SURGICAL TREATMENT AND RISK PREDICTION OF PATHOLOGICAL FRACTURES WITH MIREL'S SCORE DUE TO METASTASES OF THE APPENDICULAR SKELETON
Keywords:
Bone metastases, pathological fracture, Mirels scoreAbstract
Metastases of the appendicular skeleton are the most common neoplastic process that affects the locomotor system. According to their incidence, the most common are metastases from breast, lung, kidney, thyroid gland and prostate cancer. The type of surgical intervention in patients may influence the overall survival of patients given the growing concept of oligometastases.
Purpose: The aim of the paper is to show the frequency of pathological fracture in patients with metastases of the appendicular skeleton and the performed optimal surgical treatment, according to the stage and expected survival.
Materials and methods: The study was conducted at the University Clinic for Orthopedic Diseases in the period between 2019-2022. It is of a retro-prospective nature. The study included 74 patients with metastases to the appendicular skeleton from primary cancers of the breast, lung, prostate, and thyroid gland. The obtained data were systematized and a statistical analysis was made.
Results: According to the results of the research, breast cancer metastases are the most common, followed by lung cancer metastases. The most frequently affected region is the proximal femur, patients underwent osteosynthesis with a dynamic compression plate (DHS) and an intramedullary wedge (Intertan) respectively. In each of the patients, diagnostic investigations were performed according to the protocol: X-ray, CT, skeletal scan with tc99m. After determining the stage of the disease, patients were appropriately treated surgically, after which most were referred for adjuvant chemotherapy and palliative radiotherapy.
Conclusion: The occurrence of a pathologic fracture is a catastrophic complication for most oncology patients. A clear understanding of the life expectancy of patients with bone metastases is of great help to prevent treatment errors and failures.
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