Prediction of pathological fracture in patients with lower limb bone metastasis using computed tomography imaging
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RESEARCH PAPER
Prediction of pathological fracture in patients with lower limb bone metastasis using computed tomography imaging Yusuke Shinoda1,2 · Ryoko Sawada1,2 · Yuki Ishibashi2,3 · Toru Akiyama4 · Liuzhe Zhang4 · Toshihide Hirai2,3 · Hiroyuki Oka5 · Takahiro Ohki1,2 · Masachika Ikegami2 · Koichi Okajima3 · Tomotake Okuma3 · Hiroshi Kobayashi2 · Takahiro Goto3 · Nobuhiko Haga1 · Sakae Tanaka2 Received: 8 April 2020 / Accepted: 26 July 2020 © Springer Nature B.V. 2020
Abstract Lower limb pathological fractures caused by bone metastases can severely impair activities of daily living, so recognizing fracture risk is essential. Medial cortical involvement (MCI) in the proximal femur has been demonstrated to affect bone strength in biomechanical studies, but it has not been investigated in real patients. Between 2012 and 2019, 161 bone metastases with computed tomography (CT) images were retrospectively examined. Twenty-nine fractures were observed including 14 metastases with pathological fractures at the first examination, and prophylactic surgery was performed for 50 metastases. We extracted clinicopathological data using CT images, including patient’s background, MCI in the proximal femur, site, size, circumferential cortical involvement (CCI), pain, and nature of metastasis. Cox proportional hazard regression analyses were performed, and we created integer scores for predicting fractures. We revealed that MCI, CCI, lytic dominant lesion, and pain were significant factors by univariate analyses. By multivariable analysis, MCI and each 25% CCI were significant and integer score 1 was assigned based on hazard ratio. The full score was four points, with MCI in the proximal femur (one point) and ≥ 75% CCI (three points). With integer score two, sensitivity was 88.9% and specificity was 81.2% for predicting fracture within 60 days. In conclusion, MCI and CCI examined by CT images were the risk factors for pathological fracture. CCI ≥ 50% is a widely known risk factor, but in addition, it may be better to consider surgery if MCI in the proximal femur is observed in metastasis with 25–50% CCI. Keywords Bone metastasis · Pathological fracture · Cortical involvement · Scoring system · Lower extremities · Femur Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10585-020-10053-z) contains supplementary material, which is available to authorized users. * Yusuke Shinoda [email protected] 1
Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo 113‑0033, Japan
2
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
3
Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
4
Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
5
Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty
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