Distal femur endoprosthesis for pathological femur fractures: A multidisciplinary approach to management

Abstract

Background: There are a variety of approaches to the treatment of bony metastases. Surgery is typically reserved for lesions which have a high risk of fracture, or established pathological fractures. Case Report: We present the case of an 81-year-old woman initially diagnosed with a pathological fracture of her distal femur. Fixation was performed as guided by patient goals, but she subsequently encountered debilitating progression of the tumour burden at the site of pathological fracture. An en-bloc resection was later performed with implantation of a distal femur mega prosthesis. This was combined with radiotherapy followed by immunotherapy to significant functional benefit and systemic response. Conclusions: This case highlights the importance of the cancer multidisciplinary team approach, which allows for a more personalised approach as improvements with systemic anti-cancer therapies are seeing prolonged remissions. As such, there must be consideration of surgical options to treat bony metastases that can restore quality of life in the medium to long term, beyond just palliative measures.