Features of routing, diagnosis and combined treatment of pathological fractures of long tubular bones of tumor etiology

Abstract

Introduction. In the structure of fractures of long tubular bones, pathological fractures account for about 1 %, and 2/3 of all cases are pathological fractures associated with bone metastases. Primary bone tumors are complicated by the development of a pathological fracture in 1– 10 % of cases, bone metastases in 8–30 % of cases. With a pathological fracture, as the primary manifestation of the tumor process, as a rule, patients come to the attention of orthopedic traumatologists providing emergency care. In the practice of oncologists, there are often patients with bone tumors who have performed deliberately non-radical surgical interventions associated with insufficient oncological alertness of traumatologists.Aim. To study and present the results of combined treatment of patients with bone tumors complicated by a pathological fracture.Materials and methods. The results of treatment and observation of 159 patients with tumors of long tubular bones complicated by a pathological fracture or the threat of its development, who received combined or surgical treatment and were observed in the polyclinic of the Republican Oncological Dispensary from 2008 to 2020, were analyzed.Results. A pathological fracture that has taken place, in the absence of somatic contraindications, is not a contraindication to neoadjuvant treatment, which allows performing organ-preserving surgical treatment with optimal local and systemic control. However, with verified bone metastases, when segmental bone resections are not shown, and the diagnosis of myeloma (solitary plasmocytoma) is established, it is permissible to perform surgery in a trauma hospital, after consulting an oncologist.Conclusion. The combined approach in the treatment of malignant bone tumors complicated by a pathological fracture makes it possible to perform a functional-saving, organ-preserving surgical intervention, significantly reducing the risk of tumor recurrence and systemic progression.