Orthopedic emergencies in oncology

The management and treatment of orthopedic emergencies that develop in patients with cancer is diverse and often complex. Although treatment algorithms exist, treatment must be tailored to each patient. For the two most common orthopedic emergencies encountered, namely pathologic fracture and spinal cord compression, the primary goals of treatment in both cases are pain relief and early restoration of function. Surgical stabilization of a pathologic fracture and surgical fixation with decompression of a spinal cord compression is often performed to improve the patient’s quality of life. In less commonly seen orthopedic emergencies, such as abscesses, necrotizing fasciitis, and acute compartment syndrome, aggressive surgical intervention is warranted, to prevent the compounding complications that may arise if inadequately treated. However, the patient’s life expectancy must be considered when planning any type of treatment, since the disease stage may be advanced at the time the patient presents with an orthopedic oncologic emergency. In terminally ill patients, orthopedic surgical treatment should only be considered if there is reasonable evidence that an intervention will improve the patient’s quality of life.