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Management of Metastatic Disease in Long Bones

Summary: Patients commonly present to orthopaedic surgeons with suspicious and low-energy mechanisms of injury for long-bone fractures. Most tumor-related pathologic fractures in patients older than 40 years are due to metastatic disease. Although rare, the treating surgeon should always consider the possibility of a primary bone tumor. Obtaining a tissue sample is a required early step in the surgical process following the principles of biopsy tract selection. An adequate tissue biopsy is also necessary for the diagnosis of a primary source of metastatic disease if otherwise unknown. These patients often require adjuncts to surgery, including bisphosphonate treatment, anticoagulation, radiation therapy, chemotherapy, and follow-up with multiple medical specialists for continuing care. The surgical treatment plan is based on the location of the fracture, and various options are available depending on whether the metastatic disease is present in the diaphysis, metaphysis, or epiphysis of long bones. The orthopaedic surgeon should have a working knowledge of proper identification and treatment principles of metastatic disease in long bones to properly assist in patient care delivery. Level of Evidence: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.