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Surgical Management of Metastatic Pathologic Subtrochanteric Fractures: Treatment Modalities and Associated Outcomes

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dc.contributor.author Inchaustegui Rivasplata, María Lucía
dc.contributor.author Ruiz Arellanos, Kim Indira
dc.contributor.author Gonzales, Marcos Roberto
dc.contributor.author Pretell-Mazzini, Juan
dc.date.accessioned 2023-06-12T16:25:56Z
dc.date.available 2023-06-12T16:25:56Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/13628
dc.description.abstract Background:Subtrochanteric pathological fractures (PFs) occur in approximately one-Third of femur bone metastases. We seek to analyze surgical treatment strategies for subtrochanteric metastatic PFs and their revision rates.Methods:A systematic review was performed using the PubMed and Ovid databases. Reoperations as a result of complications were analyzed according to initial treatment modality, primary tumor site, and type of revision procedure.Results:We identified a total of 544 patients, 405 with PFs and 139 with impending fractures. The study population's mean age was 65.85 years with a male/female ratio of 0.9. Patients with subtrochanteric PFs who underwent an intramedullary nail (IMN) procedure (75%) presented a noninfectious revision rate of 7.2%. Patients treated with prosthesis reconstruction (21%) presented a noninfectious revision rate of 8.9% for standard endoprostheses and 2.5% for tumoral endoprostheses (p < 0.001). Revision rates because of infection were 2.2% for standard and 7.5% for tumoral endoprostheses. There were no infections within the IMN and plate/screws group (p = 0.407). Breast was the most common primary tumor site (41%) and had the highest revision rate (14.81%). Prosthetic reconstructions were the most common type of revision procedure.Conclusion:No consensus exists regarding the optimal surgical approach in patients with subtrochanteric PFs. IMN is a simpler, less invasive procedure, ideal for patients with a shorter survival. Tumoral prostheses may be better suited for patients with longer life expectancies. Treatment should be tailored considering revision rates, patient's life expectancy, and surgeon's expertise.Level of Evidence:Level III. en_US
dc.language.iso eng
dc.publisher Journal of Bone and Joint Surgery
dc.relation.ispartofseries JBJS Reviews
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Surgical en_US
dc.subject Metastatic en_US
dc.subject Fractures en_US
dc.subject.mesh Cirugía General
dc.subject.mesh Metástasis de la Neoplasia
dc.subject.mesh Fractura-Luxación
dc.title Surgical Management of Metastatic Pathologic Subtrochanteric Fractures: Treatment Modalities and Associated Outcomes en_US
dc.type info:eu-repo/semantics/review
dc.identifier.doi https://doi.org/10.2106/JBJS.RVW.22.00232
dc.relation.issn 2329-9185


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