title: Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone?: a meta-analysis.
abstract: We investigated whether the presence of a pathological fracture increased the risk of local recurrence in patients with a giant cell tumour (GCT) of bone. We also assessed if curettage is still an appropriate form of treatment in the presence of a pathological fracture. We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients with a GCT with and without a pathological fracture at presentation. We computed the odds ratio (OR) of local recurrence in those with and without a pathological fracture. We selected 19 eligible papers for final analysis. This included 3215 patients, of whom 580 (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients with and without a pathological fracture was 1.05 (95% confidence interval (CI) 0.66 to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75 to 2.01, p = 0.417). A post hoc sample size calculation showed adequate power for both comparisons. There is no difference in local recurrence rates between patients who have a GCT of bone with and without a pathological fracture at the time of presentation. The presence of a pathological fracture should not preclude the decision to perform curettage as carefully selected patients who undergo curettage can have similar outcomes in terms of local recurrence to those without such a fracture.
authors.affiliation: National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: A A
authors.initials: AA
authors.lastname: Salunke
authors.affiliation: National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: X
authors.initials: X
authors.lastname: Chen
authors.affiliation: National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: J H
authors.initials: JH
authors.lastname: Tan
authors.affiliation: National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: G
authors.initials: G
authors.lastname: Singh
authors.affiliation: National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
authors.forename: B C
authors.initials: BC
authors.lastname: Tai
authors.affiliation: National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: L W
authors.initials: LW
authors.lastname: Khin
authors.affiliation: National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
authors.forename: M E
authors.initials: ME
authors.lastname: Puhaindran
mesh_terms: D001859:Bone Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D003475:Curettage; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology*; D018212:Giant Cell Tumor of Bone / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012307:Risk Factors
keywords: Adjuvant; Curettage; GCT; Giant cell tumour; Local recurrence; Pathologic fracture; Wide resection