THE PITFALL OF INTERNAL FIXATION OF PRIMARY MALIGNANT TUMOURS OF THE FEMUR

Abstract

We present the management and outcome of patients who presented following internal fixation of primary malignant tumours of the femur.

This is a retrospective study of eleven patients. All underwent internal fixation of pathological or impending fractures of the femur in the assumption of metastatic disease, or prior to diagnosis of primary malignancy. Data was collected from database records and case notes.

The mean age was 47 years (range 13 – 73). Six patients were male and five female. Tumour type was osteosarcoma (3), MFH (3), chondrosarcoma (2), Ewing’s sarcoma (1), fibrosarcoma (1) and liposarcoma (1). The site of the lesion was proximal in six cases and distal in five. Nine patients presented initially with pathological fractures and two with lytic lesions. The mode of fixation was DHS (3), AO screws (1), antegrade IM nailing (2), retrograde IM nailing (3), Blade plate (1) and DCS fixation (1). No patients underwent biopsy prior to fixation. Surgical treatment at the Bone Tumour Unit was excision and segmental endoprosthetic replacement (5), total femoral replacement (2), hip disarticulation (2), above knee amputation (1) with one patient dying prior to surgery. Eight patients also received chemotherapy and three radiotherapy. Four patients had local recurrences, three presented with metastatic disease and five more went on to develop metastases. Two patients died within one year of initial surgery, three more within two years and none have so far survived five years. Three patients are still alive.

We believe that internal fixation of primary malignant tumours has a detrimental effect on limb salvage and survival, emphasising the absolute necessity of pre-operative investigation of solitary bone lesions.