Abstract
To assess the referral system and the clinical notes and radiographs of patients presenting with metastatic disease of long bones.
All oncology consultants and registrars received a questionnaire regarding referral to the orthopaedic department for metastatic disease of the appendicular skeleton.
Ninety three percent of oncologists did not use a reliable scoring system to assess risk of pathological fracture. The majority of oncologists referred with regards to degree of cortical erosion and increased pain on weight-bearing. Sixty percent felt an improvement in communication between the departments was required.
The notes and radiographs were reviewed of twentyfive patients presenting with femoral metastatic lesions to the oncology department.
Mirels scoring system was then applied to each patient to assess the risk of the possibility of a pathological fracture.
Ten patients had a Mirels score of greater than eight. Three patients were referred for an Orthopaedic opinion regarding prophylactic fixation. Two patients had no fracture of the femur after three months. Five patients had a pathological fracture within three months, resulting in an emergency admission for surgery.
Three patients had a Mirels score of 8. One patient suffered a pathological fracture.
Twelve patients had a Mirels score of less than 8. None of these patients were referred for an Orthopaedic opinion. None of these patients had a pathological fracture within three months.
In conclusion, we presently do not offer a multidisciplinary approach to metastatic disease affecting the appendicular skeleton.
The majority of patients’ who score eight or above in the Mirels scoring system are at risk of fracture and do require prophylactic surgery.
In keeping with the BOA guidelines, “Metastatic Bone Disease: A Guide to Good Practice”, we would recommend the introduction of a multidisciplinary approach and the use of a recognised scoring system to improve patient care.
The abstracts were prepared by Mrs Leslie O’Leary. Correspondence should be addressed to her at British Orthopaedic Association, 35–43 Lincoln’s Inn Fields, London WC2A 3PE or at l.oleary@boa.ac.uk
