Pathological fractures of femur: A study of surgical management and monitoring using Lower Limb Functional Score and VAS Score

Vol 4 | Issue 2 | July-Dec 2019 | page: 7-10  | Sumeet S Shinde , Atul A Patil, Chetan Pradhan, Parag Sancheti


Authors: Sumeet S Shinde [1] , Atul A Patil [1], Chetan Pradhan [1], Parag Sancheti [1]

[1] Department of Orthopaedics, Sancheti Institute & Hospital Pune, Maharashtra, India.

Address of Correspondenc
Dr. Sumeet Shinde,
Sancheti Institute & Hospital Pune, Maharashtra, India
E-mail: meetshinde207@gmail.com


Abstract

Purpose: To analyze the results of surgical intervention for pathological fractures of femur.
Materials and Methods: All patients (n = 30) that underwent osteosynthesis or arthroplasty for pathological fractures of the femur between period extending from June 2015 to November 2016 were included. Data were recorded from the patients’ medical record and the outpatients’ clinics files. Primary and secondary tumors, metastases and types of pathological fractures, surgical procedures, and postoperative complications were recorded. Lower limb functional scale was used for functional evaluation at 1 year.
Results: There were 16 males and 14 females. Following pathologies were detected – 10 cases of Unicameral Bone Cyst (UBC); 5 cases of Aneurysmal Bone cyst (ABC); 2 cases of eosinophilic granuloma; 3 cases of fibrous dysplasia; 3 cases of osteosarcoma; 4 cases of multiple myeloma; 2 cases of metastases and 1 case of osteoid osteoma. Patients were treated with following surgical interventions – Application of compression plates – 9; Recon Nail – 8; Dynamic Hip Screw – 5; Hip arthroplasty– 6; Combination of nailing and plating – 2. In our study of 30 patients the mean VAS which was pre operatively- 9; was reduced to 4 at the end of 6 months and to 1 at end of 1 year. Thus showing satisfactory reduction in the pain intensity. The mean LLFS which was pre operatively 10.88 was improved to 45.55 at the end of 6 months and to 71.91 at end of 1 year. Thus showing satisfactory improvement in the lower limb function. Three postoperative complications occurred. 2 cases of superficial surgical site infection, and 1 case of death.
Conclusion: Surgical treatment of pathological fractures at the femur excellent pain relief and good functional outcome. Surgery is necessary for improving the functional outcome of such patients; however, more cases of pathological fractures should be studied for assessing the functional outcome.
Key Words: Proximal femur, Pathological fracture, Intramedullary nailing, Arthroplasty.


References

1. Steensma M, Boland PJ, Morris CD, Athanasian E, Healey JH. Endoprosthetic treatment is more durable for pathologic proximal femur fractures. Clin Orthop Relat Res. 2012;470:920–926
2. Harvey N, Ahlmann ER, Allison DC, Wang L, Menendez LR. Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop Relat Res. 2005;88:2011–1657.

3. Wedin R, Bauer H. Surgical treatment of skeletal metastatic lesions of the proximal femur: Endoprosthesis or reconstruction nail? J Bone Joint Surg Br. 2005;87:1653–1657.
3. Clarke HD, Damron TA, Sim FH (1998) Head and neck replacement endoprosthesis for pathologic proximal femoral lesions. Clin Orthop Relat Res 353:210–217
4. Capanna R, Campanacci DA (2001) The treatment of metastases in the appendicular skeleton. J Bone Joint Surg Br 83(4):471–481
5. Wedin R, Bauer HC (2005) Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br 87(12):1653–1657.
6. van Doorn R, Stapert JW (2000) Treatment of impending and actual pathological femoral fractures with the long Gamma nail in The Netherlands. Eur J Surg 166(3):247–254.
7. Sarahrudi K, Hora K, Heinz T, Millington S, Vecsei V (2006) Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients. Int Orthop 30(6):519–524.
8. Weber KL, Randall RL, Grossman S, Parvizi J (2006) Management of lower-extremity bone metastasis. J Bone Joint Surg Am 88(Suppl 4):11–1
9. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993:241-6.
10. Australian Physiotherapy Association Policy on outcome measures and treatment justification 2001;83:471-81.
11. Gabel CP Michener La Melloh M Burkett B Modification of the Upper Limb Functional Index to a three-point response improves clinimetric properties.J Hand Ther. 2010; 23:41–52
12. Hage WD, Aboulafia AJ, Aboulafia DM. Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am 2000;31:515-28.
13. Clarke HD, Damron TA, Sim FH. Head and neck replacement endoprosthesis for pathologic proximal femoral lesions. Clin Orthop Relat Res 1
14. Capanna R, Campanacci DA. The treatment of metastases in the appendicular skeleton. J Bone Joint Surg Br 2001;83:471-81.
15. Wedin R, Bauer HC. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br 2005;87:1653-7. 998:210-7
16. Van Doorn R, Stapert JW. Treatment of impending and actual pathological femoral fractures with the long Gamma nail in The Netherlands. Eur J Surg 2000;166:247-54.
17. Sarahrudi K, Hora K, Heinz T, Millington S, Vécsei V. Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients. Int Orthop 2006;30:519-24.
18. Steinbrink K. Total femoral prosthesis: 18 years experience in 147 cases. In: Tan SK, editor. Limb Salvage: Current trends. Singapore: International Society of Limb Salvage; 1993. p.411-2.
19. Ward WG, Johnston KS, Dorey FJ, Eckardt JJ. Loosening of massive proximal femoral cemented endoprostheses. Radiographic evidence of loosening mechanism. J Arthroplasty 1997;12:741-50.
20. Selek H, Başarir K, Yildiz Y, Sağlik Y. Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur. J Arthroplasty 2008;23:112-7.
21. Wedin R, Bauer HC, Rutqvist LE. Surgical treatment for skeletal breast cancer metastases: a population-based study of 641 patients. Cancer 2001;92:257-62.
22. Zacherl M, Gruber G, Glehr M, Ofner-Kopeinig P, Radl R, Greitbauer M, et al. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation. Int Orthop 2011;35:1537-43.
23. Piccioli A; Intramedullary nailing for treatment of pathologic femoral fractures due to metastases; Injury. 2014 Feb;45(2):412-7


How to Cite this Article: Shinde S. Pathological fractures of femur: A study of surgical management  and monitoring using Lower Limb Functional Score and VAS Score.  Journal of Orthopaedics and Rehabilitation  2019 July-Dec; 4(2): 07-10.

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