RT Journal Article
SR Electronic
T1 Outcomes of Intramedullary Nail Fixation for Metastatic Disease: Impending and Pathologic Fractures
JF Anticancer Research
JO Anticancer Res
FD International Institute of Anticancer Research
SP 919
OP 922
DO 10.21873/anticanres.15550
VO 42
IS 2
A1 AARON R. OWEN
A1 MASON E. UVODICH
A1 VIVEK SOMASUNDARAM
A1 BRANDON J. YUAN
A1 PETER S. ROSE
A1 MATTHEW T. HOUDEK
YR 2022
UL http://ar.iiarjournals.org/content/42/2/919.abstract
AB 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.