Fixation of pathological fractures and impending long bone fractures in the course of neoplastic disease with the use of polymethylmethacrylate with added methotrexate.

Background. The authors present the results of operative treatment in 71 patients with pathological fractures and impending long bone fractures resulting from neoplastic metastases.<br /> Materials and methods. The discussed group of patients consists of 43 women and 28 men aged 36 to 80 years, the follow-up period is 6 to 48 months. After resection the metastatic focus was filled with cement supplemented with 2g methotrexate and stabilised with AO plate or a hip endoprosthesis was set up. <br /> Results. In 37 operated patients the pain subsided completely or markedly eased, 13 patients periodically required non-narcotic analgesics, and in 19 the pain did not subside. <br /> The treatment applied allowed all the patients with fractures within the lower extremities to abandon the bed and to move with the aid of crutches., and in 17 with fractures of the humerus it enabled the performance of daily living and self-care activities. Within the discussed group 9 patients with multiple metastases to the lungs and to the vertebral column died after average of 12 months. The longest survival period was observed in patients with metastases of renal cancer - average of 42 months, breast cancer - 37 months and ovary cancer - 29 months. No postoperative complications were observed; in 2 patients after 8 and 10 weeks destabilisation of the fixation intervened as a result of intensive weight-bearing without the aid of crutches. <br /> Conclusions. Filling the metastatic bone defect with methotrexate supplemented cement and stable fixation of a pathological fracture or an impending fracture enables movement, performance of daily living activities, eases or clears pain completely, improves the comfort of life, facilitates patient care and it may be an element of complex treatment of pathological and impending fractures in the course of neoplastic disease.