Metastases to bone are the most common cause of a destructive lesion of the skeleton in an adult. The proximal femur is the most commonly affected bone with metastatic disease in the appendicular skeleton. A systematic approach to patient management is critical, so as to avoid complications that will delay systemic therapy. The orthopedic traumatologist is often the first physician to see the patient with a pathologic fracture. As a result, the surgeon must be aware of the indications for resection versus internal fixation, as well as options for reconstruction. Polymethyl methacrylate and curettage can be useful in the appropriately selected patient. Postoperative external beam irradiation can significantly reduce disease progression and subsequent loss of fixation. A multidisciplinary approach to this patient group will help optimize prognosis as well as function. This article reviews the evaluation, management, and complications of treatment of pathologic fractures of the proximal femur, with an emphasis on metastatic disease and multiple myeloma.



Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
76% Article relates to my practice (13/17)
11% Article does not relate to my practice (2/17)
11% Undecided (2/17)
2

Will this article lead to more cost-effective healthcare?

61% Yes (11/18)
33% No (6/18)
5% Undecided (1/18)
3

Was this article biased? (commercial or personal)

0% Yes (0/17)
94% No (16/17)
5% Undecided (1/17)
4

What level of evidence do you think this article is?

5% Level 1 (1/18)
16% Level 2 (3/18)
16% Level 3 (3/18)
33% Level 4 (6/18)
27% Level 5 (5/18)