ORTHOPEDIC MANAGEMENT OF EXTREMITY AND PELVIC LESIONS

Bony metastases are ubiquitous in patients with advanced cancer, and p athologic fractures may occur within either lytic or blastic foci. App roximately 90% of such fractures that require surgical intervention oc cur in the femur, humerus, or periacetabular pelvis. Techniques for in ternal fixation or prosthetic replacement have been designed with the realization that destructive bony lysis often extends well proximal an d distal to the actual fracture site, and bony union will not occur af ter irradiation unless absolutely rigid fixation is achieved. Intramed ullary fixation using some type of interlocking device, either proxima lly or distally, is preferable to extramedullary fixation of fractures . The mean postfracture survival for most patients is approximately 2 years.