This 2014 JAAOS review covers the diagnostic workup and operative decision-making for metastatic long bone fractures, addressing how the abnormal healing environment of pathologic bone changes fixation strategy across the humerus, femur, and tibia.
When you see a lytic metastatic lesion in a long bone, calculate the Mirels score before deciding between observation, radiation, and prophylactic fixation — and remember that mechanical pain almost always signals an impending fracture regardless of the score.
For any pathologic fracture repair, plan to augment with PMMA cement and span the entire bone with your implant; short constructs and unaugmented fixation fail predictably in this population.
This 2014 JAAOS review covers the diagnostic workup and operative decision-making for metastatic long bone fractures, addressing how the abnormal healing environment of pathologic bone changes fixation strategy across the humerus, femur, and tibia.
When you see a lytic metastatic lesion in a long bone, calculate the Mirels score before deciding between observation, radiation, and prophylactic fixation — and remember that mechanical pain almost always signals an impending fracture regardless of the score.
For any pathologic fracture repair, plan to augment with PMMA cement and span the entire bone with your implant; short constructs and unaugmented fixation fail predictably in this population.