TO THE EDITOR:
In the article “Current Concepts Review. Treatment of Metastatic Adenocarcinoma of the Pelvis and the Extremities” (79-A: 917–932, June 1997), Aaron indicated that the ideal treatment for fractures secondary to metastases is internal fixation or prosthetic replacement with methylmethacrylate. Aaron cited an article by Harrington et al.3, published in 1976, that advocated the use of methylmethacrylate with internal fixation. It was also stated that the duration of survival increased from 11.6 to 246 months. (I am sure that a decimal point was omitted and that this should be 24.6 months.) This improvement was attributed to the patients being able to walk again, which was thought to be secondary to the use of methylmethacrylate. However, Aaron cited the work of other investigators2,6 who also used methylmethacrylate in addition to internal fixation or prosthetic replacement but reported much shorter durations of survival. In particular, Lane et al.6 reported a duration of survival of only 5.6 months. It seems that the duration reported by Harrington et al. may have been affected by other factors, such as the natural history of the disease, the type and location of the tumor, and so on.
Aaron cited articles by Mickelson and Bonfiglio7 as well as by Mouradian and me13 in which the Zickel subtrochanteric device was used without methylmethacrylate. Aaron noted that shortening was associated with use of this device, but he did not mention that the clinical outcomes were very good in both of those articles. There was some shortening, but it did not affect the end result of the procedure, the goals of which were mobilization and relief of pain. Those articles made two important points: first, the …
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