Prophylactic Fixation of Impending Fractures

Abstract

Aim: Pathologic fractures occur as a result of weakening of the mechanical properties of bone. There are many conditions, which lead to bone softening. There are neoplastic and non-neoplastic diseases that cause pathologic fractures. The aim is to evaluate and to highlight on value of prophylactic fixation of impending fractures in abnormal bone situation to prevent occurrence of pathological fracture and its complications. Patients and methods: Between 2003 and 2009, study on forty-nine patient (35 females and 14 males) between the age of 20 and 65 years with an average age of 49.9 years with expected possibility of fractures of lower extremities. The entire patient with fractures risks prophylactic fixation has done. Different types of fixation either surface plating (dynamic hip screws), medullary (Gamma nails or locking nail) or external fixation in cases unsuitable for surgery was used according to the type and the site of the deformity in combination of management of primary condition. Results: Most patients had significant relief of pain. 35 (71.5%) of patients with impending fracture were ambulatory after therapy and able to walk outdoor while 10 (20.5%) of patients could walk inside door. Three patients (6%) using wheel chair, and they were on renal dialysis. Only one patient (2%) was not able to walk, and he was not cooperative for unknown reason. The mean duration of hospitalization was 21 days (range from 7 to 35 days). That time included preoperative period of investigation and preparation and post-operative surgery and rehabilitation. Discussion: Pathological fractures create a serious morbidity in patients with bone disease. Orthopedic surgeons who look after patients with skeletal lesions should focus on proactive treatments designed to prevent pathologic fractures before they occur. Prophylactic fixations have decreased morbidity compared with patient's sustained fractures before fixation. Conclusion: Surgical fixation of fractures in weight-bearing long bones with impending fractures provides pain relief, and a functionally stable and durable construct. It helps early an ambulation and prevents fracture's complication. It allows independent function and avoids irretrievable catastrophes.