Intramedullary nailing without curettage and cement augmentation for the treatment of impending and complete pathological fractures of the proximal or midshaft femur

摘要

Metastases in the proximal femur and in the femoral diaphysis are usually treated with either cephalo-medullary or intramedullary nailing. The benefit of curettage and augmentation of the nail with methyl methacrylate remains controversial. The authors retrospectively studied the outcomes with cephalo-medullary and intramedullary nailing without curettage and methyl-methacrylate augmentation for lytic metastases of the proximal/diaphyseal femur. Twenty-one complete (11) or impending (10) pathological fractures in 19 consecutive patients were treated between January 2006 and August 2013. There were 11 women and 8 men. Their mean age was 62 years (range, 38 to 87). All patients received adjuvant chemotherapy or radiotherapy. The average postsurgical survival was 9.7 months (range 1-36 months). A single deep infection was debrided. Seventeen out of 19 patients were ambulatory, with or without a walking aid. No implant failure was noted. In other words, patients succumbed to the disease prior to hardware failure. Femoral nail insertion without curettage and cement augmentation provided satisfactory stabilization of proximal and diaphyseal femur fractures, impending or complete, even when there was massive bone destruction.