TREATMENT OF PATHOLOGICAL (METASTATIC) PROXIMAL FEMORAL FRACTURES BY LONG GAMMA NAIL, AO NAIL AND DYNAMIC HIP SCREW

Abstract

Introduction: While recent guidelines for the treatment of such fractures do not recommend load-bearing devices, there is little evidence actually condemning them, and there is still a lack of literature on the reconstruction nails now generally used.

Aim: To evaluate the clinical outcome of pathological (metastatic) proximal femoral fractures treated by either a long Gamma nail, an AO nail with a spiral blade plate (AO-SBP), or a dynamic hip screw (DHS).

Method: Eighty-six operations in 80 patients with average age 63.9 years were followed for 18 months or until death. Thirty-one procedures were prophylactic.

Results: Thirty Gamma nails (three bilateral), 28 AO SBP rods (three bilateral) and 28 DHS were implanted. The DHS had complications in 10 cases (35%), all occurred in less than 14 months; three implants fractured, four cut out, and three failed to relieve symptoms. The Gamma nail group had two (7%) complications, both after 20 months; one nail fractured and the other lost fixation. The AO-SBP group had two (7%) complications, with one SBP misplacement, and one postoperative death after bilateral nailing. Pain relief and function were greatly improved by the nailing procedures in 57 out of 58 cases. Survival averaged 5.5 months, and was related to primary disease, and presence of visceral metastases.

Conclusion: Both the long Gamma and AO- SBP nails reliably treated metastatic proximal femoral fractures, but loss of fixation occurred with long-term survival. The DHS had a high complication rate when used in these cases, and we do not recommend its use.