Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur.

Purpose

To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur.

Materials and methods

The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years ± 13 (SD) (range: 35–82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score ≥ 8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay.

Results

No patients treated with RPOC had a fracture during a mean follow-up time of 382 days ± 274 (SD) (range: 11–815 days). RPOC was performed under general (n = 10) or locoregional (n = 2) anesthesia. The average duration of the procedure was 95 min ± 17 (SD) (range: 73–121 min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4 days ± 3 (SD) (range: 2–10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n = 7), VAS score decreased from 6.8 ± 1.2 (SD) (range: 5–9) before treatment, to 2.3 ± 1.1 (SD) (range: 1–4) one month later.

IMACTIS Ct-Navigation™ was used for needle positionning.

Conclusion

Preventive RPOC for pathological fracture of the proximal femur is a reliable alternative for cancer patients who are not candidates for surgical stabilization. Studies involving more patients are needed to confirm our preliminary experience.

Publication

Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur, E. Mavrovi, J.-B. Pialat, H. Beji, A.-C.Kalenderian, G. Vaz, B. Richioud

Published on Elsevier, Diagnostic and Interventional Imaging, Volume 98, Issue 6, June 2017, Pages 483-489