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Contemporary Management of Appendicular Skeletal Metastasis by Primary Tumor Type

Johnson, Christopher N., DO; Gurich, Richard W. Jr, MD; Pavey, Gabriel J., MD; Thompson, Matthew J., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 15, 2019 - Volume 27 - Issue 10 - p 345–355
doi: 10.5435/JAAOS-D-17-00749
Review Article

Skeletal metastases exert a profound effect on patients and society, and will be encountered by most orthopedic surgeons. Once a primary malignancy is diagnosed, multidisciplinary management should focus on maximizing the quality of life while minimizing disease- and treatment-related morbidity. This may be best achieved with discerning attention to the unique characteristics of primary cancer types, including pathologic fracture healing rates, longevity, and efficacy of adjuvant therapies. Some lesions may respond well to nonsurgical measures, whereas others may require surgery. A single surgical intervention should allow immediate unrestricted activity and outlive the patient. In certain scenarios, a therapeutic benefit may be provided by excision with a curative intent. In these scenarios, or when endoprosthetic reconstruction is necessary, patients may be best referred to an orthopedic oncologist.

From the Department of Orthopaedic Surgery, Parkview Cancer Institute, Fort Wayne, IN (Dr. Johnson), the Department of Orthopaedic Surgery, Greenville Health System, Greenville, SC (Dr. Gurich), the Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA (Dr. Pavey), and the Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA (Dr. Thompson).

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Johnson, Dr. Gurich, Dr. Pavey, and Dr. Thompson.

© 2019 by American Academy of Orthopaedic Surgeons
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