Abstract
To evaluate the patients functional outcome and pain control after resection of metastatic femoral tumors. A prospective randomized clinical study was conducted, which included 26 cases of metastatic tumors of the femur with an associated pathologic fracture. These selected cases were randomly divided into two groups based upon the using of methylmethacrylate cement in fracture fixation. Group 1 (n=13) included all cases where the fractures were treated with bone cement augmentation. Group 2 (n=13) included all cases where the fractures were treated without bone cement augmentation. Functional outcome was evaluated according the American Musculoskeletal Tumor Society system. Good and excellent pain control was achieved in 61.5%, satisfactory in 38.5% of all cases in the Group 1 versus 15.5% (P=0.015) and 69% (chi(2)=2.4762; P=0.115) of all cases in the Group 2. Functional outcome after femoral metastasis resection and pathologic fracture fixation was significantly better in the Group 1. Total lower extremity function of full normal function was 67% in the Group 1 versus 49% in the Group 2 (P<0.05). We did not observe significant difference between patients' postoperative survival in the groups (P>0.05). The postoperative durability of stable pathologic fracture fixation was shorter in the Group 2 (273.9+/-51.7 vs. 358.9+/-116.8 days) comparing with Group 1 (P=0.03). The introduction of bone cement as the adjunct to the pathologic femoral fracture fixation significantly improved the clinical our study results: we achieved better functional outcome and better pain control.
Highlights
Femur is the most common site of the bone metastasis after spine and pelvis
Good and excellent pain control was achieved in 61.5%, satisfactory in 38.5% of all cases in the Group 1 versus 15.5% (P=0.015) and 69% (χ2=2.4762; P=0.115) of all cases in the Group 2
Functional outcome after femoral metastasis resection and pathologic fracture fixation was significantly better in the Group 1
Summary
Femur is the most common site of the bone metastasis after spine and pelvis. From 30 to 50% of metastatic bone lesions are localized in the proximal part of the femur [1,2,3]. A dynamic hip screw combined with curettage and complete defect packing with bone cement is used for the internal fixation [8]. This is a rather simple technique, which preserves the hip joint. In order to evaluate the functional outcome and pain control after fixation of pathologic femur fractures with reconstruction and retrograde intramedullary nails with or without bone cement augmentation, we constructed this clinical study.
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