Intramedullary nail combined with auxiliary plate and bone cement in treatment of pathologic fracture of extremities caused by metastatic tumors_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DENG Linglong , YU Li , WEI Chi , WANG Bing ,  ZHU Shaobo

Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China;

Corresponding author：

ZHU Shaobo, Email: zhushaobo2000@163.com

Keywords：

Intramedullary nail; auxiliary plate; bone cement; tumor; extremities; pathologic fracture

DOI：

10.7507/1002-1892.201707047

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Objective To explore the application of intramedullary nail fixation combined with auxiliary plate and bone cement in the palliative treatment of pathologic fracture of extremities caused by metastatic tumors. Methods Clinical data of 11 cases with pathologic fracture of extremities caused by metastatic tumors between April 2015 and October 2016 were retrospectively analyzed. All the patients were treated by intramedullary nail fixation combined with auxiliary plate and bone cement. There were 6 males and 5 females with an age of 54-72 years (mean, 62.9 years). The disease duration was 1.0-1.5 months. Of the 11 patients, 4 metastatic tumors were diagnosed at humerus, 6 at femur, and 1 at tibia, respectively. And the tumor infiltration length ranged from 3.3 to 5.6 cm (mean, 4.6 cm), the depth could reach the bilayer of limb bones. All the patients had suffered the limbs pain and incapability of physical movement. The preoperative visual analogue scale (VAS) score was 6.36±1.03, and the Karnofsky Performance Status (KPS) score was 42.73±10.09. The operation time, intraoperative blood loss, and postoperative complications were recorded. The VAS score, KPS score, and Musculoskeletal Tumor Society (MSTS) score were used to evaluate the effectiveness at 3 months after operation. Results The operation time was 1.1-1.8 hours (mean, 1.5 hours), the intraoperative blood loss was 102.5-211.3 mL (mean, 135.6 mL). Postoperative limb incisions healed well without infection, necrosis, and delayed healing or other complications. All the patients were followed up 7-10 months (mean, 8.2 months). At 3 months after operation, the functions of limbs recovered. The VAS score decreased to 0.82±0.75 and the KPS score increased to 85.45±5.22, both showing significant difference when compared with preoperative ones (t=35.218, P=0.000; t=–18.470, P=0.000); and the MSTS score was 23.91±2.47. At last follow-up, the anteroposterior and lateral X-ray films showed that all the limbs healing well and no breakage of intramedullary nail and steel plate, or loosening in bone cement, limb shortening, malalignment, or other complications occurred. Conclusion In treating metastatic tumors of extremities, the combination of intramedullary nail fixation with auxiliary plate and bone cement will contribute to an invariable length and fixed location for limbs, resulting in biomechanical stability for skeleton. Under this premise, the tumor lesions can be eliminated and pathological pains be relieved, so as to improve patients’ life quality.

Citation： DENG Linglong, YU Li, WEI Chi, WANG Bing, ZHU Shaobo. Intramedullary nail combined with auxiliary plate and bone cement in treatment of pathologic fracture of extremities caused by metastatic tumors. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(12): 1442-1446. doi: 10.7507/1002-1892.201707047 Copy

1.	Kim YI, Kang HG, Kim JH, et al. Closed intramedullary nailing with percutaneous cement augmentation for long bone metastases. Bone Joint J, 2016, 98-B(5): 703-709.
2.	Miller BJ, Gao Y, Duchman KR. Does surgery or radiation provide the best overall survival in Ewing’s sarcoma? A review of the National Cancer Data Base. J Surg Oncol, 2017, 116(3): 384-390.
3.	Demir B, Yavuz U, Akpinar E, et al. A novel biological reconstruction of tibial bone defects arising after resection of tumors. Acta Orthop Traumatol Turc, 2016, 50(2): 248-254.
4.	Kim YI, Kang HG, Kim TS, et al. Palliative percutaneous stabilization of lower extremity for bone metastasis using flexible nails and bone cement. Surg Oncol, 2014, 23(4): 192-198.
5.	Egeland MT, Tarangen M, Shiryaeva O, et al. Evaluation of strategies for increasing response rates to postal questionnaires in quality control of nasal septal surgery. BMC Res Notes, 2017, 10(1): 189.
6.	Karnofsky DA, Burchenal JH. The clinical eraluation of chemotherapeutic agents in cancer//Macelod CM, eds. Evaluation of chemotherapeutic Agents. New York: Columbia University Press, 1994: 191-205.
7.	Xu L, Li X, Wang Z, et al. Functional evaluation for patients with lower extremity sarcoma: application of the Chinese version of Musculoskeletal Tumor Society scoring system. Health Qual Life Outcomes, 2017, 15(1): 107.
8.	Kamal AF, Widyawarman H, Husodo K, et al. Clinical Outcome and Survival of Osteosarcoma Patients in Cipto Mangunkusumo Hospital: Limb Salvage Surgery versus Amputation. Acta Med Indones, 2016, 48(3): 175-183.
9.	Schaser KD, Melcher I, Mittlmeier T, et al. Surgical management of vertebral column metastatic disease. Unfallchirurg, 2007, 110(2): 137-161.
10.	Stihsen C, Panotopoulos J, Puchner SE, et al. The outcome of the surgical treatment of pelvic chondrosarcomas: a competing risk analysis of 58 tumours from a single centre. Bone Joint J, 2017, 99-B(5): 686-696.
11.	Augat P, Hoegel F, Stephan D, et al. Biomechanical effects of angular stable locking in intramedullary nails for the fixation of distal tibia fractures. Proc Inst Mech Eng H, 2016, 230(11): 1016-1023.
12.	Deheshi BM, Jaffer SN, Griffin AM, et al. Joint salvage for pathologic fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res, 2007, 459: 96-104.
13.	Liu XW, Jin P, Liu K, et al. Comparison of percutaneous long bone cementoplasty with or without embedding a cement-filled catheter for painful long bone metastases with impending fracture. Eur Radiol, 2017, 27(1): 120-127.
14.	Yun HH, Lee YI, Kim KH, et al. Use of auxiliary locking plates for the treatment of unstable pertrochanteric femur fractures. Orthopedics, 2015, 38(5): 305-309.
15.	Heyland M, Duda GN, Haas NP, et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury, 2015, 46 Suppl 4: S24-32.
16.	Archdeacon MT, Wyrick JD. Reduction plating for provisional fracture fixation. J Orthop Trauma, 2006, 20(3): 206-211.
17.	Oh JK, Sahu D, Park JW, et al. Use of 2.0 mini plate system as reduction plate. Arch Orthop Trauma Surg, 2010, 130(10): 1239-1242.

1. Kim YI, Kang HG, Kim JH, et al. Closed intramedullary nailing with percutaneous cement augmentation for long bone metastases. Bone Joint J, 2016, 98-B(5): 703-709.
2. Miller BJ, Gao Y, Duchman KR. Does surgery or radiation provide the best overall survival in Ewing’s sarcoma? A review of the National Cancer Data Base. J Surg Oncol, 2017, 116(3): 384-390.
3. Demir B, Yavuz U, Akpinar E, et al. A novel biological reconstruction of tibial bone defects arising after resection of tumors. Acta Orthop Traumatol Turc, 2016, 50(2): 248-254.
4. Kim YI, Kang HG, Kim TS, et al. Palliative percutaneous stabilization of lower extremity for bone metastasis using flexible nails and bone cement. Surg Oncol, 2014, 23(4): 192-198.
5. Egeland MT, Tarangen M, Shiryaeva O, et al. Evaluation of strategies for increasing response rates to postal questionnaires in quality control of nasal septal surgery. BMC Res Notes, 2017, 10(1): 189.
6. Karnofsky DA, Burchenal JH. The clinical eraluation of chemotherapeutic agents in cancer//Macelod CM, eds. Evaluation of chemotherapeutic Agents. New York: Columbia University Press, 1994: 191-205.
7. Xu L, Li X, Wang Z, et al. Functional evaluation for patients with lower extremity sarcoma: application of the Chinese version of Musculoskeletal Tumor Society scoring system. Health Qual Life Outcomes, 2017, 15(1): 107.
8. Kamal AF, Widyawarman H, Husodo K, et al. Clinical Outcome and Survival of Osteosarcoma Patients in Cipto Mangunkusumo Hospital: Limb Salvage Surgery versus Amputation. Acta Med Indones, 2016, 48(3): 175-183.
9. Schaser KD, Melcher I, Mittlmeier T, et al. Surgical management of vertebral column metastatic disease. Unfallchirurg, 2007, 110(2): 137-161.
10. Stihsen C, Panotopoulos J, Puchner SE, et al. The outcome of the surgical treatment of pelvic chondrosarcomas: a competing risk analysis of 58 tumours from a single centre. Bone Joint J, 2017, 99-B(5): 686-696.
11. Augat P, Hoegel F, Stephan D, et al. Biomechanical effects of angular stable locking in intramedullary nails for the fixation of distal tibia fractures. Proc Inst Mech Eng H, 2016, 230(11): 1016-1023.
12. Deheshi BM, Jaffer SN, Griffin AM, et al. Joint salvage for pathologic fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res, 2007, 459: 96-104.
13. Liu XW, Jin P, Liu K, et al. Comparison of percutaneous long bone cementoplasty with or without embedding a cement-filled catheter for painful long bone metastases with impending fracture. Eur Radiol, 2017, 27(1): 120-127.
14. Yun HH, Lee YI, Kim KH, et al. Use of auxiliary locking plates for the treatment of unstable pertrochanteric femur fractures. Orthopedics, 2015, 38(5): 305-309.
15. Heyland M, Duda GN, Haas NP, et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury, 2015, 46 Suppl 4: S24-32.
16. Archdeacon MT, Wyrick JD. Reduction plating for provisional fracture fixation. J Orthop Trauma, 2006, 20(3): 206-211.
17. Oh JK, Sahu D, Park JW, et al. Use of 2.0 mini plate system as reduction plate. Arch Orthop Trauma Surg, 2010, 130(10): 1239-1242.

Chinese Journal of Reparative and Reconstructive Surgery

Intramedullary nail combined with auxiliary plate and bone cement in treatment of pathologic fracture of extremities caused by metastatic tumors

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