Use of locking plates in the fixation of pathologic fractures or impending pathologic fractures due to bone metastasis: A preliminary study [Utilizzo di placche di bloccaggio nella fissazione di fratture patologiche accertate o prevedibili dovute a metastasi ossee: Studio preliminare]

Abstract

Aims: Pathologic fractures are typically more complicated to treat than traumatic fractures because of the need for extensive reconstruction Locking compression plates facilitate superior fixation of many different types of fractures compared with standard fixation. Several reports have been published concerning the use of locking plates for the fixation of pathologic fractures caused by (predominately) primary bone sarcomas. We report our preliminary experience using locking plates for treating pathologic fractures and impending pathologic fractures secondary to bone metastasis.Methods: Ten patients (4 males, 6 females; mean age = 65.5 ± 14.7 years) with 11 pathological fractures (n = 6) or impending pathological fractures (n = 4) due to bone metastasis underwent tumour resection and fixation with locking plates. Fixation was performed on the distal femur (n = 7), and proximal humerus (n = 4). Breast cancer and colorectal cancer were the most common primary cancer (8/11: 72.7%). Mean follow-up was 26.3 ± 4.7 months. Results: Nine constructs (82%) were intact at the time of last follow-up. Two patients required a second surgical procedure, one of which was implant- related. Implant failure occurred in 2 cases; 1 because of plate breakage and the other one because of screw pull out. The cases of implant failure were successfully treated conservatively and with repeat fixation. Conclusions: In this preliminary study, we found that use of locking plates for fixation of pathologic fractures and impending pathologic fracture due to bone metastasis was associated with a low rate of implant failure. Further studies, including a larger number of patients, are needed to determine whether locking plates are effective for fixing pathological fractures and impending pathological fractures secondary to bone metastasis. ? Mattioli 1885.