Improved quality of life after intramedullary nailing in femoral metastases

Abstract

Bone metastases are one of the most frequent problems in orthopaedic oncology. Impending fractures require surgical treatment in order to control pain and mechanical disrupture of the bone involved. The femur is the long bone most commonly involved by metastatic carcinoma. Preventive osteosynthesis is considered a good solution in the treatment of femoral metastases, reducing local pain and improving the quality of life. We analyzed clinical and radiographical outcomes of 21 patients with femoral metastases treated with intramedullar nailing at the Orthopaedics Department of Catholic University of Rome from 1997 to 2000. Bone metastases were located in the diaphysis or in the metadiaphysis. The primary tumors were lung in 10 cases, breast in 8 cases and kidney in 3 cases. Proximal or distal localizations constituted the indication for locked nailing. The implants used were: Küntscher nail in 8 cases, Russel-Taylor nail in 8, Recon nail in 2 cases and proximal femoral nailing in 3 cases when osteolysis involved also the femoral neck. Partial weight-bearing with external support was allowed 3 days postoperatively; full-weight bearing was allowed 20 days after operation except in the cases in which a progression of the primary tumor was observed. No infection or pulmonary embolism was observed. Adjuvant chemotherapy or local radiotherapy was used in all cases. Survival rate was related to the type of primary tumor, and varied from 3 months to 2 years.