Surgical treatment of metastatic tumors of the femur

Abstract

Objective. To evaluate the patients functional outcome and pain control after resection of metastatic femoral tumors. Material and methods. A prospective randomized clinical study was conducted, which included 26 cases of metastatic tumors of the femur with an associated pathologic fracture. These selected cases were randomly divided into two groups based upon the using of methylmethacrylate cement in fracture fixation. Group 1 (n=13) included all cases where the fractures were treated with bone cement augmentation. Group 2 (n=13) included all cases where the fractures were treated without bone cement augmentation. Functional outcome was evaluated according the American Musculoskeletal Tumor Society system. Results. Good and excellent pain control was achieved in 61.5%, satisfactory in 38.5% of all cases in the Group 1 versus 15.5% (P=0.015) and 69% (χ2=2.4762; P=0.115) of all cases in the Group 2. Functional outcome after femoral metastasis resection and pathologic fracture fixation was significantly better in the Group 1. Total lower extremity function of full normal function was 67% in the Group 1 versus 49% in the Group 2 (P<0.05). We did not observe significant difference between patients’ postoperative survival in the groups (P>0.05). The postoperative durability of stable pathologic fracture fixation was shorter in the Group 2 (273.9±51.7 vs. 358.9±116.8 days) comparing with Group 1 (P=0.03). Conclusions. The introduction of bone cement as the adjunct to the pathologic femoral fracture fixation significantly improved the clinical our study results: we achieved better functional outcome and better pain control.

Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies

“…studies that also include primary tumors, other anatomical areas, or revision procedures without reporting results separately). We contacted authors if studies published after the year 2000 included indiscernible treatment arms but were otherwise eligible (20 studies) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Only one of these could eventually be included [8].…”

The Importance of Awaiting Biopsy Results in Solitary Pathological Proximal Femoral Fractures

“…The exact histological diagnosis is of clinical significance to the surgical management of pathological fractures by informing accurate prognosis. 21 – 24 The representation of histotypes with intent-to-cure options in both patients with (>30%) and without (60%) malignant history was higher than expected. Zhang et.…”

End-Stage Cancer Patients Diagnosed with a Femoral Pathological Fracture on Admission to Palliative Care Units

“…Local treatment includes surgery and radiation therapy, with the aim of relieving pain and improving QOL. 15–17 The indications for surgery are prognosis, ability to tolerate surgery, and possible functional recovery, fixation, and support of fractured parts. 18 However, in the terminal stage of cancer, aggressive treatment is generally difficult, and it has been reported that systemic and local complications after surgery also occur at a high rate.…”