title: Metastatic disease of the long bones: a review of the health care burden in a major trauma centre.
abstract: BACKGROUND
  More than 140,000 new cases of cancer are diagnosed annually in Canada, nearly half of which metastasize to bone. The implications for orthopedic oncology services are potentially huge. We reviewed the experience in a major Canadian orthopedic trauma centre treating long bone metastases. The primary aim was to quantify the caseload, and the secondary aim was to report on the methods of fixation.
  
  
  METHODS
  We conducted a retrospective review of all patients treated for pathologic lesions or fracture secondary to metastatic disease over a 20-year period from July 1987 to March 2007.
  
  
  RESULTS
  The mean number of cases treated annually was 13. Most patients came from the local oncology centre. The median length of stay in hospital was 11 days. In-hospital mortality was 14%. The fatal pulmonary embolus rate was 5% for femoral lesions. The revision rate for the operative intervention was 3%.
  
  
  CONCLUSIONS
  The caseload was much lower than anticipated, likely owing to under-referring from oncology services. The high mortality rate may reflect delay in seeking orthopedic opinion, but overall the fixation methods appeared durable.
authors.affiliation: Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, Vancouver, BC. mbkelly37@hotmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Kelly
authors.forename: Mitchell
authors.initials: M
authors.lastname: Lee
authors.forename: Paul
authors.initials: P
authors.lastname: Clarkson
authors.forename: Peter J
authors.initials: PJ
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000191:economics / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D001955:British Columbia / Q000453:epidemiology; D019090:Case Management / Q000706:statistics & numerical data; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005269:Femur / Q000473:pathology / Q000601:surgery; D005592:Fracture Fixation / Q000191:economics* / Q000379:methods; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011884:Radius / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013977:Tibia / Q000473:pathology / Q000601:surgery; D014193:Trauma Centers / Q000191:economics / Q000706:statistics & numerical data*; D014457:Ulna / Q000473:pathology / Q000601:surgery; D016526:Workload / Q000706:statistics & numerical data