Intramedullary stabilisation of metastatic fractures of long bones

Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept. Patients and methods: From 01.01.1995 to 30.08.200136 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n=11), femoral neck (n = 6), per- and subtrochanteric region (n = 12), femoral shaft (n = 10) and tibia (n = 2). Most of them were malignancies of the kidneys (n = 13), bronchi (n = 7) and breast (n = 6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery. Results: No intraoperative complications occurred. 63% of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95% Cl 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n = 1), soft tissue infection (n = 1), dislocation of the nail (n = 2), loosening of the distal locking screw (n=1), proceeding osteolysis with high fracture risk (n = 1). Conclusion: Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure is less invasive and allows early weight bearing.