Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur

Abstract

Purpose: To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur. Materials and methods: The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years ± 13 (SD) (range: 35-82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score = 8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay. Results: No patients treated with RPOC had a fracture during a mean follow-up time of 382 days ± 274 (SD) (range: 11-815 days). RPOC was performed under general (n = 10) or locoregional (n = 2) anesthesia. The average duration of the procedure was 95 min ± 17 (SD) (range: 73-121 min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4 days ± 3 (SD) (range: 2-10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n = 7), VAS score decreased from 6.8 ± 1.2 (SD) (range: 5-9) before treatment, to 2.3 ± 1.1 (SD) (range: 1-4) one month later. Conclusion: Preventive RPOC for pathological fracture of the proximal femur is a reliable alternative for cancer patients who are not candidates for surgical stabilization. Studies involving more patients are needed to confirm our preliminary experience.