Surgical management of metastases to the long bones

Metastases to the long bones represent a common medical problem. The diagnosis of neoplastic pathology includes the location of the primary tumour and the number of peripheral metastases in the skeletal system. Imaging diagnostics, adapted according to the indications, is extremely useful in the diagnosis process. The medical management should aim at a removal of the primary tumour, a diagnosis of the cellular type, and identification of bone metastases. In practice, it often occurs that a metastasis is diagnosed first and then the primary tumour is sought. The surgical procedures in metastases to the long bones are related to the biological issue associated with radical removal of the metastasis, and the mechanical issue, that is, protection of the long bone against fracture or fixation of pathological fracture. The technical solutions depend on the local conditions and the locations of metastases. They may include prosthetic arthroplasty, intramedullary stabilisation of various types, and filling of the site where the bone was removed with acrylic cement.