title: The value of internal fixation and radiotherapy in the management of upper and lower limb bone metastases.
abstract: Fifty-four consecutive patients underwent 61 orthopaedic operations for metastatic bone disease affecting the upper and lower limbs. These patients were subsequently managed using a consistent postoperative radiotherapy (RT) policy. There were 27 prophylactic internal fixations and 34 internal fixations of pathological fractures. There was a marked difference in survival between these groups. The median postoperative survival of the prophylactic (P) group was 15 months whereas that of the fracture (F) group was 2 months (P less than 0.0001). Ninety-three per cent of the P group and 59% of the F group were able to be discharged home following treatment. Subsequent local fracture requiring further surgical intervention occurred in 11% of the P group and in none of the F group. Seventy-eight per cent of the P group and 62% of the F group did not suffer any further sequelae at the operation site until the time of death or last follow-up. Patient mobility following surgery and RT for metastatic lesions occurring in the lower limb was significantly improved in both the P group (P less than 0.05) and in the F group (P less than 0.0001) such that 91% and 58%, respectively, of these patients were subsequently able to walk.
authors.affiliation: Department of Clinical Oncology, Western General Hospital, Edinburgh, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Hardman
authors.forename: J E
authors.initials: JE
authors.lastname: Robb
authors.forename: G R
authors.initials: GR
authors.lastname: Kerr
authors.forename: A
authors.initials: A
authors.lastname: Rodger
authors.forename: A
authors.initials: A
authors.lastname: MacFarlane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D005121:Extremities; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D016268:Internal Fixators; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications; D015996:Survival Rate