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Surgical Management of Metastatic Disease of the Proximal Part of the Femur

Issack, Paul S. MD, PhD; Barker, Jordan MD; Baker, Matthew MD; Kotwal, Suhel Y. MD; Lane, Joseph M. MD

Journal of Bone & Joint Surgery - American Volume: 17 December 2014 - Volume 96 - Issue 24 - p 2091–2098
doi: 10.2106/JBJS.N.00083
Current Concepts Review
Disclosures

➤ Pathologic fracture of the proximal part of the femur resulting from metastatic disease causes severe pain and an inability to walk. Surgical stabilization can be challenging because of bone loss resulting from the underlying metastatic lesions, the potential for major blood loss, and the poor health of the patient.

➤ The goal of surgical treatment is the creation of a stable construct to allow early weight-bearing.

➤ Pathologic femoral neck fractures secondary to metastases are best managed with arthroplasty.

➤ The treatment of intertrochanteric or subtrochanteric fractures is more controversial. Surgical stabilization may be performed with cephalomedullary nailing or arthroplasty. The choice of implant and operative technique is dependent on careful consideration of multiple factors, including the patient’s life span, the type of tumor, the perceived response to other therapies, the need for adjuvant radiation therapy and chemotherapy, the location and number of metastatic lesions, and the degree of bone involvement.

➤ While the potential for complications is high, surgical stabilization of the proximal part of the femur decreases pain and improves function.

1New York-Presbyterian Hospital, 170 William Street, New York, NY 10038. E-mail address: PSIssack@aol.com

2University of Missouri at Kansas City School of Medicine, 2301 Holmes Street, Kansas City, MO 64108

3Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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