Acta Chir Orthop Traumatol Cech. 2015; 82(3):192-197 | DOI: 10.55095/achot2015/028

Skeletal Metastatic Disease of the Femur: Results by Management with Intramedullary NailingOriginal papers

S. MÄRDIAN*, K.-D. SCHASER, M. RUPPERT, I. MELCHER, N. P. HAAS, P. SCHWABE
Charité - University Medicine Berlin, Centre for musculoskeletal surgery, Berlin, Germany

PURPOSE OF THE STUDY:
This study aimed to analyse the outcome following intramedullary nailing for metastases of the femur in a large cohort with special regard to mechanical, implant associated complications and patient survival. Furthermore, we aimed to identify factors influencing the overall survival.

MATERIAL AND METHODS:
All patients (n = 74) that underwent intramedullary nailing for metastatic disease of the femur between 2004 and 2008 and were retrospectively reviewed. Data were recorded from the patients' medical record and the outpatients' clinics files. Details about the tumour biology, the surgery performed as well as the postoperative care were documented. Survival data were extracted from patient records or obtained via communication with outpatient oncologists or the community registration office.

RESULTS:
74 (28 (37.8%) male, 46 (62.2%) female; p = 0.048) patients with a mean age of 64.4 ± 11.7 years were included. Breast (25, 33.8%), lung (18, 24.3%), bone marrow (7, 9.5%) and kidney (6, 8.1%) were the primary tumours in more than 75% of all patients. The mean overall survival was 17.5 (95% CI: 9.6 - 25.5) months. Patients with osseous metastases had a significant longer survival than patients with visceral and/or cerebral metastases (p = 0.025 and p = 0.032).

CONCLUSION:
Intramedullary nailing represents a valuable fixation method for pathologic fractures or impending fractures of the femur in patients with an advanced stage of metastatic disease. It provides adequate stability to outlast the patient s remaining life-span. However, the balance must be found between therapeutic resignation and surgical overtreatment since operative treatment may be accompanied with serious complications.

Keywords: bone metastases, intramedullary nailing, metastatic disease, cement augmentation, osteolytic defect

Published: June 1, 2015  Show citation

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MÄRDIAN S, SCHASER K-D, RUPPERT M, MELCHER I, HAAS NP, SCHWABE P. Skeletal Metastatic Disease of the Femur: Results by Management with Intramedullary Nailing. Acta Chir Orthop Traumatol Cech. 2015;82(3):192-197. doi: 10.55095/achot2015/028. PubMed PMID: 26317289.
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    References

    1. BAUER, H. C.: Controversies in the surgical management of skeletal metastases. J. Bone Jt Surg., 87-B: 608-617, 2005. Go to original source... Go to PubMed...
    2. BICKELS, J., DADIA, S., LIDAR, Z.: Surgical management of metastatic bone disease. J. Bone Jt Surg., 91-A: 1503-1516, 2009. Go to original source... Go to PubMed...
    3. BIERMANN, J. S., HOLT, G. E., LEWIS, V. O., SCHWARTZ, H. S., YASZENSKI, M. J.: Metastatic bone disease: diagnosis, evaluation, and treatment. J. Bone Jt Surg., 91-A: 1518-1530, 2009.
    4. BOHM, P., HUBER, J.: The surgical treatment of bony metastases of the spine and limbs. J. Bone Jt Surg., 84-B: 521-529, 2002. Go to original source...
    5. COLEMAN, R. E.: Skeletal complications of malignancy. Cancer, 80 (8 Suppl.): 1588-1594, 1997. Go to original source...
    6. DIJSTRA, S., WIGGERS, T., VAN GEEL, B. N., BOXMA, H.: Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures. Eur. J. Surg., 160: 535-542, 1994.
    7. FAKLER, J. K.VM., HASE, F., BÖSE, J., JOSTEN, C.: Safety aspects in surgical treatment of pathological fractures of the proximal femur - modular endoprosthetic replacement vs. intramedullary nailing. Patient Saf. Surg., 7: 37, 2013. Go to original source... Go to PubMed...
    8. FENSKY, F., NUCHTERN, J. V., KOLB, J. P., HUBER, S., RUPPRECHT, M., JAUCH, S. Y.: Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures - a biomechanical cadaver study. Injury, 44: 802-807, 2013. Go to original source... Go to PubMed...
    9. GAINOR, B. J., BUCHERT, P.: Fracture healing in metastatic bone disease. Clin. Orthop. Relat. Res., 178: 297-302, 1983. Go to original source...
    10. GÄNSSLEN, A., GÖSLING, T., HILDEBRAND, F., PAPE, H. C., OESTERN, H. J.: Femoral shaft fractures in adults: treatment options and controversies. Acta Chir. orthop. Traum. čech., 81: 108-117, 2014. Go to original source...
    11. KELLY, C. M., WILKINS, R. M., ECKARDT, J. J., WARD, W. G.: Treatment of metastatic disease of the tibia. Clin. Orthop. Relat. Res., (415 Suppl.): S219-229, 2003. Go to original source...
    12. MILLER, B. J., SONI, E. E., GIBBS, C. P., SCARBOROUGH, M. T.: Intramedullary nails for long bone metastases: why do they fail? Orthopedics, 34(4), 2011. Go to original source... Go to PubMed...
    13. MIRELS, H.: Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin. Orthop. Relat. Res., 249: 256-264, 1989. Go to original source...
    14. MOON, B., LIN, P., SATCHER, R., BIRD, J., LEWIS, V.: Intramedullary Nailing of Femoral Diaphyseal Metastases: Is it Necessary to Protect the Femoral Neck? Clin. Orthop. Relat. Res., (e-pub 2014) 473: 1499-1502, 2015. Go to original source... Go to PubMed...
    15. PEREZ, C. A., BRADFIELD, J. S., MORGAN, H. C.: Management of pathologic fractures. Cancer, 29: 684-693, 1972. Go to original source...
    16. PICCIOLI, A., ROSSI, B., SCARAMUZZO, L., SPINELLI, M. S., YANG, Z., MACCAURO, G.: Intramedullary nailing for treatment of pathologic femoral fractures due to metastases. Injury, 45: 412-417, 2014. Go to original source... Go to PubMed...
    17. RATASVUORI, M., WEDIN, R., KELLER, J., NOTTROTT, M., ZAIKOVA, O., BERGH, P., KALEN, A., NILSSON, J., JONSSON, H., LAITINEN, M.: Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg. Oncol., 22: 132-138, 2013. Go to original source... Go to PubMed...
    18. RICCIO, A. I., WODAJO, F. M., MALAWER, M.: Metastatic carcinoma of the long bones. Am. Fam. Physician, 76: 1489-1494, 2007.
    19. SABO, D., BERND, L.: [Surgical management of skeletal metastases of the extremities]. Orthopade, 27: 274-281, 1998. Go to original source...
    20. SARAHRUDI, K., GREITBAUER, M., PLATZER, P., HAUSMANN, J. T., HEINZ, T., VÉCSEI, V.: Surgical treatment of metastatic fractures of the femur: a retrospective analysis of 142 patients. J. Trauma, 66: 1158-1163, 2009. Go to original source... Go to PubMed...
    21. SILVERBERG, E.: Cancer statistics, 1986. CA Cancer. J. Clin., 36: 9-25, 1986. Go to original source... Go to PubMed...
    22. SWANSON, K. C., PRITCHARD, D. J., SIM, F. H.: Surgical treatment of metastatic disease of the femur. J. Am. Acad. Orthop. Surg., 8: 56-65, 2000. Go to original source... Go to PubMed...
    23. VAN DER HULST, R. R., VAN DEN WILDENBERG, F. A., VROEMEN, J. P., GREVE, J. W.: Intramedullary nailing of (impending) pathologic fractures. J. Trauma, 36: 211-215, 1994. Go to original source... Go to PubMed...
    24. WEBER, K. L., RANDALL, R. L., GROSSMAN, S., PARVIZI, J.: Management of lower-extremity bone metastasis. J. Bone Jt Surg., 88-A (Suppl. 4): 11-19, 2006. Go to original source... Go to PubMed...
    25. YAZAWA, Y., FRASSICA, F. J., CHAO, E. Y., PRITCHARD, D. J., SIM, F. H., SHIVES, T. C.: Metastatic bone disease. A study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin. Orthop. Relat. Res., 251: 213-219, 1990. Go to original source...
    26. ZACHERL, M., GRUBER, G., GLEHR, M., OFNER-KOPEINIG, P., RADL, R., GREITBAUER, M., VECSEI, V., WINDHAGER, R.: Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation. Int. Orthop., 35: 1537-1543, 2011. Go to original source... Go to PubMed...
    27. ZORE, Z., FILIPOVIĆ ZORE, I., MATEJCIĆ, A., KAMAL, M., ARSLANI, N., KNEZOVIĆ ZLATARIĆ, D.: Surgical treatment of pathologic fractures in patients with metastatic tumors. Coll. Antropol., 33: 1383-1386, 2009.

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