Closed intramedullary biopsy for metastatic disease

The surgical stabilization of metastatic fractures or impending fractures of long bones is recommended with the use of intramedullary nails. While the primary tumour has often been diagnosed previously, there are occasions when the fracture may be the presenting feature of malignancy. In both circumstances surgical oncologists require a histological diagnosis from around the fracture site so that any adjuvant therapy can be planned. Open biopsy is often employed although a closed method has been used by percutaneous puncture. Although intramedullary specimens have been obtained before with long bronchial type biopsy forceps, we report a simple and reliable technique for closed biopsy taken from intramedullary reamings at the time of fracture fixation. Lesions from both the femur and the humerus are amenable to this technique.