Management of Pathologic Fractures around the Knee: Part 1—Distal Femur

Abstract

Pathologic fractures secondary to metastatic disease are an increasingly prevalent problem. Such patients require multidisciplinary collaboration to optimize clinical outcomes. An established algorithm for clinical, laboratory, and radiographic work-up will ensure that each patient achieves the best outcome while avoiding catastrophic complications. Metastatic disease to the region of the knee is less commonly encountered than in other regions of the body, but it presents unique difficulties that merit discussion. Part one of this two-part article series will discuss the appropriate work-up of patients with suspected or impending pathologic fracture of the distal femur, highlight biopsy principles, address perioperative nonsurgical treatments that will optimize patient outcomes, and discuss available surgical treatment modalities.

Pathologic Peri-Implant Proximal Femur Fracture: Takeaways from Our Experience

“…According to a large retrospective database study done by Willeumier et al, approximately 10% of all femoral metastases were located distally [2]. While there are many potential surgical treatments including endoprosthetic reconstruction, plate fixation, intramedullary nail fixation, and arthroplasty, the choice of surgical fixation is often based on clinical experience given the scarcity of literature regarding treatment of distal femoral pathologic fractures [6][7][8][9]. In a systematic review by Willeumier et al, only two studies were found that reported outcomes specific to this fracture type [6].…”