Surgical Treatment in Long Bone Metastatic Fractures
Hasan TATARI, Onder BARAN, Hasan HAVITCIOGLU, Mehmet ERDURAN
Keywords: Pathologic fracture, Long bone metastasis, Intramedullary nailing, Polymethylmethacrylate
Purpose: The purpose of this study is to evaluate the results of the surgical treatments performed because of long bone metastatic fractures and discuss the surgical strategy, technical indications and the use of polimethylmetacrylate (PMMA), with regard to the literature.
Patients and methods: 37 pathologic fractures of humeral and femoral shaft and femur proximal end in 35 patients, due to metastasis of the primary tumour or multiple myeloma treated with surgical intervention between 1992-1997, were evaluated. The mean age was 63.6; and the primary tumour was the breast cancer in 40 %. The mean follow-up time was 10 months and 17 cases had died. In humeral shaft fractures, the majority of the cases were treated by the open method, with intramedullary nails or tumour resection prosthesis augmented by PMMA. In femoral fractures, intramedullary Kirschner nails with PMMA or resection prosthesis were the primary choices.
Results: In all cases, except two who have died early after surgery, immediate immobilization was supplied. In 2 cases, operated before because of femur proximal end fractures, fixation defficiency was developed after retrograde nailing with Ender nails, and in 2 others, applied resection prostheses were dislocated.
Conclusion: For early function in humerus and femur metastatic fractures, intramedullary nailing and PMMA with the open method and in femur proximal end fractures, by giving regard to the expected life time of the patient, tumour resection prosthesis must be the primary choice.