Prognostic factors following pathological fractures

BackgroundPathological fractures are a significant and often devastating event in the progression of metastatic bone disease. They are frequently a marker of end-stage cancer and the end of functional independence. Although several studies look into prognosis following the development of metastatic lesions, few look into the prognosis after the fracture itself. This study investigates the variables affecting prognosis in patients suffering pathological fractures. MethodRetrospective clinical audit of 72 patients from the Orthopaedic Unit at Fremantle Hospital in Western Australia. The variables of interest include primary cancer, fracture site, method of fixation, use of cement augmentation, appendicular metastatic load, spinal metastatic load, presence of visceral metastases, patient co-morbidities and functional scoring before and after the fracture has occurred. ResultsThe median time between diagnosis of cancer to pathological fracture was 8.3 months, while the median survival post-fracture was 3.3 months. There is a statistically significant correlation between patient survival and primary cancer type, spinal metastatic burden and functional performance score. ConclusionOverall, the prognosis following pathological fracture is extremely poor. We propose that these variables are scrutinized by the treating orthopaedic team preoperatively to help guide management and provide patients and their families with a realistic expectation of functional outcome and survival time.