Surgical Treatment of Metastatic Fractures of the Femur: A Retrospective Analysis of 142 Patients

Sarahrudi, Kambiz; Greitbauer, M.; Platzer, Patrick; Hausmann, Jan-Till; Heinz, Thomas; Vécsei, V.

doi:10.1097/ta.0b013e3181622bca

Cited by 75 publications

(95 citation statements)

References 22 publications

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“…Alternative treatments have been associated with dislocation, infection, nonunion, and disease progression, often requiring reoperation. Intraoperative complications such as hypotension, oxygen desaturation, embolization, and cardiac arrest have also been reported [2,9,12,22,24,[26][27][28]. Of note, Barwood et al [4] reported acute oxygen desaturation and hypertension in 11 of 45 patients treated with intramedullary nail fixation for metastatic tumors of the femur with actual or impending fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Hattori et al [11] reported a 1-year survival rate of 69%, although this represents only eight patients who underwent endoprosthetic reconstruction. Sarahrudi et al [28] reported a 1-year survival rate of 17% in a population in which 94 patients were treated with intramedullary nail fixation, 23 with endoprosthetic reconstruction, and 22 with open reduction and internal fixation. In this study, 76.7% of patients presented with multiple metastases at the time of fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Pathologic fracture of the femur is an extremely debilitating complication of metastatic disease and multiple sources report that mortality quickly follows this diagnosis in many patients [1,3,28,33,34]. Of patients with advanced cancer, 50% develop bone metastases and one-third of all metastatic lesions occur in the proximal femur [8,20,32].…”

Section: Introductionmentioning

confidence: 99%

“…As many as 29% of these patients develop pathologic fractures and 65% of all pathologic fractures requiring surgery occur in the femur [8]. One-year survival rates after surgical treatment for metastatic lesions of the long bones or proximal femur range from 17% to 30% and 2-year survival rates are as low as 6% [28]. Treatment of pathologic fracture, therefore, is intended to restore function of the affected limb, relieve pain, improve quality of life, and facilitate custodial care as well as additional medical testing and treatment as quickly as possible.…”

Section: Introductionmentioning

confidence: 99%

“…Postoperatively, the median total MSTS score (measured at most recent followup) for the entire group of patients was 21 (range, , the median ECOG score was 2 (range, 0-3, 68% B 2), and the median KPS score was 60 (range, 40-100). For the 11 patients with at least 1 year of followup, the median total MSTS score (measured at most recent followup) was 27 (range, [21][22][23][24][25][26][27][28][29][30], the median ECOG score was 1 (range, 0-2, 100% B 2), and the median KPS score was 80 (range, 60-100). For the remaining 11 patients with less than 1 year of followup, the median total MSTS score (measured at most recent followup) was 11 (range, 5-25), the median ECOG score was 3 (range, 1-3, 36% B 2), and the median KPS score was 40 (range, 40-80).…”

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confidence: 99%

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What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

Peterson

Decilveo

O'Connor

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Traditional treatments for pathological fractures of the proximal femur resulting from metastatic bone disease include fixation with intramedullary nailing supplemented with polymethylmethacrylate, osteosynthesis with a plate-screw construct and polymethylmethacrylate, or endoprosthetic reconstruction. Despite the frequent practice of these treatments, treatment outcomes have not been rigorously compared. In addition, very few studies examine specific approaches to endoprosthetic reconstruction such as long stem hemiarthroplasty.Questions/purposes This study examines survival, functional outcomes, and complications associated with long stem hemiarthroplasty in a small group of patients treated for impending and actual pathologic fractures of the proximal femur resulting from metastatic bone disease. Methods Between 2012 and 2015, 21 patients were treated with long stem cemented hemiarthroplasty in 22 limbs. During that time, indications for this approach included lesions from metastases, myeloma, or lymphoma involving the proximal femur that resulted in an impending or actual pathological fracture. An impending fracture was classified as a painful lesion with at least 50% cortical erosion. During the study period, six patients with proximal femoral metastases not deemed to meet these indications were treated with other surgical approaches such as intramedullary nailing supplemented with polymethylmethacrylate and osteosynthesis with a plate-screw construct and polymethylmethacrylate. Mortality was tracked through medical records and phone calls to the patients and their families. Followup for the entire group of patients (n = 22) ranged from 1 to 27 months with a mean duration of 11 months. For patients with at least 1 year of followup (n = 11), the mean duration was 18 months (range, 12-27 months) and for patients with less than 1 year of followup (n = 11), the mean duration was 3 months (range, 1-11 months). Functional outcomes were evaluated according to the Musculoskeletal Tumor Society (MSTS) scoring system for lower extremities, the Eastern Cooperative Oncology Group (ECOG) Scale of Performance Status, and the Karnofsky Performance Scale (KPS) Index. Scores and complications were determined by direct patient examination, retrospective chart review, review of a longitudinally maintained institutional database, and followup phone calls. Results Ten patients died of disease within the followup period. Before surgery, the median total MSTS score for the entire group of patients (n = 22) was 4.5 (range, 0-23), Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Clinical O...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

Peterson

Decilveo

O'Connor

et al. 2017

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity and Assessment of Prophylactic Fixation

Worley

Patterson

Graboyes

et al. 2018

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE The chimeric anterolateral thigh osteomyocutaneous (ALTO) free flap is a recently described microvascular option for head and neck osseous defects associated with complex soft-tissue requirements. To date, the association of ALTO flap harvest with femur structural integrity and the need for routine prophylactic fixation following harvest has been incompletely described. OBJECTIVE To investigate the association of ALTO flap harvest, with and without prophylactic fixation, on femur structural integrity as measured by 4-point bend and torsional biomechanical testing. DESIGN AND SETTING At a research laboratory, 24 synthetic fourth-generation composite femurs with validated biomechanical properties underwent 10-cm-long, 30% circumferential osteotomies at the proximal middle third of the femur; 6 femurs served as controls. Osteotomized femurs with and without fixation underwent torsional and 4-point bend biomechanical testing. Femur fixation consisted of intramedullary nail and distal interlock screw placement. MAIN OUTCOMES AND MEASURES Force and torque to fracture (expressed in kilonewtons [kN] and Newton meters [N·m], respectively) were compared between controls, osteotomized femurs without fixation, and osteotomized femurs with fixation. Additional outcome measures included femur stiffness and fracture patterns. RESULTS On posterior to anterior (PA) 4-point bend testing, force to fracture of osteotomized femurs was 22% of controls (mean difference, 8.3 kN; 95% CI, 6.6–10.0 kN). On torsional testing the torque to fracture of osteotomized femurs was 12% of controls (mean difference, 351.1 N·m; 95% CI, 307.1–395.1 N·m). Following fixation there was a 67% improvement in PA force to fracture and a 37% improvement in torque to fracture. However, osteotomized femurs with fixation continued to have a reduced PA force to fracture at 37% of controls (mean difference, 6.8 kN; 95% CI, 4.5–9.2 kN) and torque to fracture at 16% of controls (mean difference, 333.7 N·m; 95% CI, 306.8–360.6 N·m). On torsional testing, all osteotomized femurs developed similar spiral fractures through a corner of the distal osteotomy site. This fracture pattern changed after prophylactic fixation with femurs developing nondisplaced fractures through the proximal osteotomy site. There were no underlying hardware failures during testing of osteotomized femurs with fixation. CONCLUSIONS AND RELEVANCE Anterolateral thigh osteomyocutaneous flap harvest results in significant changes in the structural integrity of the femur. Postoperative stabilization should be strongly considered, with future research directed at investigating the clinical significance of residual biomechanical changes following femur fixation.

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Future Prospects for Clinical Applications of Nanocarbons Focusing on Carbon Nanotubes

et al. 2022

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Over the past 15 years, numerous studies have been conducted on the use of nanocarbons as biomaterials towards such applications as drug delivery systems, cancer therapy, and regenerative medicine. However, the clinical use of nanocarbons remains elusive, primarily due to short‐ and long‐term safety concerns. It is essential that the biosafety of each therapeutic modality be demonstrated in logical and well‐conducted experiments. Accordingly, the fundamental techniques for assessing nanocarbon biomaterial safety have become more advanced. Optimal controls are being established, nanocarbon dispersal techniques are being refined, the array of biokinetic evaluation methods has increased, and carcinogenicity examinations under strict conditions have been developed. The medical implementation of nanocarbons as a biomaterial is in sight. With a particular focus on carbon nanotubes, these perspectives aim to summarize the contributions to date on nanocarbon applications and biosafety, introduce the recent achievements in evaluation techniques, and clarify the future prospects and systematic introduction of carbon nanomaterials for clinical use through practical yet sophisticated assessment methods.

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Surgical Treatment of Metastatic Fractures of the Femur: A Retrospective Analysis of 142 Patients

Cited by 75 publications

References 22 publications

What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity and Assessment of Prophylactic Fixation

Future Prospects for Clinical Applications of Nanocarbons Focusing on Carbon Nanotubes

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