International Orthopaedics

, Volume 35, Issue 10, pp 1537–1543 | Cite as

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures

Resection vs. stabilisation
  • Max Zacherl
  • Gerald Gruber
  • Mathias GlehrEmail author
  • Petra Ofner-Kopeinig
  • Roman Radl
  • Manfred Greitbauer
  • Vilmos Vecsei
  • Reinhard Windhager
Original Paper


Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.


PMMA Femoral Head Proximal Femur Pathological Fracture Metastatic Tissue 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Christina Levy for proofreading the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Roodman GD (2004) Mechanisms of bone metastasis. N Engl J Med 350(16):1655–1664PubMedCrossRefGoogle Scholar
  2. 2.
    Bauer HC, Wedin R (1995) Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand 66(2):143–146PubMedCrossRefGoogle Scholar
  3. 3.
    Clarke HD, Damron TA, Sim FH (1998) Head and neck replacement endoprosthesis for pathologic proximal femoral lesions. Clin Orthop Relat Res 353:210–217PubMedCrossRefGoogle Scholar
  4. 4.
    Capanna R, Campanacci DA (2001) The treatment of metastases in the appendicular skeleton. J Bone Joint Surg Br 83(4):471–481PubMedCrossRefGoogle Scholar
  5. 5.
    Wedin R, Bauer HC (2005) Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br 87(12):1653–1657. doi: 10.1302/0301-620X.87B12.16629 PubMedCrossRefGoogle Scholar
  6. 6.
    van Doorn R, Stapert JW (2000) Treatment of impending and actual pathological femoral fractures with the long Gamma nail in The Netherlands. Eur J Surg 166(3):247–254. doi: 10.1080/110241500750009366 PubMedCrossRefGoogle Scholar
  7. 7.
    Sarahrudi K, Hora K, Heinz T, Millington S, Vecsei V (2006) Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients. Int Orthop 30(6):519–524. doi: 10.1007/s00264-006-0205-9 PubMedCrossRefGoogle Scholar
  8. 8.
    Weber KL, Randall RL, Grossman S, Parvizi J (2006) Management of lower-extremity bone metastasis. J Bone Joint Surg Am 88(Suppl 4):11–19. doi: 10.2106/JBJS.F.00635 PubMedCrossRefGoogle Scholar
  9. 9.
    Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120PubMedGoogle Scholar
  10. 10.
    Perez CA, Bradfield JS, Morgan HC (1972) Management of pathologic fractures. Cancer 29(3):684–693PubMedCrossRefGoogle Scholar
  11. 11.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655PubMedCrossRefGoogle Scholar
  12. 12.
    Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26(3):298–306PubMedCrossRefGoogle Scholar
  13. 13.
    Sokol DK, Wilson J (2008) What is a surgical complication? World J Surg 32(6):942–944PubMedCrossRefGoogle Scholar
  14. 14.
    Windhager R, Ritschl P, Rokus U, Kickinger W, Braun O, Kotz R (1989) The incidence of recurrence of intra- and extra-lesional operated metastases of long tubular bones. Z Orthop Ihre Grenzgeb 127(4):402–405PubMedCrossRefGoogle Scholar
  15. 15.
    Moradi B, Zahlten-Hinguranage A, Lehner B, Zeifang F (2010) The impact of pathological fractures on therapy outcome in patients with primary malignant bone tumours. Int Orthop 34(7):1017–1023PubMedCrossRefGoogle Scholar
  16. 16.
    Jacofsky DJ, Haidukewych GJ (2004) Management of pathologic fractures of the proximal femur: state of the art. J Orthop Trauma 18(7):459–469. doi: 00005131-200408000-00013 PubMedCrossRefGoogle Scholar
  17. 17.
    Cole AS, Hill GA, Theologis TN, Gibbons CL, Willett K (2000) Femoral nailing for metastatic disease of the femur: a comparison of reamed and unreamed femoral nailing. Injury 31(1):25–31. doi: S0020-1383(99)00195-3 PubMedCrossRefGoogle Scholar
  18. 18.
    Kinkel S, Stecher J, Gotterbarm T, Bruckner T, Holz U (2009) Compound osteosynthesis for osteolyses and pathological fractures of the proximal femur. Orthopedics 32(6):403PubMedCrossRefGoogle Scholar
  19. 19.
    Schneiderbauer MM, von Knoch M, Schleck CD, Harmsen WS, Sim FH, Scully SP (2004) Patient survival after hip arthroplasty for metastatic disease of the hip. J Bone Joint Surg Am 86-A(8):1684–1689. doi: 86/8/1684 PubMedGoogle Scholar
  20. 20.
    Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu AT (2008) Modular endoprosthetic replacement for metastatic tumours of the proximal femur. J Orthop Surg Res 3:50PubMedCrossRefGoogle Scholar
  21. 21.
    Hattori H, Mibe J, Matsuoka H, Nagai S, Yamamoto K (2007) Surgical management of metastatic disease of the proximal femur. J Orthop Surg (Hong Kong) 15(3):295–298Google Scholar
  22. 22.
    Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H, Rehak P, Windhager R (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 17(11):1488–1495. doi: 10.1007/s00586-008-0763-1 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Max Zacherl
    • 1
  • Gerald Gruber
    • 1
  • Mathias Glehr
    • 1
    Email author
  • Petra Ofner-Kopeinig
    • 2
  • Roman Radl
    • 1
  • Manfred Greitbauer
    • 3
  • Vilmos Vecsei
    • 3
  • Reinhard Windhager
    • 4
  1. 1.Department of Orthopaedic SurgeryMedical University GrazGrazAustria
  2. 2.Institute for Medical Informatics, Statistics and DocumentationMedical University GrazGrazAustria
  3. 3.Department of Trauma SurgeryMedical University ViennaViennaAustria
  4. 4.Department of OrthopaedicsMedical University ViennaViennaAustria

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