The current status of prophylactic femoral intramedullary nailing for metastatic cancer

Abstract

The most common site for cancer to spread is bone. At post-mortem, bony metastases have been found in 70% of patients dying from breast and prostate cancer. Due to the prevalence of cancer, bone metastasis and the associated management represents a huge burden on NHS resources. In patients with metastasis, around 56% of these involve the lower limb long bones. Due to the huge forces placed upon long bones during weight bearing, there is a high risk of fracture through areas of metastasis. It is reported that 23% of pathological fractures occur in the femoral subtrochanteric region. This area is subjected to forces up to four times the body weight, resulting in poor union rate for these fractures, and significant morbidity associated with difficulty in mobilising, and in patient nursing. As cancer treatments improve, the life expectancy in this subgroup of patients is likely to increase. Therefore medium-to-long-term management of these fractures, beyond the palliative, will become essential. We aim to evaluate the current management for metastatic malignant femoral disease, with particular focus on the prophylactic augmentation of diseased femorii using intramedullary nails.

Keywords: arthroplasty; internal fixation; intramedullary nailing; metastatic cancer; pathological fracture; prophylactic nailing.

Figure 1.. Harringtonʼs criteria for predicting risk of pathological fracture.

Figure 2.. Mirelsʼ scoring system for pathological fracture prediction.

Figure 3.. CT-based rigidity analysis (CTRA).