title: Surgical treatment of metastatic femoral fractures: achieving an improved quality of life for cancer patients.
abstract: BACKGROUND
  The femur is the most common long bone affected by metastatic carcinoma. We report our experience regarding treatment of metastatic femoral fracture using femoral head prosthesis (FHP) or intramedullary nailing (IM nail) with augmentation by polymethylmethacrylate (PMMA).
  
  
  METHODS
  Thirty-five complete fractures in 33 patients were treated surgically. Metastatic lesions were present in the femoral head to neck region (n=9), trochanteric to shaft region (n=23) and supracondular region (n=3).
  
  
  RESULTS
  Eight out of 9 patients with proximal femoral metastasis reconstructed by FHP were later able to walk outdoors. For the 11 patients with trochanteric metastasis, the short type of gamma nail was used for bony fixation. In two patients the inserted IM nails were broken. All other cases showed excellent clinical outcomes. For the 12 patients with femoral shaft metastasis, the long type of gamma nail was inserted. Nine cases showed excellent clinical outcomes without any serious complications.
  
  
  CONCLUSIONS
  FHP is indicated for metastases in the femoral head to neck region. IM nailing is best indicated when the lesion is located in the proximal to mid shaft and the patient's life expectancy is <6 month.
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Morishige
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan muramatu@yamaguchi-u.ac.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Muramatsu
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tominaga
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary* / Q000601:surgery; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Femur; intramedullary nailing; metastasis; physical status; polymethylmethacrylate; prognosis