ESULTS OF MINIMALLY INVASIVE SURGICAL TREATMENT OF PATIENTS SUSCEPTIBLE TO PATHOLOGICAL FRACTURES DUE TO PROXIMAL FEMUR METASTASIS

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Abstract

Purpose. To study the effectiveness of minimally invasive surgical treatment of patients susceptible to pathological fractures due to proximal femur metastasis.

Materials and methods. A retrospective study was done for a group of 46 women of mean age 44.5 years (range 38 to 60 years). The histologic diagnosis of each patient was breast cancer. The overall survival of included patients was more than 18 months after intramedullary nailing and cement injection of the proximal femur. In first subgroup, 22 patients underwent intramedullary nailing and cement injection immediately after RF (radiofrequency) ablation. Second subgroup included 24 patients who underwent internal fixation of impending pathologic fractures without RF ablation. Pain relief was evaluated by visual analogue scale (VAS). Functional outcomes and life quality were assessed with MSTS and SF-36 scores.

Results. The authors obtained statistically significant differences in the scores dynamics on SF-36 scale.

Most of the patients continued comprehensive treatment as well as were receiving bisphosphonates after 18 months postoperatively. Hip function, assessed on MSTS scale, did not demonstrate statistically significant differences (83.2 for the first subgroup and 88.1 for the second). Pain syndrome in the early postoperative period was statistically lower in the first subgroup.

X-ray and CT examination of patients in the first subgroup revealed 2 cases of continued metastatic growth accompanied by cut-out syndrome, implant instability or severe pain. In the second subgroup, where prophylactic fixation was performed without radiofrequency ablation such complication was observed in 6 cases.

Conclusions. RF ablation and internal fixation of impending femoral pathologic fractures can be combined in one stage procedure. Such method proved feasibility and efficiency for treatment of osteolytic and mixed metastatic lesions of proximal femur with low incidence of implant-related complications and lower risk of revisions.

About the authors

R. M. Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg; Mechnikov North Western State Medical University, St. Petersburg

Email: fake@neicon.ru

Tikhilov Rashid M. - professor, director of Vreden Russian Research Institute of Traumatology and Orthopedics; professor of department of traumatology and orthopedics of Mechnikov NSMU

Russian Federation

D. A. Ptashnikov

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg; Mechnikov North Western State Medical University, St. Petersburg

Email: fake@neicon.ru

Ptashnikov Dmitry A. - professor, head of department N 18; the head of department of traumatology and orthopedics of Mechnikov NSMU 

Russian Federation

P. V. Grigoriev

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg

Author for correspondence.
Email: maddoc_pvg@mail.ru

Grigoriev Petr V. - research assistant of the department of bone tumors.

Ul. Akad. Baykova, 8, St. Petersburg, Russia, 195427; e-mail: maddoc_pvg@mail.ru Russian Federation

I. M. Mikailov

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg

Email: fake@neicon.ru

Mikailov Ilkin M. - research assistant of the department of bone tumors

Russian Federation

P. J. Zasulsky

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg

Email: fake@neicon.ru

Zasulsky PhilippJu. - leading researcher of the department of bone tumors

Russian Federation

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