title: Prognostic factors in pathologic fractures secondary to metastatic tumors.
abstract: OBJECTIVE
  Pathological fractures caused by metastases sharply decrease the quality of life and increase mortality rates for patients with malignant neoplasias. Orthopedic advances in osteosynthesis and endoprosthesis have been beneficial in the prevention and treatment of such fractures. The objective of our study was to determine which prognostic factors for pathologic fractures treated in our Service were significant.
  
  
  METHODS
  This was a retrospective study enrolling 112 patients treated for pathologic fractures secondary to metastatic tumors between April 1994 and December 2004 in our Service. Patients were analyzed according to sex, age, bone metastasis site, visceral metastases, origin of primary tumor, treatment type, serum hemoglobin, and survival.
  
  
  RESULTS
  The most affected site was the femur (44%), the most frequent primary tumor was breast cancer (25%); the most frequently employed surgical treatment was unconventional endoprosthesis (66%). Sex, age, primary tumor, site affected, non-bone metastasis, and clinical versus surgical treatment variables were not good predictors for survival. The only significant predictor was the type of surgery employed. Patients who received an endoprosthesis presented a worse prognosis (21.6 months) than patients undergoing osteosynthesis (47.8 months).
  
  
  CONCLUSIONS
  Patients undergoing osteosynthesis, with a less morbid surgical technique and earlier rehabilitation, had longer survival times than patients who received endoprostheses. Our case series is similar to international ones, where the most frequent primary tumor is breast tumor, followed by tumors of undetermined origin, prostate, and lung tumors.
authors.affiliation: Department of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Douglas Kenji
authors.initials: DK
authors.lastname: Narazaki
authors.forename: Carlos Coelho
authors.initials: CC
authors.lastname: de Alverga Neto
authors.forename: André Mathias
authors.initials: AM
authors.lastname: Baptista
authors.forename: Marcelo Tadeu
authors.initials: MT
authors.lastname: Caiero
authors.forename: Olavo Pires
authors.initials: OP
authors.lastname: de Camargo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary*; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis