Pathological Fractures Of The Proximal Femur Due To Metastatic Lesions: A Single Institution Experience Of Patient Characteristics And Methods Of Surgical Treatment

Objective: Pathological fractures are among the most common complications of malign neoplasms. The femur is the most frequently involved bone following spinal metastasis. This study retrospectively analyzed patients who had been surgically treated for proximal femur metastasis and aimed to determine the factors that affect survival rates.Methods: This is an IRB approved, retrospective review of all patients diagnosed with pathological fractures due to proximal femur metastasis and treated surgically in a single institution from 2004 to 2012. The Karnovsky scoring system was also used to evaluate functionality. Statistical comparisons were made by forming patient subgroups based on the existence of a primary diagnosis, the surgical method selected, and the existence of complications. The analyses attempted to recognize the factors that affect mortality.Results: Our review of the archives showed that a total of 34 patients (20 female; 14 male). Mean patient age was 59.3 +/- 13.8. The primary tumor was already diagnosed in 27 patients on admission. Pathological fractures seemed to occur at an average of 53.4 (+/- 44.5) months after primary diagnosis. Long-stemmed cemented arthroplasty was used in 15 patients and IM nail was used in 19 patients. Patients with IM nail were mobilized significantly earlier and hospitalization was shorter respectively (p=0.04, p=0.006). The need for a second surgical operation was statistically similar in the two groups (p=0.24). After an approximate follow-up of 26.5 +/- 21.9 months, the average Karnovsky score was similar (54.1 vs. 48.3; p=0.07). The patients who did not have a second skeletal system metastasis or other organ metastasis survived significantly longer (24.7 vs. 11.3; p=0.02).Conclusions: Shorter hospitalization and earlier mobilization can be in patients who were treated with an IM nail. Higher survival is expected for patients who do not have distant organ or skeletal system metastases at the time of surgically treating pathological fractures.