Implant Reconstruction of the Femoral Diaphysis: I: Intercalary Femur Prosthesis

Abstract

Pathologic fractures in the femoral diaphysis pose a treatment challenge, as healing potential is limited, and immediate function is necessary for patients with metastatic bone disease. In addition, lesions with prior radiation, healing may be impaired. Intramedullary nailing and osteosynthesis may have disadvantages such as delayed healing, incomplete cementation, and delayed weight bearing. Another technique, intercalary allografting relies on bone healing that may extend past the patient’s expected survival. In cases where resection may offer advantages of survival and local control, such as in renal cell carcinoma and in histologies that are unlikely to heal, intercalary replacement may be considered. We present the case of a patient with a pathologic displaced diaphyseal femur fracture secondary to metastatic disease. In order to address management of the fracture, preserve function, and build a construct with immediate postoperative stability for full weight bearing, an intercalary endoprosthetic reconstruction was performed.