Pathological Fractures - To Fix or to Replace? (BOOS Revalidation)

Description

The recorded session features an engaging discussion on the management and implications of pathological fractures, particularly in patients with underlying metastatic bone diseases. Robert Ashford opens with a welcoming note and mentions a future event at St. George's Park and the National Brewery Museum, encouraging attendees to save the date for a significant gathering in June 2023. Following this, Jonathan Stevenson introduces the first speaker, Christine Azzopardi, a radiologist from the Royal Orthopedic Hospital in Birmingham, who delivers an insightful talk on imaging metastatic bone disease.



Christine emphasizes the importance of diagnosing pathological fractures, which occur in abnormal bone weakened by diseases such as malignancy or benign lesions like bone cysts. She discusses various imaging modalities and the standard approach to identifying fractures, insisting that patients presenting with non-traumatic fractures warrant careful assessment of underlying pathology, including the presence of red flags such as night pain.



The session includes in-depth details on imaging characteristics necessary for diagnosing different types of bone lesions, with clear diagrams and cases illustrating pathological findings. Azzopardi elaborates on treatment modalities including cryotherapy, segmentation, and radiofrequency ablation, advising that while imaging is foundational, clinical correlation remains vital for effective patient management.



After Christine’s presentation, Will Aston from Stanmore addresses decision-making in metastatic disease and pathological fractures, ongoing treatment options, and shares his real-life cases to illustrate the complexity of managing such patients. He articulates the necessity of a multidisciplinary team (MDT) approach for optimal outcomes, especially regarding urgent referrals. Conversations around the differences in management between various types of cancers in relation to bone health, the importance of timely intervention, and considerations for using cemented implants versus non-cemented ones for stability follow.



Kenneth Rankin takes the stage next, discussing updates in metastatic bone disease notably in the context of the updated BOAST guidelines. Emphasizing the necessity for comprehensive workups and multidisciplinary management, he provides guidance on referrals, potential chemotherapy impacts, and the significance of collaboration within the MDT framework to ensure timely and appropriate interventions in their management.



Throughout the session, there is an interactive dialogue with audience members raising questions regarding protocols on unexpected cases of fractures, the healing potential in myeloma patients compared to other cancers, and how to implement effective management strategies in regional settings. The speakers highlight the importance of networking among clinicians to share insights and strategies, ultimately focusing on the need for practical solutions to expedite patient care for those with metastatic bone diseases.

Specialties