Editorials

The palliative role of orthopaedics

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7552.1227 (Published 25 May 2006) Cite this as: BMJ 2006;332:1227
  1. Wisam I Al-Hakim (wisam2410@hotmail.com), clinical research fellow, bone tumour unit,
  2. Jacub M Jagiello, clinical research fellow, bone tumour unit,
  3. Ken Mannan, specialist registrar,
  4. Tim W Briggs, consultant orthopaedic surgeon
  1. Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP
  2. Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP

    Orthopaedic procedures can help terminally ill patients and are underused

    Palliative care for patients with cancer is well established and provides important benefits. Orthopaedic interventions in terminal care are, however, underused in the United Kingdom, despite the fact that conditions that are amenable to orthopaedic intervention occur often in the terminal stages of cancer. Though the evidence base for many orthopaedic palliative interventions is not strong, since there are no trials, clinical experience and expert consensus opinion1 suggest that such interventions can ease the pain and comfort of terminally ill cancer patients with pathological fractures and other musculoskeletal effects of malignancy.

    About 9000 breast cancer patients develop metastatic bone disease each year in the UK.1 O'Donoghue et al showed that referral to an orthopaedic surgeon is requested in less than half of these patients.2 Orthopaedic input into the management of breast cancer occurs in some parts of the UK but is not national practice, and the same applies to other cancers.

    Several indications justify orthopaedic intervention. The most relevant is pain. Pain is commonly related to the presence of pathological fractures …

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