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A Journal on Orthopedics and Traumatology

Official Journal of the Piedmontese-Ligurian-Lombard Society of Orthopedics and Traumatology
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Minerva Ortopedica e Traumatologica 2002 December;53(4):187-94

language: English

Pathologic fracture in osteosarcoma. A review

Dickey I. D., Scully S. P.


Pathologic fracture with a background diagnosis of osteosarcoma represents a challenging clinical problem. These fractures can occur at/or before diagnosis, or during induction chemotherapy. With an incidence ranging between 5% to 20%, these fractures most commonly occur in the proximal humerus, followed by the distal tibia, especially in the histological subtypes of telagiectatic and fibrous osteosarcoma. In the past, such a clinical situation would warrant immediate amputation to avoid the theoretical complications associated with fracture hematoma and subsequent soft tissue contamination. Recently however, in the era of improved chemotherapy, with the ongoing interest in limb salvage, several authors have questioned this traditional approach. Alternatively, fracture immobilization and induction chemotherapy is employed, with the potential for limb salvage if there is an identifiable response to chemotherapy. In the absence of a response and/or fracture healing, amputation can be performed while still gaining information about primary tumor and response to chemotherapy. Early results have shown that although local recurrence and long term survival is poorer as a group as compared to patients without fracture, in patients with good tumor response to chemotherapy and fracture healing, limb salvage and its outcome may not be significantly different as compared to an amputation. This article provides a review of the published literature relevant to this topic.

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