Document Detail


Simultaneous nailing of skeletal metastases: is the mortality really that high?
MedLine Citation:
PMID:  21328019     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The risk of death during simultaneous nailing of pathologic and impending fractures in patients with metastatic disease is believed to be so high that some authors have advocated a staged approach, especially for impending fractures. However, there are limited data to either support or refute the appropriateness of staging of multiple impending or pathologic fractures.
QUESTIONS/PURPOSES: We therefore determined the rate of pulmonary mortality and morbidity in patients who underwent simultaneous nailing for metastatic disease of the skeleton.
METHODS: We retrospectively reviewed 16 patients who underwent simultaneous intramedullary nailing of impending or pathologic fractures between 1993 and 2009. There were 10 men and six women with a mean age of 60 years (range, 40-78 years). The intramedullary nailings included 15 femurs, 17 humeri, and one tibia. Thirty-one nails were reamed and two were unreamed.
RESULTS: Three of 16 patients died before discharge; two of these deaths were presumed to be the direct result of acute pulmonary complications related to simultaneous nailing and one was intraoperative. For the 13 patients who survived after discharge, there were three pulmonary complications. There were no intraoperative or perioperative deaths in the prophylactic nailing group.
CONCLUSIONS: Simultaneous nailing of impending and pathologic fractures can be performed with lower mortality rates than previously reported. Patients with impending fractures did not appear to be at higher risk than patients with pathologic fractures.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
Authors:
Bryan Moon; Patrick Lin; Robert Satcher; Valerae Lewis
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Publication Detail:
Type:  Journal Article     Date:  2011-02-17
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-06-30     Completed Date:  2011-09-30     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2367-70     Citation Subset:  AIM; IM    
Affiliation:
Department of Orthopaedic Oncology, MD Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402, USA. bsmoon@mdanderson.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bone Neoplasms / epidemiology,  mortality,  secondary*,  surgery*
Comorbidity
Female
Femoral Fractures / surgery*
Fracture Fixation, Intramedullary* / adverse effects
Fractures, Spontaneous / epidemiology,  surgery*
Humans
Humeral Fractures / surgery*
Male
Middle Aged
Orthopedic Procedures
Pulmonary Embolism / epidemiology
Retrospective Studies
Tibial Fractures / surgery
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