Bone Diaphysis Metastases, the Ways and Results of Surgical Treatment Saving the Joints.

BACKGROUND

A consequence of the progress in oncological treatment is an increasing number of bone complications asso-ciated with metastases. With appropriate choice of oncological treatment and appropriate surgical management, patients may recover their physical function and maintain the previous level of quality of life. Available surgical techniques include intrame-dullary nailing, stabilisation with plates and screws and the use of modular prostheses.

AIM OF THE STUDY: to retrospectively assess the techniques and outcomes of surgical treatment of long bone metastases at the Oncology Orthopaedics Department of the Speciality Hospital in Brzozów, present the possibilities of surgical management and benefits of the chosen method and tentatively choose the most effective approach for restoring function.

MATERIAL AND

METHODS

Between 2013 and 2017, a total of 82 patients were treated for long bone metastases at the Depart-ment of Oncological Orthopaedics. The most common cancers causing bone metastases were breast cancer (37%), myeloma (16%), lung cancer (8%), kidney (15%), prostate (8%), thyroid 4%, colon 1%, uterus 1%, with other sites accounting for 10%. Pathological fractures were diagnosed in 68 patients. Before the surgical treatment, the patients' quality of life was assessed using the Karnofsky scale, Bollen prognostic scale, severity of pain in a VAS scale, and MSTS performance scale. Metastasis morpho-logy was evaluated with conventional radiographs, CT and PET-CT. Types of surgery comprised intramedullary nailing, the use of plates and screws and the placement of modular prostheses. Patients were divided into three groups with regard to the stabi-li-sation systems used and another three related to tumour location (humerus, femur or tibia).

RESULTS

Post-operatively, there was a reduction of pain in the VAS scale. Function (MSTS) was best in patients treated with minimally invasive methods and modular prostheses (p <0.05). An improvement in quality of life in the Karnofsky scale was also noted. The complication rate was 7% and was related to wound healing and thromboembolic complications.

CONCLUSIONS

1. Patients with long-bone cancer metastases with pathological fractures or risk of fracture require surgical management. 2. Nailing or modular prosthesis produced the best functional result at 6 weeks post-operatively. 3. All methods of surgical treatment reduced pain and improved the quality of life.