Functional outcome analysis of skeletal stabilization in pathological fractures: A short term prospective and retrospective study.

Sunil Kumar, K (2015) Functional outcome analysis of skeletal stabilization in pathological fractures: A short term prospective and retrospective study. Masters thesis, Madras Medical College, Chennai.


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BACKGROUND: Pathological fractures of the long bones are a common complication of metastatic disease caused by skeletal metastases and variety of primary malignant bone tumors. The incidence of the metastatic bone deposits by primary malignancies has been reported in up to 50% of the patients. Surgery is indicated for intractable pain, impending or established pathological fractures. However, the majority of studies are retrospective and do not evaluate the functional improvement. AIM OF THE STUDY: This study is to evaluate the functional outcome after skeletal stabilization of fractures in patients, who sustained pathological fractures secondary to skeletal metastases, also fractures which occur at the site of primary malignant bone tumors. PATIENTS & METHODS: We studied prospectively and retrospectively a consecutive series of patients with pathological fractures of the long bone and spine treated between 2012 and 2014. Preoperatively all patients had a bone scan or a skeletal survey to assess the integrity of the remaining skeleton, and to avoid fracture of occult bone metastasis and all patients underwent basic blood investigations to confirm skeletal metastasis like serum calcium, alkaline phosphatase, phosphorus, PSA, thyroid profile, urine BJP & serum protein electrophoeresis. And other radiological investigations like USG abdomen, CT chest and CT abdomen and pelvis. Surgical treatment consisted of intramedullary (IM) nailing in 4 patients, prostheses in 6 patients, plating in two patients, posterior stabilization in 4 patients, DCS in 2 patients and arthroplasty in 2 patients. Functional status was assessed with the 1987 and 1993 versions of the Musculoskeletal Tumor Society (MSTS) functional assessment forms. RESULTS: Our findings showed an increase in the bodily pain score at 6 weeks and 12 weeks postoperatively, which is consistent with better pain control. Significant improvement in post operative MSTS scores at 6 weeks, 3 months, 6 months and one year postoperatively which shows better functional outcome. Our study shows low incidence of postoperative complications, reduction of pain, improvement in the quality of life and early ambulation, which strongly support operative treatment of pathological fractures of long bones in patients with bone metastases. Better results can be achieved with team approach by orthopedician, oncologist, radiologist and physiotherapist. CONCLUSION: However, early improvement in functional status, better pain control, early ambulation and relatively much lesser complication rate, we strongly recommend surgical stabilization for pathological fractures. Better results can be achieved with team approach including orthopaedic surgeon, oncologist, radiologist and physiotherapist. The timing of the surgery is always of paramount importance in these patients. It solely depends up on the patients’ general condition, however should be done at the very first safe opportunity.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pathological fractures ; metastases ; skeletal stabilization ; bone tumors ; Malignancy ; custom prosthesis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 25 Sep 2017 01:02
Last Modified: 25 Sep 2017 01:02

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