The treatment of patients with metastases to bone is highly challenging and complex. With the advent of the latest systemic treatment additions, survival of these patents dramatically improved. Because patients live longer, the traumatologist must adapt the historically based concept because patients may start to survive the implant. To avoid unnecessary revisions, the initial surgical approach must be revisited.

We performed a search of the current literature on bone metastasis und multidisciplinary treatment, with specific focus on how to best approach and work-up these patients.

Before performing any therapeutic act, the following 10 parameters have to be taken into consideration before initiation of any treatment. 1.) Type of diagnosis: is it indeed a metastasis? (or hematological tumor, sarcoma?); is lytic, blastic or mixed?; type of biopsy required? 2.) status of metastasis: solitary versus oligometastatic? Any visceral or cerebral lesions? 3.) ECOG of patient? Any other diagnoses? 4.) specific tumor characteristics? Type of therapies considered? 5.) survival in months? Using Pathfx.org or OptiModel. 6. Imaging: complete metastatic status, local extent of tumor; 7. Non-surgical treatment modalities and their potential response (drug, hormone and chemotherapy, radiation therapy, interventional therapies (RFA, Cryo) incl. embolization, and pain treatment; 8.) Size and localization of metastasis; 9.) potential risk of fracture (small, impending, fracture); 10.) Surgical options (osteosynthesis, resection-endoprosthesis, resection only, amputation).

Current treatment approaches for metastases to the bones are not focused any more on the evaluation of the local bone stability and thereby preparing the patient for further therapies. A modern team approach requires the multidisciplinary evaluation of all potential options at diagnosis and before initiation of treatment.