Pathological fractures in primary bone sarcomas: A review article

The treatment of pathological fractures in malignant primary bone sarcomas remains a question open for debate. They constitute 5 %–10 % of patients diagnosed with malignant primary bone sarcomas. This article reviews the latest available literature on the management of pathological fractures in patients with bone sarcomas. The options for temporary fracture treatment during chemotherapy include closed immobilization (skin traction, plaster cast, orthosis), internal fixation and external fixation and none of the options show increased risk of local recurrence. The widely accepted chemotherapy guidelines are those described by the National Comprehensive Cancer Network and the European Society for Medical Oncology, European Reference Network for Paediatric Cancers, and European Network for Rare Adult Solid Cancer. Definitive surgery must be cognizant of 4 factors: i) the objective of the surgery as guided by the overall treatment principle i.e. curative or palliative; ii) the available resources and facilities; iii) patient values and physiologic status; iv) surgeon's expertise. Limb salvage is a safe and viable option for pathological fractures however, patients with pathological fractures have a worse overall survival rate.