Abstract
Seventeen patients underwent treatment for a pathological fracture of the proximal femur due to osteosarcoma. Their age range was from 9 to 84 (mean age 42) with nine patients under the age of 40 and eight above the age of 40. Twelve patients had a fracture at diagnosis and five developed a fracture after the diagnosis. Seven patients had metastatic disease at diagnosis. Five patients were referred after internal fixation of the fracture prior to diagnosis. Chemotherapy was used when appropriate and eight patients then underwent limb salvage surgery, six had an amputation, and three had palliative treatment. The estimated five-year survival was 14%. These results are significantly worse than expected, and it proved impossible to identify any group who fared well. The high incidence of metastases both at diagnosis and subsequently suggests this group of patients are at very high risk. Review of multicentre data may suggest an optimum treatment for this patient group.
Highlights
Osteosarcoma is the commonest primary bone sarcoma arising with an incidence of approximately 3 per million population/year [8]. 70% of all osteosarcomas will arise around the knee, but 5-6% arise in the proximal femur
Between 1978 and 2008, seventeen patients had a pathological fracture of the proximal femur due to osteosarcoma
We have identified a group of patients with osteosarcoma who appear to have a very poor prognosis
Summary
Osteosarcoma is the commonest primary bone sarcoma arising with an incidence of approximately 3 per million population/year [8]. 70% of all osteosarcomas will arise around the knee, but 5-6% arise in the proximal femur. The incidence of pathological fracture in osteosarcoma is from 5% to 12%. There are many reports on osteosarcoma and pathological fracture, [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] most of these reports only dealing with patients without metastases at diagnosis. Progressive loss of bone matrix, biopsy, and minor trauma are some of the reasons for the occurrence of a pathological fracture. The presence of a pathological fracture has been noted to be an adverse prognostic factor in osteosarcoma by some authors [9] but not by others [3, 5]
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