Endoprosthetic treatment of primary bone sarcomas with pathological fractures

Abstract

BACKGROUND: Primary bone sarcomas that are associated with a pathological fracture are rare and as a group have a worse prognosis than their non-fractured counterparts. QUESTIONS/PURPOSES: Traditionally limb ablation was advised; however, recent evidence suggests that limb salvage is a safe and acceptable form of treatment for both surgeon and patient. PATIENTS AND METHODS: We present a retrospective review of a series of six patients referred to our unit with pathological fractures. These were treated by initial traction and neo-adjuvant chemotherapy where indicated with subsequent resection and endoprosthetic replacement. RESULTS: The age range of our series is from 20 to 81 years, with four males and two females. All had distal femur involvement with a 60% incidence of osteosarcoma and 40% chondrosarcoma. Three patients required total femur resection due to extensive tumour involvement. Our results show 100% of patients had clear margins at postoperative histology. Due to the aggressive nature of these types of tumours they carry a worse long-term prognosis and as such we had three deaths in our series. One patient died of a myocardial infarction post-operatively, and two patients developed lung metastases and died 2 years later. CONCLUSION: Our conclusion is that with careful planning, a safe margin can be achieved. Endoprosthetic replacement allows for rapid reconstruction and mobilisation in this group of patients facilitating further oncological management.