Comparative analysis of risk factors for pathological fracture with femoral metastases.

Autor: Van der Linden YM; Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands., Dijkstra PD, Kroon HM, Lok JJ, Noordijk EM, Leer JW, Marijnen CA
Jazyk: angličtina
Zdroj: The Journal of bone and joint surgery. British volume [J Bone Joint Surg Br] 2004 May; Vol. 86 (4), pp. 566-73.
Abstrakt: A number of risk factors based upon mostly retrospective surgical data, have been formulated in order to identify impending pathological fractures of the femur from low-risk metastases. We have followed up patients taking part in a randomised trial of radiotherapy, prospectively, in order to determine if these factors were effective in predicting fractures. In 102 patients with 110 femoral lesions, 14 fractures occurred during follow-up. The risk factors studied were increasing pain, the size of the lesion, radiographic appearance, localisation, transverse/axial/circumferential involvement of the cortex and the scoring system of Mirels. Only axial cortical involvement >30 mm (p = 0.01), and circumferential cortical involvement >50% (p = 0.03) were predictive of fracture. Mirels' scoring system was insufficiently specific to predict a fracture (p = 0.36). Our results indicate that most conventional risk factors overestimate the actual occurrence of pathological fractures of the femur. The risk factor of axial cortical involvement provides a simple, objective tool in order to decide which treatment is appropriate.
Databáze: MEDLINE