Die metastasenbedingte pathologische Fraktur der langen Röhrenknochen

Between January 1st 1990 and December 31st 2000 112 patients with a mean age of 65.5 years (women 66.1 years, men 64.2 years) have been treated operatively in the Department of Traumatology at the Marienhospital in Stuttgart due to an impending or established pathological fracture of the long bones, conditional on metastatic lesions. The bone lesions were ascribed to metastases caused by breast cancer, bronchial carcinoma, carcinoma of kidney and prostatic carcinoma in 75% and to plasmocytoma in 8%,considered because of comparable procedures. Breast cancer was the commanding primary tumor in 49% of the cases. The gender ratio was almost 2:1 (women: men). The mean age of initial tumor diagnosis was 60.3 years for women an 63.0 years for men. In spite of a previous manifestation of the tumor women showed a longer survival rate and a higher age at death (66.8 years) compared to men (65.4 years), especially due to a slower progression of breast cancer. The spreading of bronchial carcinoma, primarily diagnosed in men, was rapidly progressive. These patients had a poor prognosis. 29% of all operations had been made at the upper limb. With the exception of two procedures, intramedullary nails and plates (metal-cement-complex) have been used. In comparison with plates intramedullary nails had a lower complication rate and it was a less invasive procedure. It is difficult to favour either procedure because both of them assured stability under exposure. Two thirds of all operations at the lower limb have been made at the proximal femur. In comparison with other methods metal-cement-complex osteosyntheses showed a higher rate of reosteosynthesis. The etiological cause was a worse initial situation with radical bone defects and a postoperative less stable result. Complications might be reduced by more generous indications of total hip replacement in the trochanteric part of the femur and intramedullary nails in the subtrochanteric part. Compared to other procedures it can be assumed that leaving metastatic tissue by intramedullary nailing does not reduce life expectation. Even though a resection of the metastatic tissue is advantageous in cases of macroscopic solitary metastases because of a significant longer survival time. By that patients can also be protected from the unpredictable effects of growth of metastatic tissue. Altogether the indications for operation were justified according to the ability for narcosis of the patient and not according to the estimated life time because the progression of the tumor disease could not be predicted. Cases of death during stationary stays were not caused by tumor disease or anaesthesia. A palliative treatment (including pain relief, conservation and recovery of functionality) could be achieved by surgery. The average postoperative survival time was 11.2 months.