The Journal of Hip Surgery 2019; 03(02): 093-103
DOI: 10.1055/s-0039-1681080
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Pathologic Fractures Around the Hip: Part 1–Femur

Richard L. Auran
1   Department of Orthopaedic Surgery, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona
,
Michael D. Duran
1   Department of Orthopaedic Surgery, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona
,
Amalia M. de Comas
1   Department of Orthopaedic Surgery, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona
2   Department of Musculoskeletal Oncology, The CORE Institute, Phoenix, Arizona
,
David J. Jacofsky
2   Department of Musculoskeletal Oncology, The CORE Institute, Phoenix, Arizona
› Author Affiliations
Further Information

Publication History

21 January 2019

28 January 2019

Publication Date:
08 March 2019 (online)

Abstract

Evaluation and management of suspected pathologic fractures, secondary to metastatic disease, require a comprehensive understanding of the underlying disease process and a multidisciplinary treatment approach. Recognition of a pathologic fracture can be challenging, and the diagnosis today remains often missed, but is necessary for appropriate care. The incidence of cancer in the United States is on the rise, and with advances in medical and surgical care the prevalence of cancer is increasing as well. This will result in a similar trend of increased incidence and prevalence of metastatic disease requiring treatment from orthopaedic surgeons. The proximal femur is the most common location for metastatic lesions in the appendicular skeleton, and as such sees a disproportionate number of pathologic fractures. This site of injury is particularly challenging to manage due to the transmission of high forces through this region during ambulation. A combination of adjunct therapies and surgical intervention will maximize the outcomes for these patients. Obtaining a tissue diagnosis, especially in the setting of a solitary bone lesion, is a crucial and required early step in this process.