J Korean Orthop Assoc.  2016 Jun;51(3):183-190. 10.4055/jkoa.2016.51.3.183.

The Use of Locking Compression Plate for Stabilization of Existing and Impending Pathologic Fractures at Long Bones with Metastatic Cancer

• Jo AR
• Jung ST
• Chung YW
• Lee YM

• KMID: 2308578
• DOI: http://doi.org/10.4055/jkoa.2016.51.3.183

Abstract

PURPOSE
The purpose of this study is to evaluate the results and the advantages of the operative treatment of metastatic pathologic fractures in long bones using locking compression plates.
MATERIALS AND METHODS
Twenty-five patients (28 cases) who underwent open reduction and internal fixation with a locking compression plate with or without cement augmentation for pathologic fractures in long bones resulting from metastatic cancer between 2004 and 2013 were reviewed retrospectively. Mean age at the time of surgery was 62.8 years. Pathologic fractures occurred in 11 cases in the humerus, 11 cases in the femur, and 6 cases in the tibia. Functional analysis of Musculoskeletal Tumor Society (MSTS) scores, functional restoration condition of patients with upper extremity involvements, and interval to wheelchair ambulation in patients with lower extremity involvements was performed. Pain relief (visual analogue scale, VAS) and operation time, postoperative satisfaction with individuals, and complications were evaluated.
RESULTS
Mean operation time was 81.3 minutes and mean MSTS scores were 19.8. Mean time from operation to wheelchair ambulation was 3.3 days. Mean VAS improved from 8.1 preoperatively to 2.9 at 1 week postoperatively. Most patients reported that they were more than 'satisfied' One transient radial nerve palsy and one late complication of screw breakage and reduction loss had occurred at postoperative 3 months.
CONCLUSION
Internal fixation with a locking compression plate in metastatic pathologic fractures can be an effective treatment option in the meta or diaphyseal area of long bones.

Keyword

metastatic pathologic fractures; metastatic impeding fractures; locking compression plate

MeSH Terms

Femur
Fractures, Spontaneous*
Humans
Humerus
Lower Extremity
Paralysis
Radial Nerve
Retrospective Studies
Tibia
Upper Extremity
Walking
Wheelchairs

Figure

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  Figure 1 Patients' survival during follow-up.

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  Figure 2 A 42-year-old male with metastatic lung cancer. (A) Preoperative plain radiograph of the right distal femur shows a pathologic fracture with an osteolytic lesion. (B) The distal femur pathologic fracture was stabilized by locking compression plate with cement augmentation. (C) Plain radiograph shows loss of reduction and failure of the internal fixation after postoperative 3 months. (D) Revision of the screws with breakage was performed with additional anterior plate fixation.

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  Figure 3 A 70-year-old male with multiple myeloma. (A) Preoperative plain radiograph of the right proximal humerus shows an osteolytic lesion with impending fracture. (B) Coronal T2 weighted image magnetive resonance imaging shows high signal intensity with heterogeneous enhancement. (C) Prophylactic internal fixation was performed with a locking compression plate and bone cement augmentation.

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