Abstract
Introduction A literature review, supplemented by a small personal series of fractures in osteosarcoma, treated with internal fixation is presented.
Methods In a cooperative effort of the Musculoskeletal Tumor Society (2), retrospective data was gathered on fifty-two patients with osteosarcoma who had a pathologic fracture and on fifty-five matched patients with osteosarcoma who had not had a pathologic fracture.
Results From the literature review. Abudu et al (1) reviewed the Birmingham experience in 40 patients with pathological fractures from localised osteosarcoma of the long bones to determine the outcome of limb salvage in their management. All had had adjuvant chemotherapy. The authors undertook limb salvage in 27 patients and amputation in 13. The margins of resection were radical in five patients, wide in 26, marginal in six, and contaminated in three cases. Local recurrence developed in 19% of those treated by limb salvage and in none of those who had an amputation. The cumulative five-year survival of all the patients was 57% and in those treated by limb salvage or amputation it was 64% and 47%, respectively (p > 0.05). The authors concluded that limb-sparing surgery with adequate margins of excision can be achieved in many patients with pathological fractures from primary osteosarcoma without compromising survival, but the risk of local recurrence is significant.
From our retrospective study. The five-year estimated survival rates were 55% for the group with a pathologic fracture and 77% for the group without a fracture (p = 0.02). Eleven (37%) of the 30 patients with a fracture who were managed with limb salvage and 10 (45%) of the 22 patients with a fracture who were managed with an amputation died of the disease (p = 0.50). The performance of a limb-salvage procedure in patients with pathologic fracture did not seem to significantly increase the risk of local recurrence or death.
Conclusions Factors predictive of improved outcome, such as the response to chemotherapy and union of the fracture, should be taken into account when limb salvage is being considered. The limited Toronto experience with fracture fixation prior to chemotherapy and limb salvage will be discussed.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
References
Abudu A., Sferopoulos N.K., Tillman R.M., Carter S.R., Grimer R.J.. The surgical treatment and outcome of pathological fractures in localised osteosarcoma. JBJS1996; 78B:694–8. Google Scholar
Scully S., Ghert M.A., Zurakowski D., et al in Representation of the Musculoskeletal Tumor Society. Pathologic Fracture in Osteosarcoma Prognostic Importance and Treatment Implications. JBJS200284A:49–57. Google Scholar
