{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T06:44:36Z","timestamp":1769928276102,"version":"3.49.0"},"reference-count":77,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Pathologic fractures secondary to metastatic disease are an increasingly prevalent problem. Such patients require multidisciplinary collaboration to optimize clinical outcomes. An established algorithm for clinical, laboratory, and radiographic work-up will ensure that each patient achieves the best outcome while avoiding catastrophic complications. Metastatic disease to the region of the knee is less commonly encountered than in other regions of the body, but it presents unique difficulties that merit discussion. Part one of this two-part article series will discuss the appropriate work-up of patients with suspected or impending pathologic fracture of the distal femur, highlight biopsy principles, address perioperative nonsurgical treatments that will optimize patient outcomes, and discuss available surgical treatment modalities.<\/jats:p>","DOI":"10.1055\/s-0042-1745740","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T22:49:12Z","timestamp":1649458152000},"page":"607-618","source":"Crossref","is-referenced-by-count":2,"title":["Management of Pathologic Fractures around the Knee: Part 1\u2014Distal Femur"],"prefix":"10.1055","volume":"35","author":[{"given":"John R.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2728-8505","authenticated-orcid":false,"given":"Richard L.","family":"Auran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael D.","family":"Duran","sequence":"additional","affiliation":[{"name":"The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amalia M. de","family":"Comas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona"},{"name":"The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Jacofsky","sequence":"additional","affiliation":[{"name":"The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.21037\/aoj-20-977","article-title":"Narrative review of the epidemiology, economic burden, and societal impact of metastatic bone disease","author":"M R DiCaprio","year":"2021","journal-title":"Ann Joint"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1002\/1097-0142(1950)3:1<74::AID-CNCR2820030111>3.0.CO;2-7","article-title":"Metastases in carcinoma; analysis of 1000 autopsied cases","volume":"3","author":"H L Abrams","year":"1950","journal-title":"Cancer"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1053\/ctrv.2000.0210","article-title":"Metastatic bone disease: clinical features, pathophysiology and treatment strategies","volume":"27","author":"R E Coleman","year":"2001","journal-title":"Cancer Treat Rev"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3109\/02841868609136410","article-title":"Bone metastasis. prognosis, diagnosis and treatment","volume":"25","author":"K Lote","year":"1986","journal-title":"Acta Radiol Oncol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"6243s","DOI":"10.1158\/1078-0432.CCR-06-0931","article-title":"Clinical features of metastatic bone disease and risk of skeletal morbidity","volume":"12","author":"R E Coleman","year":"2006","journal-title":"Clin Cancer Res"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"S230","DOI":"10.1097\/01.blo.0000093849.72468.82","article-title":"Metastatic disease of the femur: surgical treatment","author":"W G Ward","year":"2003","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"56","DOI":"10.5435\/00124635-200001000-00006","article-title":"Surgical treatment of metastatic disease of the femur","volume":"8","author":"K C Swanson","year":"2000","journal-title":"J Am Acad Orthop Surg"},{"issue":"178","key":"ref10","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/00003086-198309000-00041","article-title":"Fracture healing in metastatic bone disease","author":"B J Gainor","year":"1983","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1302\/2058-5241.1.000008","article-title":"Treatment of pathological fractures of the long bones","volume":"1","author":"J J Willeumier","year":"2017","journal-title":"EFORT Open Rev"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1016\/j.ejrad.2012.08.016","article-title":"Imaging differentiation of pathologic fractures caused by primary and secondary bone tumors","volume":"82","author":"T Soldatos","year":"2013","journal-title":"Eur J Radiol"},{"issue":"07","key":"ref13","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/00005131-200408000-00013","article-title":"Management of pathologic fractures of the proximal femur: state of the art","volume":"18","author":"D J Jacofsky","year":"2004","journal-title":"J Orthop Trauma"},{"issue":"14","key":"ref14","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.1200\/JCO.2004.08.181","article-title":"Bone imaging in metastatic breast cancer","volume":"22","author":"T Hamaoka","year":"2004","journal-title":"J Clin Oncol"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1002\/jso.23654","article-title":"Prognostic role of en-bloc resection and late onset of bone metastasis in patients with bone-seeking carcinomas of the kidney, breast, lung, and prostate: SSG study on 672 operated skeletal metastases","volume":"110","author":"M Ratasvuori","year":"2014","journal-title":"J Surg Oncol"},{"key":"ref16","first-page":"417086","article-title":"Surgical management of appendicular skeletal metastases in thyroid carcinoma","volume":"2012","author":"R L Satcher","year":"2012","journal-title":"Int J Surg Oncol"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.2106\/00004623-199309000-00003","article-title":"Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy","volume":"75","author":"B T Rougraff","year":"1993","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S0305-7372(96)90021-3","article-title":"Effects of bone metastases on bone metabolism: implications for diagnosis, imaging and assessment of response to cancer treatment","volume":"22","author":"J Vinholes","year":"1996","journal-title":"Cancer Treat Rev"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.suronc.2018.05.028","article-title":"Predictors of survival after intramedullary nail fixation of completed or impending pathologic femur fractures from metastatic disease","volume":"27","author":"R N Kotian","year":"2018","journal-title":"Surg Oncol"},{"issue":"02","key":"ref20","first-page":"140","article-title":"Is 99m Tc-methylene diphosphonate bone scintigraphy a sensitive method for detecting bone lesions in multiple myeloma?","volume":"9","author":"M Vakili Sadeghi","year":"2018","journal-title":"Caspian J Intern Med"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"889","DOI":"10.2967\/jnumed.106.039479","article-title":"Comparison of 18F-FDG PET and bone scintigraphy in detection of bone metastases of thyroid cancer","volume":"48","author":"S Ito","year":"2007","journal-title":"J Nucl Med"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"504","DOI":"10.2214\/AJR.08.1823","article-title":"Imaging-guided percutaneous biopsy of pathologic fractures: a retrospective analysis of 129 cases","volume":"193","author":"A Datir","year":"2009","journal-title":"AJR Am J Roentgenol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/2047-783X-17-29","article-title":"Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study","volume":"17","author":"F Pohlig","year":"2012","journal-title":"Eur J Med Res"},{"issue":"06","key":"ref24","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s00256-002-0474-3","article-title":"Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions","volume":"31","author":"A Hau","year":"2002","journal-title":"Skeletal Radiol"},{"issue":"07","key":"ref25","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s00586-008-0678-x","article-title":"Percutaneous CT-guided biopsy of the spine: results of 430 biopsies","volume":"17","author":"E Rimondi","year":"2008","journal-title":"Eur Spine J"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"759","DOI":"10.2214\/ajr.171.3.ajronline_171_3_001","article-title":"Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms","volume":"171","author":"D E Dupuy","year":"1998","journal-title":"AJR Am J Roentgenol"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.2106\/JBJS.N.00661","article-title":"Current concepts in the biopsy of musculoskeletal tumors","volume":"97","author":"F Traina","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref28","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s003300050969","article-title":"Preoperative embolization of bone metastases from renal cell carcinoma","volume":"10","author":"A N Chatziioannou","year":"2000","journal-title":"Eur Radiol"},{"issue":"10","key":"ref29","doi-asserted-by":"crossref","first-page":"3179","DOI":"10.1007\/s11999-014-3734-3","article-title":"Embolization of hypervascular bone metastases reduces intraoperative blood loss: a case-control study","volume":"472","author":"T J Pazionis","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1002\/(SICI)1097-0142(19971015)80:8+<1588::AID-CNCR9>3.0.CO;2-G","article-title":"Skeletal complications of malignancy","volume":"80","author":"R E Coleman","year":"1997","journal-title":"Cancer"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s11999-007-0051-0","article-title":"Predictors of survival in patients with bone metastasis of lung cancer","volume":"466","author":"H Sugiura","year":"2008","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.bone.2010.09.008","article-title":"Skeletal complications and survival in renal cancer patients with bone metastases","volume":"48","author":"E Woodward","year":"2011","journal-title":"Bone"},{"issue":"01","key":"ref33","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1002\/ijc.27988","article-title":"Site-specific survival rates for cancer of unknown primary according to location of metastases","volume":"133","author":"K Hemminki","year":"2013","journal-title":"Int J Cancer"},{"issue":"08","key":"ref34","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1002\/cncr.22991","article-title":"Pathologic fractures correlate with reduced survival in patients with malignant bone disease","volume":"110","author":"F Saad","year":"2007","journal-title":"Cancer"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1756-9966-27-11","article-title":"Effect of pathologic fractures on survival in multiple myeloma patients: a case control study","volume":"27","author":"M Sonmez","year":"2008","journal-title":"J Exp Clin Cancer Res"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/978-3-642-83668-8_6","article-title":"Clodronate therapy of metastatic bone disease in patients with prostatic carcinoma","volume":"116","author":"S Adami","year":"1989","journal-title":"Recent Results Cancer Res"},{"issue":"46","key":"ref37","doi-asserted-by":"crossref","first-page":"e2014","DOI":"10.1097\/MD.0000000000002014","article-title":"Bisphosphonates in the treatment of patients with metastatic breast, lung, and prostate cancer: a meta-analysis","volume":"94","author":"J Liu","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"ref38","first-page":"CD003188","article-title":"Bisphosphonates in multiple myeloma: an updated network meta-analysis","volume":"12","author":"R Mhaskar","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/s005200050060","article-title":"Should bisphosphonates be standard therapy for bone pain?","volume":"5","author":"A H Paterson","year":"1997","journal-title":"Support Care Cancer"},{"issue":"12","key":"ref40","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1023\/A:1008238422151","article-title":"Relationships between biochemical and symptomatic response in a double-blind randomised trial of pamidronate for metastatic bone disease","volume":"8","author":"J J Vinholes","year":"1997","journal-title":"Ann Oncol"},{"issue":"16","key":"ref41","doi-asserted-by":"crossref","first-page":"3082","DOI":"10.1016\/j.ejca.2012.08.002","article-title":"Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials","volume":"48","author":"A Lipton","year":"2012","journal-title":"Eur J Cancer"},{"issue":"13","key":"ref42","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1016\/j.ejca.2015.05.016","article-title":"Hypocalcaemia in patients with metastatic bone disease treated with denosumab","volume":"51","author":"J-J Body","year":"2015","journal-title":"Eur J Cancer"},{"issue":"04","key":"ref43","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1002\/cncr.24837","article-title":"Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial","volume":"116","author":"D E Dupuy","year":"2010","journal-title":"Cancer"},{"issue":"05","key":"ref44","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1002\/cncr.27793","article-title":"Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial","volume":"119","author":"M R Callstrom","year":"2013","journal-title":"Cancer"},{"issue":"238","key":"ref45","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/00003086-198901000-00042","article-title":"Preoperative embolization in the treatment of osseous metastases from renal cell carcinoma","author":"M W Roscoe","year":"1989","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref46","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s12891-018-2141-4","article-title":"Deep vein thrombosis following the treatment of lower limb pathologic bone fractures - a comparative study","volume":"19","author":"M-L Mioc","year":"2018","journal-title":"BMC Musculoskelet Disord"},{"issue":"04","key":"ref47","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1634\/theoncologist.2017-0274","article-title":"Therapeutic anticoagulation in patients with primary brain tumors or secondary brain metastasis","volume":"23","author":"R J Lin","year":"2018","journal-title":"Oncologist"},{"issue":"11","key":"ref48","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1200\/JCO.1994.12.11.2345","article-title":"Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease","volume":"12","author":"P W Townsend","year":"1994","journal-title":"J Clin Oncol"},{"issue":"01","key":"ref49","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.radonc.2004.12.020","article-title":"Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma","volume":"75","author":"A M Davis","year":"2005","journal-title":"Radiother Oncol"},{"issue":"04","key":"ref50","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.ijrobp.2009.12.038","article-title":"Predictors of local control after single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases","volume":"79","author":"C Greco","year":"2011","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"05","key":"ref51","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1016\/j.ijrobp.2011.02.040","article-title":"Tumor control outcomes after hypofractionated and single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases from renal cell carcinoma","volume":"82","author":"M J Zelefsky","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"12","key":"ref52","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1007\/s00402-010-1066-7","article-title":"Do locking plates have a role in orthopaedic oncological reconstruction","volume":"130","author":"S Rastogi","year":"2010","journal-title":"Arch Orthop Trauma Surg"},{"issue":"04","key":"ref53","doi-asserted-by":"crossref","first-page":"321","DOI":"10.4055\/cios.2013.5.4.321","article-title":"Locking compression plate in musculoskeletal oncology \u2018a friend in need\u2019","volume":"5","author":"M Umer","year":"2013","journal-title":"Clin Orthop Surg"},{"issue":"03","key":"ref54","first-page":"362","article-title":"The outcome of locking plate fixation for the treatment of periarticular metastases","volume":"77","author":"J J Gregory","year":"2011","journal-title":"Acta Orthop Belg"},{"issue":"12","key":"ref56","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1097\/00005373-198012000-00006","article-title":"The surgical treatment of pathologic and impending pathologic fractures of the long bones","volume":"20","author":"W H Bouma","year":"1980","journal-title":"J Trauma"},{"issue":"169","key":"ref57","first-page":"70","article-title":"The pathology and treatment of metastatic disease of the femur","author":"E T Habermann","year":"1982","journal-title":"Clin Orthop Relat Res"},{"key":"ref58","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1016\/j.otsr.2017.05.029","article-title":"Primary total knee arthroplasty for acute fracture around the knee","volume":"104","author":"S Parratte","year":"2018","journal-title":"Orthop Traumatol Surg Res"},{"issue":"400","key":"ref59","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/00003086-200207000-00028","article-title":"Distal femur resection with endoprosthetic reconstruction: a long-term followup study","author":"J Bickels","year":"2002","journal-title":"Clin Orthop Relat Res"},{"issue":"02","key":"ref60","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1302\/0301-620X.76B2.8113272","article-title":"Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur","volume":"76","author":"R Capanna","year":"1994","journal-title":"J Bone Joint Surg Br"},{"issue":"04","key":"ref61","doi-asserted-by":"crossref","first-page":"345","DOI":"10.3109\/17453679609002328","article-title":"Megaprostheses after resection of distal femoral tumors. A rotating hinge design in 30 patients followed for 2-7 years","volume":"67","author":"P F Choong","year":"1996","journal-title":"Acta Orthop Scand"},{"issue":"438","key":"ref62","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/01.blo.0000180056.84593.47","article-title":"Favorable long-term results of prosthetic arthroplasty of the knee for distal femur neoplasms","volume":"438","author":"S J Frink","year":"2005","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref63","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.knee.2015.08.010","article-title":"Long term outcomes of cemented endoprosthetic reconstruction for periarticular tumors of the distal femur","volume":"23","author":"M T Houdek","year":"2016","journal-title":"Knee"},{"issue":"01","key":"ref64","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s00264-019-04408-9","article-title":"Outcomes of knee arthroplasty for primary treatment of pathologic peri-articular fractures of the distal femur and proximal tibia","volume":"44","author":"J D Johnson","year":"2020","journal-title":"Int Orthop"},{"issue":"04","key":"ref65","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1302\/0301-620X.89B4.18631","article-title":"Endoprosthetic replacement of the distal femur for bone tumours: long-term results","volume":"89","author":"G JC Myers","year":"2007","journal-title":"J Bone Joint Surg Br"},{"issue":"13","key":"ref66","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1002\/cncr.25836","article-title":"Survival after complete surgical resection of multiple metastases from renal cell carcinoma","volume":"117","author":"A L Alt","year":"2011","journal-title":"Cancer"},{"issue":"01","key":"ref67","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1302\/0301-620X.82B1.0820062","article-title":"Radical surgery for the solitary bony metastasis from renal-cell carcinoma","volume":"82","author":"K G Baloch","year":"2000","journal-title":"J Bone Joint Surg Br"},{"issue":"08","key":"ref68","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.2106\/00004623-200708000-00018","article-title":"Patient survival after surgery for osseous metastases from renal cell carcinoma","volume":"89","author":"P P Lin","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"ref69","doi-asserted-by":"crossref","first-page":"850","DOI":"10.2106\/JBJS.17.00156","article-title":"Long-term outcomes of pedicled gastrocnemius flaps in total knee arthroplasty","volume":"100","author":"M T Houdek","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"ref70","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1097\/CORR.0000000000000489","article-title":"What is the adverse event profile after prophylactic treatment of femoral shaft or distal femur metastases?","volume":"476","author":"R P McLynn","year":"2018","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref71","first-page":"427","article-title":"Surgical treatment of metastatic femoral fractures: achieving an improved quality of life for cancer patients","volume":"35","author":"M Morishige","year":"2015","journal-title":"Anticancer Res"},{"issue":"03","key":"ref72","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/(SICI)1096-9098(199703)64:3<190::AID-JSO3>3.0.CO;2-5","article-title":"Operative management of impending pathological fractures: a critical analysis of therapy","volume":"64","author":"E Van Geffen","year":"1997","journal-title":"J Surg Oncol"},{"key":"ref73","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ctrv.2017.09.008","article-title":"Early identification and intervention matters: A comprehensive review of current evidence and recommendations for the monitoring of bone health in patients with cancer","volume":"61","author":"T Brodowicz","year":"2017","journal-title":"Cancer Treat Rev"},{"issue":"04","key":"ref74","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1038\/pcan.2016.26","article-title":"Do skeletal-related events predict overall survival in men with metastatic castration-resistant prostate cancer?","volume":"19","author":"L E Howard","year":"2016","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"ref75","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1097\/01.blo.0000093045.56370.dd","article-title":"Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. 1989","author":"H Mirels","year":"2003","journal-title":"Clin Orthop Relat Res"},{"issue":"02","key":"ref76","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s00256-009-0823-6","article-title":"Inter- and intra-observer variation in classification systems for impending fractures of bone metastases","volume":"39","author":"M El-Husseiny","year":"2010","journal-title":"Skeletal Radiol"},{"issue":"08","key":"ref77","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1302\/0301-620X.100B8.BJJ-2018-0300.R1","article-title":"The validity of the Mirels score for predicting impending pathological fractures of the lower limb","volume":"100-B","author":"E L Howard","year":"2018","journal-title":"Bone Joint J"},{"issue":"03","key":"ref78","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s11999-015-4453-0","article-title":"CT-based structural rigidity analysis is more accurate than mirels scoring for fracture prediction in metastatic femoral lesions","volume":"474","author":"T A Damron","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref79","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1007\/s11999-015-4371-1","article-title":"Does CT-based rigidity analysis influence clinical decision-making in simulations of metastatic bone disease?","volume":"474","author":"A Nazarian","year":"2016","journal-title":"Clin Orthop Relat Res"},{"key":"ref80","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.bone.2018.02.011","article-title":"Pathological fracture risk assessment in patients with femoral metastases using CT-based finite element methods. A retrospective clinical study","volume":"110","author":"A Sternheim","year":"2018","journal-title":"Bone"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1745740.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T05:24:09Z","timestamp":1675229049000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1745740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,8]]},"references-count":77,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2022,6,20]]},"published-print":{"date-parts":[[2022,5]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1745740","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,8]]}}}