Abstract
BackgroundPathologic fractures of the femoral intertrochanteric and subtrochanteric region require special consideration in terms of biomechanically stable fixation and durability of the implant. In addition, the type of surgery might also influence patient survival. We conducted this retrospective study to evaluate the safety of modular proximal femur replacement compared to intramedullary nailing with patient survival being the primary and complications the secondary endpoint.MethodsWe retrospectively studied the records of 20 consecutive patients with actual pathologic fracture due to bone metastasis in the intertrochanteric and subtrochanteric part of the femur. The pathologic fractures were stabilized with a locked cephalomedullary nail in 12 patients and treated with en-bloc resection and modular proximal femur replacement in eight patients.ResultsIn the tumor prosthesis group median patient survival was more than twice as high (4.5 months, IQR 2.3 – 16.5) than in the osteosynthesis group (2.0 months, IQR 0.3 – 20.5), but did not reach significance (p = 0.58). Besides, a significantly better preoperative general health status in patients with endoprosthetic reconstruction puts better survival into perspective. Median implant survivorship did not differ between groups with 2.5 (IQR 1.0 – 7.5) months for endoprothesis and 3.0 (IQR 0.3 – 11.0) months for osteosynthesis (p = 0.93). Complication rates were comparable with 25% in each group.ConclusionPatient survival was not influenced by type of surgery or choice of implant. Preoperative general health condition and ambulatory capacity may aid in decision for type of surgery and improve patient safety, respectively.
Highlights
Pathologic fractures of the femoral intertrochanteric and subtrochanteric region require special consideration in terms of biomechanically stable fixation and durability of the implant
That patient survival may benefit from resection and modular replacement with a tumor prosthesis compared to intramedullary nailing in pathologic fracture of the proximal femur [5]
With respect to implant durability, referring only to complications associated with the structural integrity of the implant, superiority was seen for the endoprosthesis compared to the intramedullary nail, but the difference was not significant (p = 0.31)
Summary
Pathologic fractures of the femoral intertrochanteric and subtrochanteric region require special consideration in terms of biomechanically stable fixation and durability of the implant. The type of surgery might influence patient survival We conducted this retrospective study to evaluate the safety of modular proximal femur replacement compared to intramedullary nailing with patient survival being the primary and complications the secondary endpoint. Previous studies reported on strategies and outcome, optimal treatment is still under debate It was demonstrated, that patient survival may benefit from resection and modular replacement with a tumor prosthesis compared to intramedullary nailing in pathologic fracture of the proximal femur [5]. That patient survival may benefit from resection and modular replacement with a tumor prosthesis compared to intramedullary nailing in pathologic fracture of the proximal femur [5] We conducted this retrospective study to evaluate the safety of modular proximal femur replacement compared to intramedullary nailing in the treatment of pathologic trochanteric femoral fracture with respect to survival time of patients and implants as well as complications
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