Feasibility of a percutaneous technique for repairing proximal femora with simulated metastatic lesions.

Full Abstract

Fracture of the proximal femur due to metastatic disease is a significant cause of morbidity and mortality among breast cancer patients. Prophylactic surgical fixation is advised for patients at risk of fracture and typically involves placement of an orthopaedic implant. We propose that some proximal femora with metastases can be repaired by removing the lesion and filling the resulting defect with bone cement (polymethylmethacrylate), a procedure that could be performed percutaneously without the use of hardware. We studied the strengths of 12 matched pairs of cadaveric proximal femora under single-limb stance loading. One femur from each pair remained intact, while a simulated metastatic lesion, measuring approximately 75% of the neck diameter, was burred into the neck of the contralateral femur. The defects were repaired using a procedure similar to the one proposed. Femoral strength was measured via mechanical testing to failure. The strengths of the repaired femora averaged 94.7% of the strength of their respective contralateral intact femur (standard deviation, 8.7%). These findings suggest that the proposed procedure may be useful for some patients with metastases in the femoral neck. If the proximal femur could be safely repaired using the proposed technique in place of conventional surgical fixation, the patient would benefit from a shorter and less invasive surgical procedure, less pain and discomfort, greatly reduced recovery time, and a shorter hospital stay-all at a much lower cost.

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Author information

Author/s: Kaneko, Tadashi S (TS); Skinner, Harry B (HB); Keyak, Joyce H (JH);

Affiliation: Department of Orthopaedic Surgery, University of California, Irvine, B170 Medical Sciences I, Irvine, CA 92697, USA. tkaneko(-atsign-)uci.edu

Grants: 1-R21-CA79568-01 (Agency:NCI NIH HHS)

Journal and publication information

Publication Type: In Vitro; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.

Journal: Medical engineering & physics (Med Eng Phys), published in England. (Language: eng)

Reference: 2007-Jun; vol 29 (issue 5) : pp 594-601

Dates: Created 2007/03/06; Completed 2007/04/24; Revised 2007/12/03;

PMID: 16949854, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Aged, 80 and over
Bone Cements - therapeutic use
Cadaver
Feasibility Studies
Female
Femoral Fractures - etiology; physiopathology; therapy

Femoral Fractures - etiology; physiopathology; therapy
Femoral Neoplasms - complications; physiopathology; secondary; therapy
Fractures, Spontaneous - physiopathology; therapy
Humans
Male
Middle Aged
Treatment Outcome

Associated Chemicals: Bone Cements (0)

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