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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2007 June;58(3):245-50
Surgical options for the treatment of tibial metastases
Muratori F. 1, Esposito M. 2, Rossi B. 2, Liuzza F. 2, Maccauro G. 2
1 First Orthopaedic Division San Pietro Hospital, Rome, Italy
2 Orthopaedic Department Catholic University, Rome, Italy
Aim. Tibial metastases are a rare event, the expression usually of more advanced illness. Mechanical and biological complications, of which pain constitutes a key symptom, are the most important risks for affected patients. Adjuvant treatments such as chemotherapy, radiotherapy, pain therapy, and therapy with diphosphonate are the treatment of choice in these metastases, while surgery is the effective treatment for impending and pathological fractures. The authors analyze the literature and consider their personal experience of 11 secondary tibia localizations surgically treated; they outline the diagnosis and particularly the different surgical options for these lesions.
Methods. Surgical options were different depending on different parameters, site, histology, visceral metastasis; plurimetastatic patients with metadiaphyseal lesions were treated with an intramedullary locked nail inserted in a static mode. The three locations of the proximal tibia were treated with emptying and filling with cement. In two distal locazations of the tibia, treatment was curettage and cement with pins; in the latter case the patient was afflicted by kidney cancer that at the beginning (2001) had developed a solitary diaphyseal localization treated with bone resection and reconstruction with diaphyseal spacer; one year later a distal metaphyseal location appeared, treated with resection of the distal metaepiphyseal of the tibia.
Results. All the patients reported pain relief, with a relevant reduction in analgesic drug use.
Conclusion. Surgical treatment must be wider when the lesion is solitary and the patient has a good prognosis, and less invasive when the prognosis is poor, but always guaranteeing the mechanical stability of the system.