Unreamed intramedullary nailing for pathological femoral fractures : Good results in 30 cases

Pv, Giannoudis; Ss, Bastawrous; Ja, Bunola; Macdonald, D A; Rm, Smith

doi:10.3109/17453679909000953

Cited by 37 publications

(30 citation statements)

References 16 publications

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“…Although the rate of perioperative mortality for simultaneous nailing of skeletal metastasis is high, our mortality rates are not markedly different from those of series of unilateral nailings and are lower than those of previous reports of simultaneous nailings (Table 2) [2,[4][5][6][7]11]. Although simultaneous nailing should be approached with caution, our findings do not support previous recommendations of the mandatory staging of multiple nailings.…”

Section: Discussioncontrasting

confidence: 98%

“…Of our three perioperative deaths, one occurred intraoperatively. Our intraoperative death rate of 6% is comparable to that of reports of primarily single nailings for impending and pathologic fractures, which range from 0% to 10% [1,2,5,6].…”

Section: Discussionsupporting

confidence: 69%

“…There were three perioperative deaths. Although three of 16 patients reflects a high rate, it is similar to the perioperative mortality reported in series that predominately were regarding single nailings [2,[4][5][6]11], which range from 0% to 17%. As perioperative deaths can result from a multitude of causes, examining the intraoperative death rate may be a better gauge for evaluating the risk of an acute embolic event during simultaneous nailings.…”

Section: Discussionsupporting

confidence: 66%

“…Although this form of treatment is commonplace, concerns still arise regarding the risks of pulmonary compromise and mortality owing to fat and tumor emboli that are generated during nailing. The concern for these risks is substantial and has resulted in discussion of techniques, such as venting and unreamed nailing, that potentially might reduce production of emboli [6,9,10].…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous Nailing of Skeletal Metastases: Is the Mortality Really that High?

Moon

Lin

Satcher

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Introduction The risk of death during simultaneous nailing of pathologic and impending fractures in patients with metastatic disease is believed to be so high that some authors have advocated a staged approach, especially for impending fractures. However, there are limited data to either support or refute the appropriateness of staging of multiple impending or pathologic fractures. Questions/purposes We therefore determined the rate of pulmonary mortality and morbidity in patients who underwent simultaneous nailing for metastatic disease of the skeleton. Methods We retrospectively reviewed 16 patients who underwent simultaneous intramedullary nailing of impending or pathologic fractures between 1993 and 2009. There were 10 men and six women with a mean age of 60 years (range, 40-78 years). The intramedullary nailings included 15 femurs, 17 humeri, and one tibia. Thirty-one nails were reamed and two were unreamed.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Simultaneous Nailing of Skeletal Metastases: Is the Mortality Really that High?

Moon

Lin

Satcher

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…El tratamiento quirúrgico está indicado en: las fracturas patológicas, las fracturas inminentes y las lesiones que no perteneciendo a los dos grupos anteriores tienen una pobre o nula respuesta a la radioterapia, permaneciendo sintomáticas y siendo previsible su progresión 2,4,19,49,50 . Aunque estos conceptos referidos a los huesos largos de las extremidades, por generales, pueden aplicarse también a raquis y pelvis, estas localizaciones tienen unas connotaciones específicas que se abordarán más adelante.…”

Section: Cirugíaunclassified

Enfermedad metastásica ósea: Diagnóstico y tratamiento

Garbayo

Villafranca

Blas

et al. 2004

Anales Sis San Navarra

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RESUMENLa alta incidencia de metástasis óseas secundarias a carcinomas y la grave repercusión funcional que provocan, son motivos de constante estudio y avance en los métodos de evaluación, diagnóstico y tratamiento. El dolor es el síntoma más frecuente de presentación, aunque a veces el comienzo es una fractura patológica.Las pruebas clásicas de detección y valoración de extensión en la enfermedad metastásica, la radiología simple y la gammagrafía, se complementan en la actualidad con otras como la tomografía computarizada (TC) y la resonancia magnética (RM), mejorando la información sobre las características de la lesión tanto dentro como fuera del hueso. Por otra parte la tomografía por emisión de positrones (PET) está mostrando una sensibilidad muy superior a la gammagrafía y se perfila como la prueba de futuro para la detección precoz de metástasis y de tumores primarios de curso silente.Las posibilidades de tratamiento de las metástasis óseas se basan en el empleo de los regeneradores óseos, la radioterapia y la cirugía. Los dos primeros tienen su indicación en las lesiones ya detectadas en la radiología, sintomáticas o no, si no existe riesgo previsible de fractura. La cirugía tiene su indicación en situaciones de pobre o nula respuesta a estos tratamientos, cuando el riesgo de fractura es alto o ya se ha producido una fractura patológica.Antes de cualquier planificación terapéutica se debe realizar una valoración minuciosa del paciente, tanto a nivel local (tamaño, localización, extensión de la metástasis) como general (tipo de tumor primario, fase de tratamiento y respuesta, supervivencia estimada).Palabras clave. Cáncer. Metástasis óseas. Diagnóstico y tratamiento. ABSTRACTThe high incidence of bone metastasis secondary to carcinomas and its serious functional repercussion are motives for constant study and advance in the methods of evaluation, diagnosis and treatment. Pain is the most frequently shown symptom, although at times the start is a pathological fracture.The classic tests of detection and evaluation of the spread of the metastatic disease, simple radiology and gammagraphy, are today complemented by others such as computerised tomography (CT) and magnetic resonance (MR), improving the information on the characteristics of the lesion both inside and outside the bone. On the other hand, positron emission tomography (PET) is showing a far higher sensitivity than gammagraphy and will probably be the test of the future for the early detection of metastasis and of silent primary tumours.The possibilities of treatment of bone metastasis are based on the use of bone regenerators, radiotherapy and surgery. The former two are indicated in lesions already detected in radiography, whether symptomatic or not, if there is no foreseeable risk of fracture. Surgery is indicated in situations of poor or null response to those treatments, when the risk of fracture is high or a pathological fracture has been produced.Before any therapeutic planning, a detailed evaluation of the patient must be carried out, both ...

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