Percutaneous stabilization of impending pathological fracture of the proximal femur.
OBJECTIVE
Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur.


METHODS
We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score ≥8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients.


RESULTS
The mean Mirels' score was 9.8 ± 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 ± 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 ± 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days.


CONCLUSIONS
POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.
Interventional Radiology Department, Institut Gustave Roussy, 39 rue Camilles Desmoulins, 94805, Villejuif, France. frederic.deschamps@igr.fr
Frederic
F
Deschamps
Geoffroy
G
Farouil
Antoine
A
Hakime
Christophe
C
Teriitehau
Ali
A
Barah
Thierry
T
de Baere
D000328:Adult; D000368:Aged; D060826:Cementoplasty / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology* / Q000473:pathology*; D005266:Femoral Neoplasms / Q000150:complications*; D005598:Fractures, Spontaneous / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D016268:Internal Fixators; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome