title: Benefits of early intramedullary nailing in femoral metastases.
abstract: OBJECTIVE
  Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in prophylactic and therapeutic intramedullary nailing in femoral metastasic implants.
  
  
  METHODS
  Sixty-five patients with metastasis of the femur were analysed retrospectively (37 females; 28 males) between 1995 and 2011 (follow-up 15 months). Forty-four presented with pathological fractures and 21 impending fractures (Mirel ≥7). The operative treatments used were intramedullary fixation with reamed long Gamma nails. The studied parameters were survival, radiological and analytical findings, and functional outcomes.
  
  
  RESULTS
  Prophylactic nailing resulted in immediate postoperative deaths in 5% vs. 11.4% in therapeutic, and one technical complication was detected in each group. Among the surviving patients 75.9% of the fractures and 100 % of impending lesions were able to walk after the operation. The mean survival time was 11 months in the therapeutic (range 1-49) and 14 in the prophylactic group (1-34). The prophylactic intramedullary nails required a lower transfusion rate (1.4 concentrates vs. 3.0), mobilised earlier (day 4.0 vs. 9.7) and needed a shorter hospital stay (eight days vs. 16 days) compared to therapeutic nails (p < 0.05).
  
  
  CONCLUSIONS
  Femoral intramedullary nailing of metastasic lesions provides satisfactory results both clinically and radiologically. Early treatment of the metastases prevents fractures and gives better results, improving life quality of these patients.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology at Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040, Madrid, Spain, arviniuscamilla@hotmail.com.
authors.forename: Camilla
authors.initials: C
authors.lastname: Arvinius
authors.forename: Juan Luis Cebrián
authors.initials: JL
authors.lastname: Parra
authors.forename: Laura Serrano
authors.initials: LS
authors.lastname: Mateo
authors.forename: Roberto García
authors.initials: RG
authors.lastname: Maroto
authors.forename: Alberto Francés
authors.initials: AF
authors.lastname: Borrego
authors.forename: Luis López-Durán
authors.initials: LL
authors.lastname: Stern
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001858:Bone Nails; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome