The most common site for pathologic fracture secondary to metastatic carcinoma is the proximal femur secondary to the fact that the femur is the most common long bone associated with metastatic disease and the stress risers around the proximal femur make it easy to fracture. The spine however is the most common site of all bone metastasis. Both Mirel's criteria and Harrington's criteria are used to predict the risk of pathologic fracture in the presence of a metastatic lesion and indications for prophylactic fixation.
The cited reference by Ward et al emphasizes the benefit of prophylactic stabilization in improving the quality of life in patients with metastatic disease.
The cited reference by Weber et al provides a treatment algorithms for metastatic disease, including the use of radiation and bisphosphonates, augmenting the primary fixation. Recent literature from the UK and Memorial Sloan Kettering suggests improved patient related outcomes and decreased mechanical failure in proximal femoral metastatic lesions treated with megaprostheses rather than intramedullary nails.
Review of Orthopaedics, 4th Edition, Mark D. Miller, W B Saunders Co, March 2004
Ward WG, Spang J, Howe D. Metastatic disease of the femur. Surgical management. Orthop Clin North Am. 2000 Oct;31(4):633-45. Review.
PMID:11043102 (Link to Abstract)
Weber KL, Lewis VO, Randall RL, Lee AK, Springfield D. An approach to the management of the patient with metastatic bone disease. Instr Course Lect. 2004;53:663-76. Review.
PMID:15116657 (Link to Abstract)