Evaluation of impending fractures and indications for prophylactic fixation of metastases in long bones. Review of the literature.

This paper reviews the current literature on metastatic lesions most likely to result in a pathologic fracture of a long bone. Prophylactic surgery is recommended in the following situations: Persisting or increasing local pain despite the completion of radiation therapy; permeative involvement; a solitary well-defined lytic lesion greater than 2.5 cm; a solitary well-defined lytic lesion circumferentially involving more than 50% of the cortex; metastatic involvement of the proximal femur associated with a fracture of the lesser trochanter.