BACKGROUND: Successful treatment of pathologic femur fractures can preserve a patient's independence and quality of life. The choice of implant depends on several disease- and patient-specific variables; however, its durability must generally match the patient's estimated life expectancy. Failures do occur, however, it is unclear which implants are associated with greater risk of failure. QUESTIONS/PURPOSES: We evaluated patients with femoral metastases in whom implants failed to determine (1) the rate of reoperation; (2) the timing of and most common causes for failure; and (3) incidence of perioperative complications and death. METHODS: From a prospectively collected registry, we identified 93 patients operated on for failed treatment of femoral metastases from 1990 to 2010. We excluded five patients who subsequently underwent amputations leaving 88 who underwent salvage procedures. These included intramedullary nails (n = 11), endoprostheses (n = 61), and plate fixation (n = 16). The primary outcome was reoperation after salvage treatment. RESULTS: Seventeen of the 88 patients (19%) required subsequent reoperation a median of 10 months (interquartile range, 4-14) from the time of salvage surgery: 15 for material failure, one for local progression of tumor, and one for a combination of these. Five patients died within 4 weeks of surgery. Although perioperative complications were higher in the endoprosthesis group and dislocations occurred, overall treatment failures after salvage surgery were lower in the that group (four of 61) compared the group with plate fixation (eight of 16) and intramedullary nail groups (five of 11). CONCLUSIONS: Despite relatively common perioperative complications, salvage using endoprostheses may be associated with fewer treatment failures as compared with internal fixation. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
BACKGROUND: Successful treatment of pathologic femur fractures can preserve a patient's independence and quality of life. The choice of implant depends on several disease- and patient-specific variables; however, its durability must generally match the patient's estimated life expectancy. Failures do occur, however, it is unclear which implants are associated with greater risk of failure. QUESTIONS/PURPOSES: We evaluated patients with femoral metastases in whom implants failed to determine (1) the rate of reoperation; (2) the timing of and most common causes for failure; and (3) incidence of perioperative complications and death. METHODS: From a prospectively collected registry, we identified 93 patients operated on for failed treatment of femoral metastases from 1990 to 2010. We excluded five patients who subsequently underwent amputations leaving 88 who underwent salvage procedures. These included intramedullary nails (n = 11), endoprostheses (n = 61), and plate fixation (n = 16). The primary outcome was reoperation after salvage treatment. RESULTS: Seventeen of the 88 patients (19%) required subsequent reoperation a median of 10 months (interquartile range, 4-14) from the time of salvage surgery: 15 for material failure, one for local progression of tumor, and one for a combination of these. Five patients died within 4 weeks of surgery. Although perioperative complications were higher in the endoprosthesis group and dislocations occurred, overall treatment failures after salvage surgery were lower in the that group (four of 61) compared the group with plate fixation (eight of 16) and intramedullary nail groups (five of 11). CONCLUSIONS: Despite relatively common perioperative complications, salvage using endoprostheses may be associated with fewer treatment failures as compared with internal fixation. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors: Rikard Wedin; Bjarne H Hansen; Minna Laitinen; Clement Trovik; Olga Zaikova; Peter Bergh; Anders Kalén; Gunnar Schwarz-Lausten; Fredrik Vult von Steyern; Anders Walloe; Johnny Keller; Rüdiger J Weiss Journal: J Shoulder Elbow Surg Date: 2011-10-07 Impact factor: 3.019
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Authors: Sophie R Merckaert; Christian D Fontanellaz-Castiglione; Eric D Fornari; Moritz Tannast Journal: Arch Orthop Trauma Surg Date: 2019-12-06 Impact factor: 3.067
Authors: Andrea Piccioli; M Silvia Spinelli; Jonathan A Forsberg; Rikard Wedin; John H Healey; Vincenzo Ippolito; Primo Andrea Daolio; Pietro Ruggieri; Giulio Maccauro; Alessandro Gasbarrini; Roberto Biagini; Raimondo Piana; Flavio Fazioli; Alessandro Luzzati; Alberto Di Martino; Francesco Nicolosi; Francesco Camnasio; Michele Attilio Rosa; Domenico Andrea Campanacci; Vincenzo Denaro; Rodolfo Capanna Journal: BMC Cancer Date: 2015-05-22 Impact factor: 4.430
Authors: Oliver E Bischel; Arnold J Suda; Paul M Böhm; Burkhard Lehner; Rudi G Bitsch; Jörn B Seeger Journal: J Clin Med Date: 2020-03-11 Impact factor: 4.241