Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Abstract

Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n=33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n=31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n=7) vs. the S group (n=3), with no statistically significant difference.Patients with surgery-related complications had a higher survival rate (p=0.049), as did patients with mechanical implant failure (p=0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

Surgery and Functional Results of Pathological Fractures of Long Bones of Lower Extremities in Malignant Tumors

“…38 hasta ilerlemiş metastatik hastalıklar nedeniyle ex olmuş olup bu hastaların ortalama yaşam süreleri 7.9 aydır. Won-Sik Chay ve arkadaşlarının çalışmasında 10.6 ay, Max Zacheri ve arkadaşlarının çalışmasında 12 ay ve Johannes KM ve arkadaşlarının çalışmasında ise altı ve on iki aylık takiplerde tüm hastaların sağkalımı sırasıyla% 45.0 ve% 35.0 idi (16,17,18).…”

“…Max Zacheri ve arkadaşlarının çalışmasında 10 hastada cerrahi komplikasyon gelişmiş, 8 tanesine revizyon yapılmıştır. 3 hastada da PTE gelişmiştir (17).…”

When is hemiarthroplasty preferable to intramedullary prophylactic fixation of malignant lesions of the proximal femur?

“…Femoral head and neck fractures are usually treated by hemiarthroplasty. Pathologic fractures at the intertrochanteric and subtrochanteric areas or diaphysis can be managed with internal fixation, often by IM nailing with polymethylmethacrylate (PMMA) cement …”

Successful treatment of solitary intraosseous haemangioma of the femoral neck

“…(6) For lesions involving the articular surface of the femoral head, resection and reconstruction with hip endoprosthesis is often required. (7,11) If the lesion involves the femoral neck or intertrochanteric area with a risk of impending pathological fracture, but preservation of the hip articular surface is possible, curettage and bone grafting with application of an internal fixation device is preferred and has been described with excellent outcomes in previous studies. (6,12,13) For bone grafting, cortical bone grafts such as fibular cortical strut grafts are favoured, as they work as a mechanical strut and biological bone graft.…”