The evaluation of fitness and quality of life after palliative fixation of fractures caused by neoplastic metastases to the bones

Abstract

Background

Pathological fractures in the last phase of a neoplastic disease impair fitness and cause additional physical and mental suffering. Only surgical treatment ensures stabilization of a broken bone and thus lessens the pain and restores the function of the limb. The aim of this study is to evaluate fitness and quality of life after intramedullary fixation stabilizing of pathological fractures.

Material and methods

12 patients (8 femoral shaft fractures, 2 pertrochanteric fractures, 2 tibial shaft fractures) were treated with this method. In all patients a disseminated neoplastic disease was diagnosed. In 10 patients closed intramedullary fixation with a Kuntscher nail was performed (in 7 patients it was locked in a dynamic manner), in two patients fixation was made with Ender nails. Fitness was evaluated according to the ability to move, to load the operated limb, the range of motion in adjacent joints and muscle atrophy. One month after the operation quality of life was evaluated according to: the ability of self care, self dependence, subjective feeling of pain, necessity of analgesic intake and psychosomatic state.

Results

Three patients achieved preoperative fitness, despite worsened of fitness 6 patients were able to function independently and three patients required continuous care. All patients had to take analgesics, relief in severe pain typical of fracture was observed, but chronic pain typical of metastases was still present. The patients died within 2 to 16 months after the operation.

Conclusions

Palliative intramedullary bone fixation in the last phase of a neoplastic disease makes possible stabilization of pathological fractures and is sufficient for the patient to function independently.