Metastatic Disease
A 65-year-old woman with known breast cancer presents with progressive right thigh pain over 3 weeks. She describes pain at rest and at night, requiring opioid analgesia. Plain radiographs show a 4cm lytic lesion in the proximal femoral diaphysis with cortical destruction involving over 50% of the circumference. The Mirels score is calculated at 9. Staging CT shows multiple bone metastases but no visceral metastases. Her oncologist has her on hormonal therapy and bisphosphonates. The orthopaedic oncologist discusses the risk of pathological fracture, indications for prophylactic fixation, and surgical principles. Regarding metastatic bone disease and pathological fractures:
Mark each as TRUE or FALSE
Bone is the THIRD most common site of metastatic disease (after lung and liver); the most common pri...
LYTIC lesions (bone destruction) are most common with breast, lung, thyroid, kidney, and multiple my...
The upper limb is the most common skeletal metastasis site; BLASTIC lesions have the HIGHEST fractur...
The MIRELS SCORE predicts pathological fracture risk in long bones (1-3 points each): SITE (upper li...
Surgical principles: PROPHYLACTIC fixation before fracture has better outcomes; INTRAMEDULLARY NAILI...
Answer the questions to see explanations
Click T (True) or F (False) for each option