Abstract
Introduction: Current guidelines from the British Orthopaedic Oncology Society indicate that the role of the orthopaedic surgeon in the management of the meta-static bone disease (MBD) of the long bones falls into two principal categories; prophylactic fixation of meta-static deposits at risk of fracture and stabilisation following pathological fractures. Bone biopsy and MRI scan is advocated if the primary tumour is not identified.
Aim: The aim of this study is to audit at the current practice in the South Trent region.
Method: A postal questionnaire with three case scenarios was sent to all orthopaedic consultants and SpR’s in the South Trent region. They were asked how they would manage a patient with a fracture and; a single bone metastasis and a known primary tumour, a single bone metastasis and an unknown primary tumour, and multiple metastases of unknown origin.
Results: 80 % of the questionnaires were completed and returned. In the presence of a known primary tumour and a single metastasis, 75 % would send intra-medullary reamings for histology at the time of fixation. In the presence of a single metastasis and an unknown primary tumour, 38 % would perform a biopsy prior to fracture fixation. In the event of multiple metastases with an unknown primary, 15 % would perform a biopsy.
Conclusion: There is a lack of consensus among the orthopaedic surgeons sampled about the management of the MBD. Intramedullary reamings sent during fixation have a high rate of false negative results but are still preferred by many surgeons to aid diagnosis in MBD. Thorough clinical and radiological assessments are probably more useful in the diagnosis of the primary tumour.
The abstracts were prepared by Mr Roger Tillman. Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
