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Clinical and radiological evaluation of fracture union in pathologic fractures after closed intramedullary nailing and adjuvant radiotherapy: A retrospective study

Okay Erhan (Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Orthopedics, Istanbul, Turkey), erhanokay@yahoo.com
Ozkan Korhan (Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Orthopedics, Istanbul, Turkey)
Karadag Zilan (Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Orthopedics, Istanbul, Turkey)
Celik Aykut (Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Orthopedics, Istanbul, Turkey)
Batibay Giray Sefa (Ankara Occupational and Environmental Diseases Hospital, Department of Orthopaedics, Ankara, Turkey)
Yildiz Yavuz (Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Orthopedics, Istanbul, Turkey)
Reddy Krishna (University of Cincinnati Medical Center, Department of Orthopedic Surgery, Cincinnati, Ohio, United States)
Spinelli Maria Silvia (Azienda Ospedaliera Istituto Ortopedico Gaetano Pini, Department of Orthopedic Oncology, Milano, Italy)

Introduction/Objective. Pathologic fractures are devastating complications in metastatic bone disease. Treatment of these condition varies, and includes systemic therapies and surgical interventions. Lack of evidence still exists for standardized care. The aim of this study is to analyze radiological healing response and clinical outcomes after intramedullary nailing (IMN) and adjuvant radiotherapy in complete pathologic fractures of femur or humerus Methods. A total of 19 patients who presented with pathological fracture were retrospectively reviewed. Data regarding demographic characteristics, clinical outcomes and radiologic images were obtained from hospital records. All patients in this cohort were treated with closed, unreamed IMN and adjuvant radiation treatment. Results. Pain relief and full range of motion was obtained in all patients. The mean postoperative Musculoskeletal Tumor Society scores at last follow-up were 69% (range 50–85). All patients demonstrated complete radiographic healing between 2 and 6 months. Only one patient required reoperation for refracture at the tip of the nail which was revised with a longer nail. Conclusion. Our study demonstrated that pathologic fractures managed with closed unreamed IMN and adjuvant multifractional 20 Gy dose radiotherapy yielded good clinical outcomes with complete radiologic response regardless of patient’s life expectancy, adjuvant treatments and overall condition. Closed unreamed IMN was also associated with decreased surgical time in these high-risk patients.

Keywords: pathologic fracture, intramedullary nailing, adjuvant radiotherapy, bone healing