Impending Fracture and Prophylactic Fixation

Question 1

If a biopsy of a lesion suggests a primary sarcoma what steps should be taken next?

Answer 1

Closure of wound and referral to orthopedic oncologist

Do not prophylactically fix bone; can contaminate entire bone and jeopardize limb salvage

Question 2

What factors are graded in Mirel’s criteria?

Answer 2

Pain- mild, moderate, severe
Size- 2/3 cortical involvement
Lesion- blastic, mixed, lytic
Location- UE, LE, peritrochanteric

> 8 suggest prophylactic fixation

Question 3

What is an alternative to prophylactic fixation in patients with a low Mirel’s score?

Answer 3

Radiation

Question 4

Following surgical fixation for impending fracture what is the next step?

Answer 4

Referral to radiation oncologist; can decrease pain, decrease tumor burden

Question 5

What is the most common site for boney metastasis?

Answer 5

Spine

Question 6

What is the most common site of pathologic fracture after metastasis?

Answer 6

Proximal femur