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Research ArticleClinical Studies

Outcomes of Intramedullary Nail Fixation for Metastatic Disease: Impending and Pathologic Fractures

AARON R. OWEN, MASON E. UVODICH, VIVEK SOMASUNDARAM, BRANDON J. YUAN, PETER S. ROSE and MATTHEW T. HOUDEK
Anticancer Research February 2022, 42 (2) 919-922; DOI: https://doi.org/10.21873/anticanres.15550
AARON R. OWEN
1Mayo Clinic Department of Orthopedic Surgery, Rochester, MN, U.S.A.;
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MASON E. UVODICH
1Mayo Clinic Department of Orthopedic Surgery, Rochester, MN, U.S.A.;
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VIVEK SOMASUNDARAM
2Mayo Clinic Alix School of Medicine, Rochester, MN, U.S.A.
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BRANDON J. YUAN
1Mayo Clinic Department of Orthopedic Surgery, Rochester, MN, U.S.A.;
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PETER S. ROSE
1Mayo Clinic Department of Orthopedic Surgery, Rochester, MN, U.S.A.;
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MATTHEW T. HOUDEK
1Mayo Clinic Department of Orthopedic Surgery, Rochester, MN, U.S.A.;
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  • For correspondence: houdek.matthew@mayo.edu
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Abstract

Background/Aim: Intramedullary nail (IMN) fixation has become a treatment mean for impending and pathologic femur fractures. Currently there continues to be a lack of data examining functional outcomes, complications, and survivorship of patients treated with IMNs for metastatic disease of the femur. Patients and Methods: We retrospectively identified 183 IMNs placed for impending (n=145) or pathologic (n=38) metastatic fractures from 2010 to 2018. Functional outcomes and complications including blood transfusions, venous thromboembolisms (VTEs) and reoperations were studied. Results: Patients with impending lesions were more likely to be ambulatory at final follow-up (pathologic: 82%, impending: 99%, p<0.0001) and reported greater musculoskeletal tumor society scores (p<0.0001). Likewise, pathologic fractures were associated with greater discharge to non-home locations (p<0.0001) and were more likely to require a postoperative transfusion (pathologic: 66%, impending: 22%, p=0.0001). However, there was no difference in the incidence of VTEs (p=1.00) or reoperations (p=0.69) between cohorts. Patients treated for impending fractures had improved overall survival at 1 year (54% vs. 26%, p<0.0001). Conclusion: IMN fixation was durable in impending and pathologic femoral fractures. Early identification of metastases remains critical as patients treated for impending lesions had greater functional outcomes, fewer complications and improved survivorship compared to patients treated for pathologic fractures.

Key Words:
  • Intramedullary nail
  • metastatic disease
  • pathologic fracture
  • functional outcomes
  • Received December 12, 2021.
  • Revision received December 30, 2021.
  • Accepted December 31, 2021.
  • Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Anticancer Research: 42 (2)
Anticancer Research
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February 2022
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Outcomes of Intramedullary Nail Fixation for Metastatic Disease: Impending and Pathologic Fractures
AARON R. OWEN, MASON E. UVODICH, VIVEK SOMASUNDARAM, BRANDON J. YUAN, PETER S. ROSE, MATTHEW T. HOUDEK
Anticancer Research Feb 2022, 42 (2) 919-922; DOI: 10.21873/anticanres.15550

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Outcomes of Intramedullary Nail Fixation for Metastatic Disease: Impending and Pathologic Fractures
AARON R. OWEN, MASON E. UVODICH, VIVEK SOMASUNDARAM, BRANDON J. YUAN, PETER S. ROSE, MATTHEW T. HOUDEK
Anticancer Research Feb 2022, 42 (2) 919-922; DOI: 10.21873/anticanres.15550
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Keywords

  • Intramedullary nail
  • metastatic disease
  • pathologic fracture
  • functional outcomes
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