Predictors of survival after intramedullary nail fixation of completed or impending pathologic femur fractures from metastatic disease

Ronak N Kotian; Varun Puvanesarajah; Sandesh Rao; Jad M El Abiad; Carol D Morris; Adam S Levin

doi:10.1016/j.suronc.2018.05.028

Predictors of survival after intramedullary nail fixation of completed or impending pathologic femur fractures from metastatic disease

Surg Oncol. 2018 Sep;27(3):462-467. doi: 10.1016/j.suronc.2018.05.028. Epub 2018 May 31.

Authors

Ronak N Kotian¹, Varun Puvanesarajah², Sandesh Rao³, Jad M El Abiad⁴, Carol D Morris⁵, Adam S Levin⁶

Affiliations

¹ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: rkotian1@jhmi.edu.
² Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: vpuvane1@jhmi.edu.
³ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: srao16@jhmi.edu.
⁴ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: jelabia1@jhmi.edu.
⁵ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: cmorri61@jhmi.edu.
⁶ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA. Electronic address: alevin25@jhmi.edu.

PMID: 30217303
DOI: 10.1016/j.suronc.2018.05.028

Abstract

Background: Surgical decision-making can be challenging when treating patients with osseous metastases. Numerous factors, including expected duration of survival, must be considered to ensure optimal operative stabilization of the affected bone. However, life expectancy of patients with metastatic carcinoma is often difficult to estimate. The goal of our study was to assess the associations of various clinical and demographic factors with survival time after intramedullary nail fixation of impending or completed pathologic femur fractures.

Methods: One hundred thirty-eight consecutive patients treated with intramedullary nail fixation for impending or completed pathologic femur fractures between 2005 and 2017 were included in this study. Factors related to patient survival were assessed with Cox multivariate survival analysis. For all analyses, p < 0.05 was considered significant.

Results: The median overall postoperative survival time was 8.4 months. Lower hemoglobin concentration (p = 0.001), lower albumin concentration (p = 0.002), and having a group 2 primary cancer (p = 0.001) were associated with shorter survival on multivariate analysis. When considering the subgroup of 88 prophylactically stabilized patients, lower hemoglobin concentration (p = 0.005), lower albumin concentration (p = 0.015), and having a group 2 primary cancer (p = 0.037) were predictive of shorter survival.

Conclusion: Several factors are associated with shorter survival after intramedullary nail fixation of pathologic femur fractures. These factors should be considered by orthopedic surgeons when educating patients and determining appropriate treatment.

Keywords: Carcinoma; Duration of survival; Femur fractures; Intramedullary nail fixation; Osseous metastases; Risk factors.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Bone Nails*
Bone Neoplasms / mortality*
Bone Neoplasms / secondary
Bone Neoplasms / surgery
Female
Femur / pathology
Femur / surgery*
Follow-Up Studies
Fractures, Spontaneous / mortality*
Fractures, Spontaneous / pathology
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Rate
Young Adult