Yonsei Med J.  2015 Mar;56(2):460-465. 10.3349/ymj.2015.56.2.460.

Surgical Treatment of Pathological Fractures Occurring at the Proximal Femur

Affiliations
  • 1Department of Orthopaedic Surgery, Eulji University College of Medicine, Daejeon, Korea. oskkj@eulji.ac.kr

Abstract

PURPOSE
To analyze the results of surgical treatment for pathological fractures at the proximal femur.
MATERIALS AND METHODS
Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate.
RESULTS
The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months.
CONCLUSION
Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.

Keyword

Proximal femur; pathological fracture; intramedullary nailing; joint replacement surgery

MeSH Terms

Adult
Aged
Aged, 80 and over
Bone Nails
Bone Neoplasms/*secondary/surgery
Female
Femoral Fractures/etiology/pathology/*surgery
Fracture Fixation, Intramedullary/*methods
Fracture Healing
Fractures, Spontaneous/pathology/*surgery
Hip Fractures/surgery
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Recurrence, Local/surgery
Neoplasms/complications/pathology/*surgery
Postoperative Complications
Quality of Life
Survival Rate
Treatment Outcome

Figure

  • Fig. 1 The Kaplan-Meier survival rates of patients at postoperative month 6, month 12, and month 24 (95% confidence interval).


Reference

1. Bauer HC. Controversies in the surgical management of skeletal metastases. J Bone Joint Surg Br. 2005; 87:608–617.
Article
2. Rougraff B. Indications for operative treatment. Orthop Clin North Am. 2000; 31:567–575.
Article
3. Clarke HD, Damron TA, Sim FH. Head and neck replacement endoprosthesis for pathologic proximal femoral lesions. Clin Orthop Relat Res. 1998; 210–217.
4. Bauer HC, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995; 66:143–146.
Article
5. Capanna R, Campanacci DA. The treatment of metastases in the appendicular skeleton. J Bone Joint Surg Br. 2001; 83:471–481.
Article
6. Wedin R, Bauer HC. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail. J Bone Joint Surg Br. 2005; 87:1653–1657.
7. van Doorn R, Stapert JW. Treatment of impending and actual pathological femoral fractures with the long Gamma nail in The Netherlands. Eur J Surg. 2000; 166:247–254.
Article
8. Sarahrudi K, Hora K, Heinz T, Millington S, Vécsei V. Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients. Int Orthop. 2006; 30:519–524.
Article
9. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; 241–246.
Article
10. Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1998. CA Cancer J Clin. 1998; 48:6–29.
Article
11. Hage WD, Aboulafia AJ, Aboulafia DM. Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am. 2000; 31:515–528.
Article
12. Coleman RE. Skeletal complications of malignancy. Cancer. 1997; 80:8 Suppl. 1588–1594.
Article
13. Böhm P, Huber J. The surgical treatment of bony metastases of the spine and limbs. J Bone Joint Surg Br. 2002; 84:521–529.
Article
14. Wedin R, Bauer HC, Wersäll P. Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop Relat Res. 1999; 128–139.
Article
15. Steinbrink K. Total femoral prosthesis: 18 years experience in 147 cases. In : Tan SK, editor. Limb Salvage: Current trends. Singapore: International Society of Limb Salvage;1993. p. 411–412.
16. Ward WG, Dorey F, Eckardt JJ. Total femoral endoprosthetic reconstruction. Clin Orthop Relat Res. 1995; 1:195–206.
Article
17. Ward WG, Johnston KS, Dorey FJ, Eckardt JJ. Loosening of massive proximal femoral cemented endoprostheses. Radiographic evidence of loosening mechanism. J Arthroplasty. 1997; 12:741–750.
18. Selek H, Başarir K, Yildiz Y, Sağlik Y. Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur. J Arthroplasty. 2008; 23:112–117.
Article
19. Wedin R, Bauer HC, Rutqvist LE. Surgical treatment for skeletal breast cancer metastases: a population-based study of 641 patients. Cancer. 2001; 92:257–262.
Article
20. Zacherl M, Gruber G, Glehr M, Ofner-Kopeinig P, Radl R, Greitbauer M, et al. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation. Int Orthop. 2011; 35:1537–1543.
Article
21. Choy WS, Kim KJ, Lee SK, Yang DS. Implant failure of long proximal femoral nail antirotation in patient with subtrochanteric pathologic fracture. Eur J Orthop Surg Traumatol. 2012; 22:609–612.
22. Zafiropoulos G, Pratt DJ. Fractured Gamma nail. Injury. 1994; 25:331–336.
23. Tillman RM. The role of the orthopaedic surgeon in metastatic disease of the appendicular skeleton. Working Party on Metastatic Bone Disease in Breast Cancer in the UK. J Bone Joint Surg Br. 1999; 81:1–2.
24. Manabe J, Kawaguchi N, Matsumoto S, Tanizawa T. Surgical treatment of bone metastasis: indications and outcomes. Int J Clin Oncol. 2005; 10:103–111.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr