Femoral recon nails for metastatic disease: indications, technique, and results

The senior author has used 41 femoral recon nails of one design in 41 consecutive patients with 30 impending and 11 pathologic femur fractures. All nails were inserted with minimally invasive surgical technique. The hospital stay was shorter (average, 5.6 days) and discharge to home was more likely (77%) after stabilization of impending pathologic fractures compared with fixation of completed fractures (length of hospital stay averaged 7.8 days, with a 36% discharge-to-home rate), as patients with completed fractures required a higher level of postoperative care. Fixation prior to fracture occurrence results in predictably better early results than that of fixation after fracture occurrence, confirming the benefit of prophylactic fixation of impending pathologic fractures. To date, there have been no fixation failures and only one significant complication: a nonfatal pulmonary embolus. This technique provides a safe and effective method of stabilizing properly selected femoral lesions resulting from metastatic disease, especially impending pathologic fractures.