Surgical treatment for metastatic pathological fractures

Pathological fractures of the long bones occur in 10-29% of patients with bone metastases. Following biopsy, stabilization of the fracture and oncological treatment (limb salvage or amputation, and adjuvants) should be performed. Concern should be given to the initial displacement, stability and location of the pathological fracture. Initial temporary stabilization can be performed with a brace or cast, or external fixation. Prognosis is better in patients with solitary bone metastasis, pathological fractures of the upper limb, and a longer median postoperative survival for patients with pathological fractures secondary to breast cancer compared with other types of primary tumors. The long survival after surgery is the most important risk factor for failure of the reconstruction or osteosynthesis of the pathological fracture secondary to disease progression, implant failure or loss of fixation.