title: The role of internal fixation for long bone metastasis prior to impending fracture: an experimental model.
abstract: BACKGROUND
  Patients with long bone metastasis have many therapeutic options, including surgery. However, the appropriate time for surgical intervention and the use of internal fixation prior to impending fracture remains controversial. The purpose of this study was to establish a long bone metastatic model with internal fixation, and to determine whether prophylactic internal fixation for long bone metastasis prior to impending fracture would affect bone destruction, tumor progression, and mortality.
  
  
  METHODS
  We implanted VX2 tumor cells into the tibiae of 45 rabbits divided equally into three groups: internal fixation, control, and sham groups. Rabbits were monitored by X-ray and computed tomography, and blood serum levels were examined every 2 weeks.
  
  
  RESULTS
  Computed tomography data revealed significantly higher bone destruction in rabbit tibiae in the sham and control groups compared with those in the fixation group; there were volumetric bone losses of 0.2, 0.4, and 2.3% in the fixation, sham, and control groups, respectively, at 3 weeks, which increased to 1.2, 2.5, and 6.1% at 5 weeks. Rabbits in the fixation group showed significantly prolonged survival (64.5 ± 13.5 days) in comparison with rabbits in the sham group (50.3 ± 11.6 days) and control group (38.2 ± 4.9 days).
  
  
  CONCLUSIONS
  Our results suggest that prophylactic internal fixation may hinder bone destruction and tumor progression, thus extending the survival period for patients with long bone metastasis.
authors.affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Hidetomi
authors.initials: H
authors.lastname: Terai
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamada
authors.forename: Akinobu
authors.initials: A
authors.lastname: Suzuki
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Toyoda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000818:Animals; D001859:Bone Neoplasms / Q000150:complications* / Q000556:secondary*; D004195:Disease Models, Animal; D005260:Female; D005593:Fracture Fixation, Internal; D005598:Fractures, Spontaneous / Q000209:etiology* / Q000517:prevention & control*; D011817:Rabbits