Management of metastatic disease of the appendicular skeleton

Treatment advances have resulted in improved prognosis for patients with cancer metastatic to bone. The management of appendicular skeletal metastases requires a multi-disciplinary approach. The overall disease prognosis is important in determining the appropriate surgical treatment of metastases, with simple measures for those with the poorest prognosis and resection with reconstruction for those expected to survive more than 1 year. This article reviews management options available for patients with skeletal metastases affecting the appendicular skeleton and broaches the controversies of prophylactic fixation of impending fractures.