Surgical treatment of metastatic femoral fractures: achieving an improved quality of life for cancer patients.

BACKGROUND The femur is the most common long bone affected by metastatic carcinoma. We report our experience regarding treatment of metastatic femoral fracture using femoral head prosthesis (FHP) or intramedullary nailing (IM nail) with augmentation by polymethylmethacrylate (PMMA). PATIENTS AND METHODS Thirty-five complete fractures in 33 patients were treated surgically. Metastatic lesions were present in the femoral head to neck region (n=9), trochanteric to shaft region (n=23) and supracondular region (n=3). RESULTS Eight out of 9 patients with proximal femoral metastasis reconstructed by FHP were later able to walk outdoors. For the 11 patients with trochanteric metastasis, the short type of gamma nail was used for bony fixation. In two patients the inserted IM nails were broken. All other cases showed excellent clinical outcomes. For the 12 patients with femoral shaft metastasis, the long type of gamma nail was inserted. Nine cases showed excellent clinical outcomes without any serious complications. CONCLUSION FHP is indicated for metastases in the femoral head to neck region. IM nailing is best indicated when the lesion is located in the proximal to mid shaft and the patient's life expectancy is <6 month.