Metastatic lesions involving weight-bearing long bones should have prophylactic internal fixation to prevent pathologic fracture if certain features are present. These features predict fractures with significant clinical consequences.
Criteria for internal fixation of weight-bearing long bones:
(1) lesions involving >= 50% of the diaphysis
(2) lesions destroying >= 50% of the cortex
(3) lesions > 2.5 cm in the femoral neck or intertrochanteric region
(4) lytic permeative lesions located in other high-stress areas
(5) involvement of the lesser trochanter, subtrochanteric or supracondylar regions
