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

Abstract

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.

Intramedullary nailing has sufficient durability for metastatic femoral fractures

“…The role of IMN should be carefully considered in patients who have pre-existing pulmonary dysfunction. Moon et al reported that prophylactic IMN did not appear to be safer than curative IMN for femoral fractures [ 18 ]. Barwood et al reported that acute oxygen desaturation and hypotension occurred in 24.4 % of patients during IMN procedures for metastatic femoral fractures and 6.6 % of patients died from cardiorespiratory dysfunctions during the perioperative period [ 19 ].…”

Safety and Efficacy of a Single-Stage versus Two-Stage Intramedullary Nailing for Synchronous Impending or Pathologic Fractures of Bilateral Femur for Oncologic Indications: A Systematic Review

“…Modern advances in cancer diagnosis and treatment have increased survival rates, which has subsequently resulted in a higher incidence and prevalence of metastatic disease to the bone, including synchronous involvement of multiple long bones [1][2][3][4][5]. The femur is 2 of 22 the most common long bone involved and intramedullary nail (IMN) fixation is widely considered the surgical standard of care for most patients as it reduces hospital length of stay, promotes patient's independence at the end of life, aims to relieve pain, maintains and restores early postoperative weight-bearing, mobility, and function, expedites adjuvant treatment of the primary malignancy, and improves patients' quality of life [2,[6][7][8][9][10][11][12][13][14][15][16].…”

“…Due to the increased theoretical thromboembolic and cardiopulmonary events with bilateral IMN, historically TS was the preferred approach for bilateral femur IMN [25][26][27][28]. However, some recent studies have shown encouraging results with SS bilateral IMN citing potential advantages of a single anesthesia, early start of rehabilitation and adjuvants, reduced length of stay, and most importantly, non-inferior clinical outcomes [1,3,7,[29][30][31].…”

Letter to the Editor: Prophylactic Stabilization For Bone Metastases, Myeloma, or Lymphoma: Do We Need to Protect the Entire Bone?

“…It has long been stated that the whole bone should be protected, although there is unease regarding the cardiopulmonary risks of prophylactic intramedullary fixation [2,4,5].We believe the article raises some important points that the main feature was not required to emphasize.We previously reported on two patients who had new metastases develop at the tip of an intramedullary nail. The nail subsequently fractured, resulting in complex revision surgery [3].…”

“…It has long been stated that the whole bone should be protected, although there is unease regarding the cardiopulmonary risks of prophylactic intramedullary fixation [2,4,5].…”