Metastatic Bone Disease: Forearm and Hand

Acrometastasis is a rare manifestation of carcinomatous dissemination, on the order of 0.1% of metastases. It is associated with a poor prognosis and is usually seen in late-stage disease. Treatment is directed at palliation of pain and preservation of function except in the setting of solitary metastasis or oligometastatic disease. Nonoperative treatment of symptomatic metastasis in this region is associated with a poor outcome. In the radius and ulna, most lesions can be managed surgically with plate stabilization augmented with the application of methyl methacrylate followed by radiation therapy. In the carpus, curettage and cementation followed by radiation have been used successfully. In the hand, most symptomatic lesions are managed with ablative surgery, and with the exception of proximal thumb amputations, these are associated with reasonably good functional outcome.