Question
A 66 year old woman with breast cancer has thigh pain for weeks, then falls and cannot walk.
- Describe the radiographs.
- What workup is needed before surgery?
- How would you fix this fracture?
Answer
Radiographs
- Lytic lesion in the proximal femur on the first film
- Later pathological fracture through the lesion
- Breast cancer metastasis is the likely cause
Workup
- Do not assume a solitary lesion is a metastasis
- Biopsy if no known primary or a first relapse
- Staging CT chest, abdomen and pelvis, and bone scan or PET
- Imaging of the whole femur
- Calcium, full blood count, renal function
- Embolisation for vascular tumours (renal, thyroid, myeloma)
- Multidisciplinary discussion
Fixation
- Aim for immediate full weight bearing that outlasts the patient
- Long cephalomedullary nail protecting the whole femur
- Head or neck lesions, cemented arthroplasty
- Endoprosthesis for extensive destruction or solitary renal metastases with good prognosis
- Postoperative radiotherapy to the whole implant
- Bisphosphonates or denosumab
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.