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[Intramedullary fixation in (impending) femur fractures caused by tumor metastases]
R van Doorn1, R R van der Hulst, F A van den Wildenberg
1Academisch Ziekenhuis, afd. Algemene Heelkunde, Maastricht.
Objective:
To determine the results and complications of intramedullary nailing of (impending) pathologic femoral fractures.
Design:
Retrospective.
Setting:
University Hospital Maastricht. TIME. Between 1979 and 1993.
Method:
We analysed the results of 29 patients treated before 1990, and 12 patients treated after 1990, with a total of 46 (impending) pathologic femoral fractures. We evaluated primary cancer, duration of illness, pain, mobility, complications and survival.
Results:
Mobility and pain improved after intramedullary nailing. In the group operated before 1990, in whom the femoral neck had not been stabilised, a femoral neck fracture was seen in 5 cases as a result of a metachronous metastasis. Once a metastasis developed in the scar. Because of these results we decided to stabilise the whole femur, including the femoral neck, with the Russell-Taylor Reconstruction Nail, and to irradiate the whole operation field. Neither femoral neck fractures nor metastases in the scar occurred after 1990.
Conclusion:
Intramedullary nailing is a valuable technique for stabilising (impending) pathologic femoral fractures. It is important that the whole femur, including the femoral neck, be stabilised and that the entire operation field be irradiated. The Russel-Taylor Reconstruction Nail is a suitable implant for this purpose.