Outcomes of Proximal Femoral Locking-plate Fixation for Pathological Fractures of the Proximal Femur

Kongkhet  Riansuwan; Somkiat Jivasomboonkul; Rapin  Phimolsarnti; Chandhanarat  Chandhanayingyong; Apichat  Asavamongkolkul

doi:10.33192/Smj.2021.78

Authors

Kongkhet Riansuwan Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Somkiat Jivasomboonkul Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Rapin Phimolsarnti Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Chandhanarat Chandhanayingyong Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Apichat Asavamongkolkul Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University

DOI:

https://doi.org/10.33192/Smj.2021.78

Keywords:

Outcomes; proximal femur, locking-plate fixation, pathological fracture, LCP® Proximal Femur Plate

Abstract

Objective: To study the treatment outcomes of proximal femoral locking-plate fixation of pathological fractures of
the proximal femur relative to clinical results, implant failure, and surgical complications.
Materials and Methods: From 2007 to 2018, 17 patients (18 femurs) with a diagnosis of impending or existing
pathological fracture of the proximal femur were treated with proximal femoral locking-plate fixation. Data collected
included operative duration, estimated blood loss, ambulatory status, hardware failure events, and postoperative
complications.
Results: Of the 18 femurs that were included, 13 were existing pathological fractures and 5 were impending fractures.
The mean age of patients was 53.7 years (range: 28-89), and 12 of them were female. The mean follow-up was 11.3
months (range: 1-67). Ten of 17 patients (62.5%) had progressive lung disease from pulmonary metastasis or from
lung primary. No patient developed oxygen desaturation or cardiac arrest during the intraoperative or postoperative
period. Thirteen of 17 patients (76.5%) could walk with or without an assistive device at the time of final follow-up.
Two patients required close postoperative monitoring in the intensive care unit due to poor preoperative status,
and both of those patients died within one month after surgery from other medical problems. No hardware failure
occurred.
Conclusion: For pathological fracture of the proximal femur, proximal femoral locking-plate fixation is a treatment
option that results in fewer perioperative and postoperative cardiopulmonary events and surgical complications.
Most patients can ambulate with or without an assistive device at the final follow-up.

References

Sharma H, Bhagat S, McCaul J, MacDonald D, Rana B, Naik M. Intramedullary nailing for pathological femoral fractures. J Orthop Surg. 2007;15:291–4.

Wangsaturaka P, Asavamongkolkul A, Waikakul S, Phimolsarnti R. The results of surgical management of bone metastasis involving the periacetabular area: Siriraj Experience. J Med Assoc Thai 2007;90:1006-13.

Fakler JKM, Hase F, Böhme J, Josten C. Safety aspects in surgical treatment of pathological fractures of the proximal femur – modular endoprosthetic replacement vs. intramedullary nailing. Patient Safety in Surgery. 2013;7:37. http://www.pssjournal.com/content/7/1/37.

Guzik G. Oncological and functional results after surgical treatment of bone metastases at the proximal femur. BMC Surgery. 2018;18:5. Doi:10.1186/s12893-018-0336-0.

Harrington KD. Orthopedic surgical management of skeletal complications of malignancy. Cancer. 1997;80 Suppl 8:1614–27.

Harvey N, Ahlmann ER, Allison DC, Wang L, Menendez LR. Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop. 2012;470:684–91.

Forward DP, Doro CJ, O’Toole RV, Kim H, Floyd JC, Sciadini MF, et al. A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma. 2012;26:334–40.

Ozkan K , Türkmen I , Sahin A, Yildiz Y, Erturk S, Soylemez MS. A Biomechanical Comparison of Proximal Femoral Nails and Locking Proximal Anatomic Femoral Plates in Femoral Fracture Fixation: A Study on Synthetic Bones. Indian J Orthop. 2015;49:347-51. Doi:10.4103/0019-5413.156220.

Tencer AF, Johnson KD, Johnston DW, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res. 1984;2:297–305.

Gibbons CER, Pope SJ, Murphy JP, Hall AJ. Femoral metastatic fractures treated with intramedullary nailing. Int Orthop. 2000; 24:101–3.

Tsuda Y, Yasunaga H, Horiguchi H, Fushimi K, Kawano H, Tanaka S. Complications and postoperative mortality rate after surgery for pathological femur fracture related to bone metastasis: Analysis of a nationwide database. Ann Surg Oncol. 2016;23:801–10. Doi:10.1245/s10434-015-4881-9.

Jamshidi K, Mirkazemi M, Izanloo A, Mirzaei A. Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population. Int Orthop. 2018;42:169-74. Doi:10.1007/s00264-017-3648-2.

Kushare IV, Colo D, Bakhshi H, Dormans JP. Fibrous dysplasia of the proximal femur: Surgical management options and outcomes. J Child Orthop. 2014;8:505-11. Doi:10.1007/s11832-014-0625-9.

Virkus WW, Miller BJ, Chye PC, Gitelis S. The use of locking plates in orthopaedic oncology reconstructions. Orthopaedics. 2008;31:438. Doi:10.3928/01477447-20080501-31.

Angelini A, Trovarelli G, Berizzi A, Pala E, Breda A, Maraldi M, Ruggieri P. Treatment of pathologic fractures of the proximal femur. Injury. 2018;49 Suppl 3:S77-S83. Doi:10.1016/j.injury. 2018.09.044.

Asavamongkolkul A, Waikakul S, Phimolsarnti R, Kiatisevi P, Wangsaturaka P. Endoprosthetic reconstruction for malignant bone and soft-tissue tumors. J Med Assoc Thai 2007; 90: 706-17.

Mirels H. Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 1989; 249: 256-64.

Bain GI, Zacest AC, Paterson DC, Middleton J, Pohl AP. Abduction strength following intramedullary nailing of the femur. J Orthop Trauma. 1997; 11:93–7.

Brumback RJ, Wells JD, Lakatos R, Poka A, Bathon GH, Burgess AR. Heterotopic ossification about the hip after intramedullary nailing for fractures of the femur. J Bone Joint Surg (Am). 1990; 72:1067–73.

Ozsoy MH, Basarir K, Bayramoglu A, Erdemli B, Tuccar E, Eksioglu MF. Risk of superior gluteal nerve and gluteus medius muscle injury during femoral nail insertion. J Bone Joint Surg (Am). 2007;89:829–34.

Högel F, Gerlach UV, Südkamp NP, Müller CA. Pulmonary fat embolism after reamed and unreamed nailing of femur fractures. Injury. 2010;41:1317–22.

Coles RE, Clements FM, Lardenoye JW, Wermeskerken GV, Hey LA, Nunley JA, et al. Transesophageal echocardiography in quantification of emboli during femoral nailing: reamed versus unreamed techniques. J South Orthop Assoc. 2000;9: 98–104.

Kerr PS, Jackson M, Atkins RM. Cardiac arrest during intramedullary nailing for femoral metastases. J Bone Joint Surg (Br). 1993;75:972–3.

Charnley G, Coleman NP, Hashemi-Nejad A. Cardiac arrest during nailing. J Bone Joint Surg (Br). 1994;76:506.

Selek H, Başarir K, Yildiz Y, Sağlik Y. Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur. J Arthroplasty. 2008;23:112–7.

Xie XT, Gao YS, Zhang CQ. Salvage of a femoral nonunion after primary non-Hodgkin’s lymphoma of bone: a case report and literature review. Med Sci Monit. 2011;17:138–43.

Glassner PJ, Tejwani NC. Failure of proximal femoral locking compression plate: a case series. J Orthop Trauma. 2011;25:76–83.

Wieser K, Babst R. Fixation failure of the LCP proximal femoral plate 4.5/5.0 in patients with missing posteromedial support in unstable per-, inter-, and subtrochanteric fractures of the proximal femur. Arch Orthop Trauma Surg. 2010;130:1281–7.