Reconstruction nailing for pathological subtrochanteric fractures with coexisting femoral shaft metastases

Abstract

We describe the use of intramedullary reconstruction nails in the treatment of 14 patients with pathological subtrochanteric fractures and coexisting metastases in the femoral shaft. After nailing, all patients were free from pain and regained mobility. They were followed up clinically and radiologically until death from the primary disease. There were no mechanical failures even when a less than ideal reduction had been achieved.

Femoral metastatic fractures treated with intramedullary nailing

“…Intramedullary stabilization for both impending and complete pathological femoral fractures due to metastatic bone disease has previously been shown to give good pain control and restore function and mobility in the majority of patients [1,3].…”

“…In published series so far using the Russell-Taylor reconstruction nail there have been no reports of implant failure [1,3].…”

“…In metastatic disease of the femur intramedullary nailing with neck fixation is often indicated as the neck and proximal femur are commonly involved [3]. We compared the use of the reamed long Gamma nail and the unreamed AO femoral nail with a spiral blade in the treatment of pathological lesions due to metastatic femoral bone disease at The Chelsea and Westminster and Charing Cross trauma units over a 5-year period, in conjunction with The Royal Marsden Regional cancer center.…”

The importance of stable distal locking in intramedullary nail stabilisation of proximal femoral metastatic deposits

“…1,2 It is recommended that the femur is overreamed by 1.5-2.0 mm to allow smooth nail insertion and allow rotatory adjustments for proximal locking. 1,2,4 With such overreaming, interference fit at the isthmus cannot be relied upon to give stability to the construct and distal locking has been recommended. 1 It is important to stabilise long bones with metastatic deposits to prevent occurrence of a fracture, which carries a poorer prognosis for subsequent mobilisation.…”

“…1,2,4,6 There is debate whether to distally lock the nail in such cases where the isthmus is intact. 6 Recent reports suggest that distal locking is necessary to prevent pathological fractures through the bone lesion.…”