الفهرس 
Bone metastatic work-upOnly 14 pages are availabe for public view
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Abstract
Bone, is the third most common site of metastatic disease after lung and liver. Prostate, breast, lung, kidney, and thyroid cancers are responsible for most of skeletal metastases. Bone metastasis have effect on quality of life. This effect depends on the aggressiveness of the primary tumor. The early diagnosis and treatment of bone mets would lessen comorbidities and improve quality of life . The evaluation and management of patients with metastatic bone disease is best done with a multidisciplinary approach including medical oncologist, radiologist, pathologist, orthopedic surgeon, physical therapist, and social worker.
Patient with bone metastasis may be presented with pathological fracture or only pain and limitation of movement. The last is still at risk to pathological fracture.
Pathological fracture can greatly affect the quality of life. As it occurs in unhealthy bone. The risk of non-union is extremely high.
The other group suffers from persistent pain and disturbed function. Medical treatment and radiotherapy play a role in improving this symptoms. But patients who are at risk of pathological fracture are advised to have prophylactic fixation.
Prophylactic fixation of the impending fracture is generally preferred as treatment of actual pathological fractures. Quick relief of pain, early mobility, decreased hospital stay, reduction of operative complications are benefits of such fixation.
This study aimed to assess the impact of fixation of metastasized bone on the quality of life. 20 Patients (21 cases) were classified to 2 groups:
• 16 Patients presented with pathological fracture.
• 5 patients impending pathological fracture.
The both groups underwent fixation and the results were followed over months using MSTS score.
We got out this study with these results:
• Evaluation of 6 cases of the upper limb using MSTS score and comparing between preoperative and postoperative values, it was found that there is a significant improvement of pain, function, emotional status, hand positioning, manual dexterity, lifting ability and total score.
• Evaluation of 15 cases of the lower limb using MSTS score and comparing between preoperative and postoperative values, it was found that there is significant improvement of pain, function, emotional status, support, walking, gait and total score.
• There is a significant improvement in the total MSTS score in cases of bone mets after fixation.
• There is a significant improvement in the total score after the fixation of cases presented with pathological fracture.
• There is an insignificant improvement after the prophylactic fixation of cases with bone mets with impending pathological fracture.
Summary
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So, we conclude the following:
• Early fixation of metastatic bone lesions, either there is a pathological fracture or not, has a significant role in the improvement of pain, emotional status and functions. It helps in providing independence and improving the quality of life.
• Significance of improvements in life quality after fixation of patients with pathological fractures due to bone mets is more than that in patients who underwent prophylactic fixation. This cannot deny the good role of fixation in the last group, and how it plays a role in decreasing pain and early mobilization.
We recommend fixation and prophylactic fixation of metastatic bone lesion because of its positive efficacy on the quality of life.