Survival after Pathological Fractures of the Proximal Femur

Abstract

We report on the survival of 145 patients presenting to a single centre with a pathological metastatic fracture of the proximal femur. The single surviving patient had a follow-up of 17.7 years. Mean survival for the 144 patients who died was 332 days (range 2 to 3053 days), being longest for those with myeloma (662 days), lymphoma (> 633 days) and breast tumours (477 days) and lowest for lung tumours (110 days). The most common sites for the primary tumour were breast (36%), prostate (23%) and lung (17%). 47% of fractures were intracapsular, 28% trochanteric and 25% subtrochanteric. 99% of the fractures were treated surgically with a mean hospital stay of 19 days. The commonest fracture healing complication was further fracture of the femur around or immediately below the implant which occurred after 9/144 (6.2%) of operations. The difference in survival of patients related to the primary tumour site is of relevance in planning surgical treatment and discussing prognosis with patients.

Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies

“…Dislocations can technically only occur after endoprosthetic reconstruction and required reoperation in 0-8% of the cases. The finding of comparable overall reoperation rates but different reasons for reoperation are confirmed when focusing on the seven studies that describe both endoprosthetic reconstructions and intramedullary nailing [44,[46][47][48]54,55,62,63]. Four out of these seven studies describe timing of the reoperations; deep infections seem to occur Journal of Surgical Oncology early (within the first months), while fixation failures seem to occur late [47,48,54,62].…”

“…[43] 163 167 100 (61) 12 (7) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 51 (31) MM, multiple myeloma, Lymph., lymphoma. Primary tumor type for femur metastases not available for the following studies: [8,30,45,63] EPR 105 --0 (0) 0 (0) 0 (0) 0 (0) 105 (100) Weiss et al [47] EPR 82 --0 (0) 0 (0) 82 (100) 0 (0) 0 (0) Harvey et al [48] EPR 113 70 (62) 113 (100) 0 (0) 0 (0) 0 (0) 0 (0) 113 (100) Steensma et al [46] EPR 197 80 (41) 197 (100) 0 (0) 115 (58) 82 (42) 0 (0) 0 (0) Hattori et al [41] EPR 16 13 (81) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 16 (100) Parker et al [44] EPR 54 54 (100) 29 (54) 0 (0) 0 (0) 0 (0) 0 (0) 54 (100) Zacherl et al [55] EPR 13 13 (100) 13 (100) 0 (0) 0 (0) 0 (0) 0 (0) 13 (100) Potter et al [45] EPR 39 16 (41) 39 (100) 0 (0) 0 (0) 0 (0) 0 (0) 39 (100) Sarahrudi et al [36] EPR 23 23 (100) 23 (100) 0 (0) 0 (0) 0 (0) 0 (0) 23 (100) Chandrasekar et al [30] EPR 81 56 (69) 81 (100) 0 (0) 0 (0) 0 (0) 0 (0) 81 (100) Selek et al [85] EPR 45 28 (62) 45 (100) 0 (0) 0 (0) 0 (0) 0 (0) 45 (100) Park et al [80] EPR 31 --0 (0) 0 (0) 0 (0) 0 (0) 31 (100) Wedin et al […”

“…In case of overlapping cohorts (14 studies) , we included the most comprehensive or largest study . Authors were contacted if studies published after the year 2000 insufficiently reported outcomes (14 studies) . Eight authors responded and additional information on outcome was obtained for four studies which could then be included .…”

“…In case of overlapping cohorts (14 studies) [26][27][28][29][30][31][32][33][34][35][36][37][38][39], we included the most comprehensive or largest study [26][27][28]30,34,36,38]. Authors were contacted if studies published after the year 2000 insufficiently reported outcomes (14 studies) [26,28,30,34,36,[40][41][42][43][44][45][46][47]. Eight authors responded [30,34,36,41,42,44,45,47] and additional information on outcome was obtained for four studies which could then be included [30,41,42,47].…”

“…Authors were contacted if studies published after the year 2000 insufficiently reported outcomes (14 studies) [26,28,30,34,36,[40][41][42][43][44][45][46][47]. Eight authors responded [30,34,36,41,42,44,45,47] and additional information on outcome was obtained for four studies which could then be included [30,41,42,47]. The bibliographies of included studies were checked for publications missed by our search; 1 additional study was found and included ( Fig.…”