Metastatic Disease of the Extremities

Bone is one of the most common sites of metastasis, along with the lungs and liver. Treatment of skeletal metastases is most often nonsurgical, but when surgery is needed, it varies from simple nailing to excessive resections and reconstructions with prostheses. Metastases can occur in any bone in the body, but more often in extremities and usually causing pathologic fractures in proximal femur, pelvis, and diaphysis of the humerus. The treatment of skeletal metastases is aimed at palliation of symptoms. Pharmacological therapies are the foundation of cancer pain management. Radiation therapy also plays an important role in the treatment of skeletal metastases. The proximal femur is one of the most common sites for pathological fracture treatment. The neck of the femur is most uniformly treated with endoprostheses. The trochanteric area is also more commonly treated with an endoprosthetic solution since biological healing is impaired in the pathologic bone. In nonweight-bearing extremities like the humerus, the method of choice for surgical treatment of diaphyseal pathologic fractures, according to the literature, does not seem to play an important role. Pelvis is a very common site for skeletal metastases. Fractures can occur anywhere in pelvis, but most vulnerable area is periacetabulum where high mechanical forces stress hip joint. Treatment of skeletal metastases is most often nonsurgical, but when surgery is needed, it varies from simple nailing to excessive resections and reconstructions with prostheses. Surgical treatment is not without risk, and reconstruction survival should be longer than patient survival.