Skeletal Radiology

, Volume 48, Issue 2, pp 219–225 | Cite as

Preliminary results: use of multi-hole injection nails for intramedullary nailing with simultaneous bone cement injection in long-bone metastasis

  • Jong Woong Park
  • Yong-il Kim
  • Hyun Guy KangEmail author
  • June Hyuk Kim
  • Han Soo Kim
Scientific Article



For symptomatic metastasis of the long bones, intramedullary nailing has been the most accepted fixation method. Intramedullary nailing has effective control of pain, perioperative bleeding, and local tumor progression by augmentation with bone cement around the nail. Here, we report the preliminary results of a new surgical implant that allows for simultaneous injection of bone cement while inserting a percutaneous, flexible intramedullary nail.

Materials and methods

We performed palliative surgeries for long-bone metastasis using a multi-hole injection nail (MIN) with multiple side holes in the distal one third. When the nail tip entered the metastatic cancer lesion, the bone cement injection was started, and continued until the nail was completely seated. Ten patients with advanced cancer underwent palliative surgery using the new implant with simultaneous bone cement injection for humeral (n = 4), femoral (n = 4), and tibial (n = 2) metastases.


The mean operative time was 42 min (range, 36–52 min). The mean length of the injection nail was 23.0 cm (range, 18.0–33.0 cm), and the mean volume of cement was 28.0 ml (range, 14.0–40.0 ml). Marked pain palliation (p < 0.001) and functional recovery (p = 0.01) were verified. The mean Musculoskeletal Tumor Society (MSTS) functional score improved significantly from 12.5 at 6 weeks preoperatively, to 24.9 postoperatively. No acute postoperative complications, including cement embolism, occurred.


This minimally invasive surgical method with MIN could be useful for stabilization of long-bone metastases in patients with advanced cancer.


Cancer Bone metastasis Palliative Minimally invasive Intramedullary nail Cementoplasty 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© ISS 2018

Authors and Affiliations

  • Jong Woong Park
    • 1
  • Yong-il Kim
    • 2
  • Hyun Guy Kang
    • 1
    Email author
  • June Hyuk Kim
    • 1
  • Han Soo Kim
    • 3
  1. 1.Orthopaedic Oncology ClinicNational Cancer CenterGoyang-siSouth Korea
  2. 2.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Orthopaedic SurgerySeoul National University HospitalSeoulSouth Korea

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