had a significantly higher CIS at two years (p=0.03) and a significantly lower non-surgical and surgical site complication rate (p=0.04 and p=0.02). Our study reported an overall complication rate of 36%.
Conclusion: The prognosis of patients with surgically treated BM remains grim, irrespective of the surgical technique. The majority of patients demised with functioning implants providing good palliation. Surgical treatment of impending as opposed to complete pathological fractures yielded better clinical results. Early stabilisation of impending fractures is thus advised. RT may further provide improved clinical outcomes. With complication rates known, it is possible to provide patients with accurate information regarding the risks of surgical treatment.

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