Prof' Peter FM Choong

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INDEPENDENCE AND MOBILITY THE MANAGEMENT OF
METASTATIC CARCINOMA TO BONE

• Prof. Peter FM Choong

Department of Orthopaedics, University of
Melbourne Department of Surgery St. Vincents
Hospital, Melbourne, Victoria, Australia
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Distribution of Cancers
Percentage ()
Prostate
Colorectal
Breast
Melanoma
Lung
AIHW (2005)
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New Cases
Total (n)



Total (n) 100,514
AIHW (2005)
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Since 1982
AIHW (2005)
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Location determines impact
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Main problems

• PAIN
• IMMOBILISATION
• PATHOLOGICAL FRACTURE
• ANAEMIA
• HYPERCALCAEMIA

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Characteristics
LYTIC
MIXED
SCLEROTIC
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Multifocality
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Indications for surgery

• Impending fracture
• Fracture
• Palliation

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When is surgery not indicated

• Limited life span lt 6-8 weeks
• Too dangerous to operate
• Lungs
• Brain

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What type of surgery

• Fracture fixation
• Joint replacement
• Amputation

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Fracture fixation
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Fracture fixation
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Benefits of fixation

• Early relief of pain
• Early mobilisation / transfer

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Disadvantages of fixation

• Metastasis is a progressive disease
• Loss of fixation
• Refracture
• Protected weight bearing

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Fracture fixation
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Fracture fixation
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Joint replacement
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Joint replacement
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Benefits of joint replacement

• Early mobilisation with full weight bearing
• Reliant on intact bone
• Straight forward procedure

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Disadvantages of joint replacement

• Expensive
• Selecting the correct prosthesis
• Infection Risk
• Pulmonary embolic phenomenon

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Joint replacement
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Pulmonary embolic phenomenon

• Hypotension
• O2 desaturation
• Combination
• Circulatory Collapse

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Pulmonary embolic phenomenon

• EMBOLI AND IM MANIPULATION
• Ereth et al. 1992
• Pell et al 1993
• Lafont et al. 1994
• Duwelius et al. 1997

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Pulse Rate
Blood Pressure (mmHg)
EtCO2 (mmHg)
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1
2
3
4
5
6
7
8
9
10
11
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Time (min)
0
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Pulmonary embolic phenomenon
SURGERY (N45)
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Upper limb tumours
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Upper limb tumours
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Upper limb tumours
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Upper limb tumours
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Upper limb tumours
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Upper limb tumours
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Upper limb tumours
SPINE OF SCAPULA
MESH
RHOMBOIDS
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Upper limb tumours
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Upper limb tumours
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Lower limb tumours
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Lower limb tumours
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Lower limb tumours
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Lower limb tumours
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Lower limb tumours
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Lower limb tumours
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Lower limb tumours
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Lower limb tumours
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Lower limb tumours
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Minimally invasive surgery
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Targeted therapies
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Future

• Better understanding of patient/carer needs

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DEPARTMENT OF ORTHOPAEDICS
DEPARTMENT OF SURGERY UNIVERSITY OF MELBOURNE
ST. VINCENTS HOSPITAL PETER MacCALLUM CANCER
CENTRE
MELBOURNE