Foundations⎪Pathology⎪Metastatic Disease of Extremity
Apr 8, 2025
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The discussion dives into the complexities of metastatic disease in the extremities, revealing how prevalent it is among cancer patients. With insights on diagnosing and treatment approaches, it highlights critical radiographic findings and fracture risk assessment. The surgical management section explores addressing unstable bones, emphasizing the urgency for stability. It outlines factors that can lead to surgical failure and underlines the vital role that surgery plays in treating these pathological fractures.
Accurate diagnosis of metastatic disease in extremities requires comprehensive imaging and history-taking to identify primary cancers effectively.
Treatment options for metastatic bone lesions range from non-operative therapies to surgical interventions based on the fracture's severity and patient health.
Deep dives
Overview of Metastatic Disease in Extremities
Metastatic disease in extremities represents the most prevalent cause of destructive bone lesions in adults, emphasizing the need for accurate diagnosis and management. The workup process typically includes a thorough history, physical examination, radiographs, and CT scans of the chest, abdomen, and pelvis to identify primary tumors, which can be confirmed in approximately 85% of cases. Commonly affected areas include the spine, pelvis, proximal femur, and humerus, with the proximal femur being a frequent site for pathologic fractures. Identifying underlying carcinomas, such as those from the breast, lung, or prostate, is crucial as the presentation may involve significant symptoms like night pain, weight loss, and difficulty weight-bearing.
Imaging and Assessment Techniques
Effective imaging techniques are pivotal for evaluating suspected metastatic lesions, with initial assessments typically starting with plain radiographs in multiple planes of the affected limb. The presence of lytic, mixed, or blastic lesions can be indicative of various primary cancers, guiding further diagnostic actions. For patients over 40, chest, abdomen, and pelvis CTs are recommended to check for a primary tumor source when lesions are of unknown origin. It is essential to recognize specific imaging patterns that can point toward metastatic disease, particularly in patients with a history of malignancy.
Treatment Strategies for Metastatic Lesions
Treatment for metastatic bone lesions is multifaceted, often starting with non-operative options such as bisphosphonate therapy or radiation for those with asymptomatic or non-displaced fractures. However, surgical interventions become necessary for complete fractures or cases where pain persists despite conservative measures, as they allow for stabilization and improved quality of life. The selection of surgery, such as endoprosthetic fixation or intramedullary nailing, often depends on the patient’s life expectancy and overall health condition. Postoperative radiation is generally indicated to enhance recovery, and a comprehensive evaluation of fracture risk, utilizing scoring systems like Morell's criteria, is vital for deciding on prophylactic measures.
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Understanding Metastatic Disease of the Extremities
Today's show is Foundations, where we review foundational knowledge for frontline MSK providers such as junior orthopaedic residents, ER physicians, and primary care providers.
This episode will cover the topic of Metastatic Disease of Extremity, from our Pathology section at Orthobullets.com.
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