Comparison of Outcome in Surgical Treatment of Patients with Metastatic Impending and Pathological Fractures of Proximal Femur: Intramedullary vs. Extra Medullary Fixation
Keywords:
Metastatic bone tumor, Fracture, Fixation, Outcomes of surgery, Comparison of treatmentAbstract
Background: Metastatic bone tumors often result in debilitating fractures of the proximal femur, necessitating surgical intervention to alleviate pain and restore function. While intramedullary and extramedullary fixation techniques are commonly employed, their comparative effectiveness in achieving treatment goals remains uncertain. Objective: The purpose of this study was to compare treatment outcomes of metastatic bone tumor of proximal femur with fracture surgically treated at Rajavithi Hospital, by focusing on patients treated with intramedullary fixation and extramedullary fixation. The Musculoskeletal Tumor Society (MSTS) functional outcome score and post-operative complications between two groups were compared. Methods: Data record of patients with pathological fracture or impending fracture underwent surgery in Rajavithi Hospital. Collected data included baseline and post-operative data. Results: Forty cases of pathological proximal femur fracture or impending fracture were reviewed (18 males and 22 females), patients were categorized into intramedullary fixation (20 cases) and Extramedullary fixation (20 cases). Most recorded type of primary tumor was Breast cancer with a total number of 16 cases. Pathological fracture or impending fractures included 33 cases of intertrochanteric region, 4 cases of sub trochanteric region and 3 cases of proximal femoral shaft region. Mean MSTS score was 23.901.07 in intra- medullary fixation group and 19.70
1.13 in extramedullary fixation group. One case of post-operative wound infection was found in extramedullary fixation group. Conclusion: MSTS functional score was higher and intra-operative blood loss was significantly lesser in Intramedullary fixation group. No significant difference in postoperative complication was found. However, to be able to study more about outcomes, and other complications such as Implant survival and failure rates, higher number of patients and longer follow up period are required.
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