Pathological fracture characteristics and their impact on osteosarcoma prognosis: A systematic review

Introduction: Currently, there is no consensus whether timing, fracture displacement & union of pathological fractures affects outcomes in patients with osteosarcoma of the extremities. Material and methods: A systematic review was conducted to assess the impact of fracture timing, displacement, and union on oncologic outcomes in osteosarcoma patients. The review included a total of 417 patients, 117 of whom had pathological fractures. The prevalence of pathological fractures in osteosarcoma was found to be 28 %. Results: Among the patients with fractures, 68 % had fractures at presentation, while 32 % developed fractures during treatment. In this study, 31 % of the fractures were displaced, while 69 % were undisplaced. Adequate surgical margins were achieved in 91 % of cases with pathological fractures. However, no statistically significant correlation was found between the timing of fracture development, fracture displacement, or fracture union with local recurrence or mortality rates. Conclusion: This systematic review found no significant association between the timing of fracture development, fracture displacement, or fracture union with local recurrence or mortality outcomes in osteosarcoma patients. Further research is needed to investigate the role of factors such as tumor size and hematoma in oncologic outcomes. The timing of fracture and other relevant fracture characteristics are may be the subject of evaluation in further trials.