Evaluating surgical techniques for bone metastasis in the extremities: A review of limb salvage procedures, functional outcomes and long-term prognosis

Bone metastases in the extremities cause severe pain, reduced bone density and fractures, often resulting in spinal cord compression, neurological deficits and hypercalcaemia. Early detection through imaging techniques such as X-rays, CT scans, MRI and PET scans is crucial for improving outcomes, with biopsy recommended for lesions with an unknown primary cancer. Bone markers like BSAP, osteocalcin, P1NP and resorption markers (CTX, NTX, DPD) aid in diagnosis and treatment monitoring. Treatment involves bisphosphonates, RANKL inhibitors, chemotherapy, radiation therapy and surgery. Local treatments, such as radiotherapy, offer pain relief and prevent fractures, while systemic treatments slow the progression of bone disease. Supportive care includes NSAIDs, opioids, corticosteroids and physical therapy for mobility and fracture prevention. Surgical interventions, such as intramedullary nailing (IMN), endoprosthetic replacement (EPR) and cement augmentation, are used for bone stabilisation, with IMN involving moderate invasiveness and EPR offering long-term stability but at higher surgical risks. Biological reconstruction methods, including bone grafts and tissue engineering, aim to repair and restore bone function, although they present challenges related to tumour biology and patient immunity. Future research thus should focus on integrating mechanical stabilisation with biological healing methods to enhance patient outcomes in the management of metastatic bone disease.