Table of Contents
ISRN Oncology
Volume 2012 (2012), Article ID 512389, 6 pages
http://dx.doi.org/10.5402/2012/512389
Clinical Study

Pathological Fracture of the Proximal Femur in Osteosarcoma: Need for Early Radical Surgery?

1Consultant Orthopaedic Surgeon, Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Prescot Street, Liverpool L7 8XP, UK
2Consultant Orthopaedic Oncologist, ROH Bone Tumour Service, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
3Department of Radiology, Royal Infirmary, Edinburgh EH16 4SA, UK
4Department of Emergency Medicine, George Elliot Hospital, Nuneaton CV1O 7DJ, UK

Received 5 December 2011; Accepted 11 January 2012

Academic Editors: N. A. Franken and A. H. Wolfson

Copyright © 2012 C. R. Chandrasekar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Seventeen patients underwent treatment for a pathological fracture of the proximal femur due to osteosarcoma. Their age range was from 9 to 84 (mean age 42) with nine patients under the age of 40 and eight above the age of 40. Twelve patients had a fracture at diagnosis and five developed a fracture after the diagnosis. Seven patients had metastatic disease at diagnosis. Five patients were referred after internal fixation of the fracture prior to diagnosis. Chemotherapy was used when appropriate and eight patients then underwent limb salvage surgery, six had an amputation, and three had palliative treatment. The estimated five-year survival was 14%. These results are significantly worse than expected, and it proved impossible to identify any group who fared well. The high incidence of metastases both at diagnosis and subsequently suggests this group of patients are at very high risk. Review of multicentre data may suggest an optimum treatment for this patient group.