Universidad Peruana Cayetano Heredia
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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