Our aim was to assess the value of external fixation in pathological fractures in selected patients.

During 2003–2008 we treated 35 patients with multiple myeloma or disseminated cancer, visceral metastases and pathological fractures with external fixation under sedation and local anaesthetic, because they were not fit for general anaesthesia. We used external fixation on 1 hip fracture, 1 fracture of the second metatarsal, 2 wrist fractures, 4 radial, 5 intertrochanteric, 1 subtro-chanteric, 12 fractures of the humerus, 1 ulna fracture, 4 femoral fractures, 3 tibial fractures and 1 femoral osteolysis. Operating times were 15–35 min, all patients were comfortable, cooperated well and they did not experience any pain during the procedure. In all cases XRT was applied either pre- or post-operatively.

On follow up (2–48 months) 4 of the patients were deceased. Fracture stabilization was adequate and X-rays confirmed porosis in 4 fractures; however, two lesions expanded further, despite proper adjuvant bio-pharmaceutical therapy. 5 patients impoved so we could operate them later to treat the fractures definitively. All individuals experienced pain relief, they were adequately mobilized and most function was restored, while there was no major problem with pin tract infections.

We suggest external fixation as a palliative treatment in patients with pathological fractures and multiple metastases, who don’t qualify for major surgery because of their critical illness. The later puts under local offer an excelent chance to fix fractures quikly, manage the pain and restore function without the risks of general anaesthesia

We evaluated the use of unreamed expanding nails in prophylactic stabilization of impending fractures in patients with multiple bone mets.

During 2004–2008 we treated 25 impending fractures due to metastasis (11 male, 14 female patients) with so-called expanding intramedullary nails. All they had multiple bone mets and signs of impending fracture due to extensive osteolysis. We stabilized 6 impending humeral fractures, 15 femoral and 1 tibial with antegrade nailing and 3 pertrochanteric with cephalomedullary nailing. Fluoroscopy was used to check the nail entry-point. No medullary reaming was performed. The nails were not interlocked at the mid-shaft but fixed rather firmly within the medullary cavity after introducing normal saline under pressure that expands its walls. The operation time ranged from 12min (humerus) to 25min (pertrochanteric). No blood transfusion was necessary. On follow-up (8–41 mos) all patients were reviewed. In all cases the risk of impending fracture was remarkably decreased. The patients with humeral fractures regained function quickly. The patiens with lower limb fractures were mobilized immediately post-op and were allowed to walk with TWB.

Surgery of impending fractures of long bones in patients with multiple bone mets is palliative. It aims in safer patient’s mobilization, fracture risk reduction, pain control and function restoration in order to render the patient capable to continue the treatment for the main disease. The expanding nailing is indicated in selected cases as it can be inroduced quickly and effectively with minimal blood loss and morbidity.