Prostate cancer, combined with breast cancer, contributes to 80% of all skeletal metastasis (O). However, blastic lesions in high risk areas such as the proximal femur have a high rate of fracture. Based on the author's experience, breast cancer metastases that are purely lytic are more likely to fracture than those that are blastic or mixed lytic and blastic. Because breast carcinoma has a relatively long survival, these patients are more likely to sustain a pathological fracture. The risk of pathologic fracture increases with the duration of metastatic disease. Breast cancer is the most important source of bone metastasis, and it is responsible for the majority of the skeletal metastases that require orthopedic consultation (M). This article will critically review the literature and provide guidelines for estimating fracture risk that are useful for orthopedic surgeons.Ĭancer Diagnosis The patient's underlying cancer diagnosis is an important component of their pathologic risk profile (Table 1). the use of biomechanics to predict fracture. In addition, some have proposed a detailed biomechanical analysis based on finite element modeling. These include type of cancer type of treatment size of the lesion location of the lesion whether the lesion is lytic or blastic and symptoms due to the lesion. Many different characteristics have been proposed as important criteria for determining risk of fracture. In order to determine which patients require prophylactic fixation to prevent pathologic fracture, it is necessary to perform an accurate and reliable risk evaluation. Some of the advantages that have been cited include shorter hospital stays(R,A) easier rehabilitation and nursing with more rapid restoration of function (U,V,K,R) easier radiotherapy treatment (R,A.) more immediate pain relief (U,V,K,R,A) and faster and less complicated surgery (R,A). Prevention of pathologic fractures is superior to treatment after the fact. This review will focus on the evaluation of fractures that occur secondary to bone destruction by metastatic cancer. The most common condition associated with pathologic fractures is osteoporosis(q). Conditions associated with pathologic fractures include underlying metabolic disorders, primary benign tumors, and primary and metastatic malignant tumors (q). Unlike fractures of normal bone, pathologic fractures occur during normal activity or minor trauma due to weakening of the bone by disease. The goal of this review is to establish a systematic screening tool and treatment algorithm that orthopedic surgeons can easily apply to their patients in order to optimize the management of metastatic skeletal disease. For this reason, it is critical to identify both patients and skeletal lesions that are at increased risk of pathologic fracture. Prevention of pathologic fractures result in better patient outcome, lower cost, and less difficult operative procedures. Orthopedic surgeons who treat patients with metastatic skeletal lesions should focus on proactive treatments designed to prevent pathologic fractures before they occur. Pathologic fractures create a serious morbidity in patients with metastatic bone disease. Evaluation of the Risk of Pathologic Fractures Secondary to Metastatic Bone Disease
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