Surgical treatment of pathological fractures occurring at the proximal femur

• Published in: Yonsei medical journal Vol. 56; no. 2; pp. 460 - 465
• Main Authors: Choy, Won-Sik, Kim, Kap Jung, Lee, Sang Ki, Yang, Dae Suk, Jeung, Sang Wook, Choi, Han Gyul, Park, Hyun Jong
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.03.2015; 연세대학교의과대학
• Subjects: Adult; Aged; Aged, 80 and over; Bone Nails; Bone Neoplasms - secondary; Bone Neoplasms - surgery; Female; Femoral Fractures - etiology; Femoral Fractures - pathology; Femoral Fractures - surgery; Fracture Fixation, Intramedullary - methods; Fracture Healing; Fractures, Spontaneous - pathology; Fractures, Spontaneous - surgery; Hip Fractures - surgery; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local - surgery; Neoplasms - complications; Neoplasms - pathology; Neoplasms - surgery; Original; Postoperative Complications; Quality of Life; Survival Rate; Treatment Outcome; 의학일반; intramedullary nailing; Proximal femur; pathological fracture; joint replacement surgery
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2015.56.2.460

To analyze the results of surgical treatment for pathological fractures at the proximal femur. Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.