PATHOLOGICAL FRACTURE OF THE FEMUR AS A PRESENTING FEATURE OF PRIMARY BONE TUMOUR

Abstract

Background:The study aimed to analyse the demographic, clinical, and histological features of patients with a malignant primary bone tumour of the femur presenting with a pathological fracture.

Methods: Eighty-six patients with primary malignant bone tumours of the femur presenting with pathological fracture were identified from a unique national database that contains original radiographs, casenotes and histology for all patients diagnosed with a primary bone tumour since september 1936 to the present. Demographic data, presenting features, tumour location, histological diagnosis, treatment, local recurrence, metastasis and survival data were gathered.

Results: The median age was 63 years (range 4 to 87 years) and 47% were men. Forty-two percent of patients presented with a history of trauma. Forty percent of lesions were in the proximal femur, 34% in the diaphysis and 26% in the distal femur. The most common histological diagnoses were osteosarcoma (13 patients), Paget’s sarcoma (12 patients), myeloma (11 patients), chondrosarcoma and lymphoma (9 patients each). Other diagnoses were fibrosarcoma, Ewing’s sarcoma, spindle cell sarcoma, reticulum cell sarcoma, malignant fibrous hystiocytoma, and malignant giant cell tumour. The local recurrence rate was 31%. The median survival was 12 months (95% confidence interval 6 to 18 months). Overall 5 and 10-year survival were 22.4% and 17.4% respectively. Specifically for osteosarcoma, chondrosarcoma and Paget’s sarcoma the five year survival rates were 15.4%, 11.1% and 19.0% respectively. Those in whom the age at the time of presentation was over 60 years had a significantly worse prognosis (log rank 13.4, p< 0.001).

Conclusion: Pathological fracture as a presenting symptom of primary malignant bone tumours is associated with a poor prognosis in nearly all tumour types studied. The prognosis is worse in those who are over 60 years at the time of presentation.