Management of Metastatic Osseous Lesions of the Lower ExtremityStephen, David M.D., F.R.C.S.(C)Techniques in Orthopaedics: March 2004 - Volume 19 - Issue 1 - p 15-24 ARTICLES Buy Abstract Author InformationAuthors Bone is the third most common site of metastasis after the lung and liver. The possibility of a metastatic lesion should be suspected after a detailed history and physical examination. Pain is the most common clinical presentation in over 80% of patients. Investigations to confirm the diagnosis include plain radiographs, computed tomography, radionucleotide scans, and rarely magnetic resonance imaging. The goal is to identify those patients who are at high risk of progressing from an impending fracture to a pathologic fracture. Accepted guidelines for operative intervention include lesion >2.5 cm or more than 50% of the diameter of the bone, pertrochanteric lesions (including fractures of the lesser trochanter), and painful lesions that are refractory to radiotherapy. The general principles of surgical intervention include tumor removal, reconstruction (filling/bypass) of the resultant defect, and stabilization of the bone involved. Most commonly, a second-or third-generation intramedullary nail will be used for femoral stabilization and can be inserted without a fracture table. The major complications include implant failure, fat embolism, and perioperative hemorrhage. From the University of Toronto, Sunnybrook and Women's College Health Science Center, Toronto, Ontario, Canada. Address correspondence and reprint requests to David Stephen, MD, FRCS(C), University of Toronto, Sunnybrook and Women's College Health Science Center, Toronto, Ontario, Canada. E-mail: David.Stephen@sw.ca. © 2004 Lippincott Williams & Wilkins, Inc.