title: Closed intramedullary nailing with percutaneous cement augmentation for long bone metastases.
abstract: OBJECTIVE
  The purpose of the study was to investigate whether closed intramedullary (IM) nailing with percutaneous cement augmentation is better than conventional closed nailing at relieving pain and suppressing tumours in patients with metastases of the femur and humerus.
  
  
  METHODS
  A total of 43 patients (27 men, 16 women, mean age 63.7 years, standard deviation (sd) 12.2; 21 to 84) underwent closed IM nailing with cement augmentation for long bone metastases. A further 27 patients, who underwent conventional closed IM nailing, served as controls. Pain was assessed using a visual analogue scale (VAS) score pre-operatively (pre-operative VAS), one week post-operatively (immediate post-operative VAS), and at six weeks post-operatively (follow-up post-operative VAS). Progression of the tumour was evaluated in subgroups of patients using F-18-fludeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) and/or bone scintigraphy (BS), at a mean of 8.8 and 7.2 months post-operatively, respectively.
  
  
  RESULTS
  The mean pain scores of patients who underwent closed nailing with cement augmentation were significantly lower than those of the control patients post-operatively (immediate post-operative VAS: 3.8, sd 0.9 versus 6.0, sd 0.9; follow-up post-operative VAS: 3.3, sd 2.5 versus 6.6, sd 2.2; all p < 0.001). The progression of the metastasis was suppressed in 50% (10/20) of patients who underwent closed nailing with augmentation, but in only 8% (1/13) of those in the control group.
  
  
  CONCLUSIONS
  Percutaneous cement augmentation of closed IM nailing improves the relief of pain and limits the progression of the tumour in patients with metastases to the long bones.
  
  
  CONCLUSIONS
  Percutaneous cement augmentation while performing closed IM nailing has some advantages for long bone metastases. Cite this article: Bone Joint J 2016;98-B:703-9.
authors.affiliation: Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: Y-I
authors.initials: YI
authors.lastname: Kim
authors.affiliation: National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
authors.forename: H G
authors.initials: HG
authors.lastname: Kang
authors.affiliation: National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
authors.forename: S-K
authors.initials: SK
authors.lastname: Kim
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Orthopaedic Oncology, 1400 Pressler Street, Houston, TX 77030, USA.
authors.forename: P P
authors.initials: PP
authors.lastname: Lin
authors.affiliation: Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D000072716:Cancer Pain / Q000209:etiology / Q000601:surgery; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D001843:Bone Cements
keywords: Bone metastasis; Cementoplasty; Intramedullary nail; Pathologic fracture; Positron emission tomography