Dr. University of California, San Diego La Jolla, California, United States
Objective: Primary bone sarcomas are rare and account for approximately 0.2% of registered malignancies. The occurrence of pathologic fractures in these sarcomas ranges from 5% to 15%, presenting a treatment challenge due to an increased risk of tissue contamination and need for stabilization while undergoing systemic therapy. Approaches to temporizing pathologic fractures of bone sarcomas of the hip have not been standardized. We describe a surgical option that may be used in stabilizing these fractures prior to definitive resection and reconstruction.
Methods: This is a single institution report reviews the use of a novel temporization technique of pathologic fractures in two patients (both male, aged 18 and 63) with osteosarcoma and chondrosarcoma of the proximal femur, respectively. Both patients underwent internal fixation with the Femoral Neck System (Synthes) combined with fluoroscopic-guided cement augmentation. Both patients underwent subsequent limb salvage with proximal femoral replacement.
Results: Both surgeries were completed without complications, and there was no evidence of hardware complications, failures, or local recurrence 1 year post operatively. The 18-year-old male patient progressed to limb salvage surgery 68 days after the temporization of the pathologic fracture and completion of neoadjuvant chemotherapy. The 63-year-old male patient was temporized at the same time as biopsy and returned for definitive resection after the diagnosis was confirmed.
Conclusion: Treatment considerations for pathologic hip fractures due to sarcoma are complex. Surgeons need a variety of techniques at their disposal for optimal patient outcomes. Treatment strategy will differ based on the details of each case, the patient and tumor characteristics, and the preference of each surgeon. Amputation remains a good option for some patients. We show here that cement-augmented internal fixation can be a viable temporizing measure for pathologic fractures in primary bone sarcomas. This technique provides palliative stabilization to allow time for additional workup, patient optimization, or neoadjuvant chemotherapy.
