title: Surgical treatment of metastatic tumors of the femur.
abstract: OBJECTIVE
  To evaluate the patients functional outcome and pain control after resection of metastatic femoral tumors.
  
  
  METHODS
  A prospective randomized clinical study was conducted, which included 26 cases of metastatic tumors of the femur with an associated pathologic fracture. These selected cases were randomly divided into two groups based upon the using of methylmethacrylate cement in fracture fixation. Group 1 (n=13) included all cases where the fractures were treated with bone cement augmentation. Group 2 (n=13) included all cases where the fractures were treated without bone cement augmentation. Functional outcome was evaluated according the American Musculoskeletal Tumor Society system.
  
  
  RESULTS
  Good and excellent pain control was achieved in 61.5%, satisfactory in 38.5% of all cases in the Group 1 versus 15.5% (P=0.015) and 69% (chi(2)=2.4762; P=0.115) of all cases in the Group 2. Functional outcome after femoral metastasis resection and pathologic fracture fixation was significantly better in the Group 1. Total lower extremity function of full normal function was 67% in the Group 1 versus 49% in the Group 2 (P<0.05). We did not observe significant difference between patients' postoperative survival in the groups (P>0.05). The postoperative durability of stable pathologic fracture fixation was shorter in the Group 2 (273.9+/-51.7 vs. 358.9+/-116.8 days) comparing with Group 1 (P=0.03).
  
  
  CONCLUSIONS
  The introduction of bone cement as the adjunct to the pathologic femoral fracture fixation significantly improved the clinical our study results: we achieved better functional outcome and better pain control.
authors.affiliation: Department of Orthopedics and Traumatology, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania. toliusisvytautas@gmail.com
authors.forename: Vytautas
authors.initials: V
authors.lastname: Toliusis
authors.forename: Romas Jonas
authors.initials: RJ
authors.lastname: Kalesinskas
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Kiudelis
authors.forename: Almantas
authors.initials: A
authors.lastname: Maleckas
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Griksas
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D001843:Bone Cements / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D005264:Femoral Fractures / Q000601:surgery*; D005266:Femoral Neoplasms / Q000556:secondary*; D005269:Femur / Q000502:physiology*; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D020366:Methylmethacrylate / Q000627:therapeutic use*; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
chemical_list: D001843:Bone Cements; D020366:Methylmethacrylate