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Purpose <p>To present the clinical outcomes of pathologic femur fractures treated with retrograde intramedullary nails (rIMNs) and to compare outcomes to a matched antegrade IMN (aIMN) cohort.</p> Methods <p>We retrospectively reviewed pathologic femur fractures that underwent IMNs from 2014–2021. Clinical outcomes of patients undergoing rIMN were collected. The patients who received a rIMN were then propensity matched to aIMNs based on age, BMI, smoking status, pre-operative concomitant therapy, and post-operative concomitant therapy. Univariate analysis was conducted with Chi-square or Mann–Whitney U tests.</p> Results <p>19 patients who received rIMN for pathologic lesions were identified. 17 patients had complete fractures mostly in the distal diaphysis (15). No patients had local recurrence and six had progression of their disease. The 19 rIMN patients were matched to 19 patients who received an aIMN. The primary lesions included breast (<i>n</i> = 9, 24%), lung (<i>n</i> = 6, 16%), and kidney (<i>n</i> = 4, 11%). The rIMN cohort had more complete fractures compared to the aIMN cohort (17 vs. 5, <i>p</i> &lt; 0.001). There were no differences in rates of post-operative concomitant therapy. Six patients who underwent rIMN (32%) received peri-operative radiation therapy which included knee joint at an average dose of 28.6&#xa0;Gy. There were no documented cases of arthrofibrosis in the patients who received knee radiation. There were no differences in local recurrence, progression of disease, or revision surgeries across the cohorts (<i>p</i> &gt; 0.05).</p> Conclusion <p>The minimally invasive approach of rIMN for fixation of more distal lesions may have benefits of restoration of range of motion with low morbidity and mortality.</p> Level of evidence III <p>Retrospective Cohort Study.</p>

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Retrograde intramedullary nailing is an appropriate approach to pathologic femur fracture fixation: a retrospective analysis

  • 期刊论文

  • 发表日期：

    2025年7月8日

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  • Margaret A. Sinkler,
  • Jeremy M. Adelstein,
  • Luc M. Fortier,
  • John T. Strony,
  • Logan M. Good,
  • Ajay Mahenthiran,
  • Andrew Qi,
  • Rohan Patel,
  • Brandon Jonard

摘要

Purpose

To present the clinical outcomes of pathologic femur fractures treated with retrograde intramedullary nails (rIMNs) and to compare outcomes to a matched antegrade IMN (aIMN) cohort.

Methods

We retrospectively reviewed pathologic femur fractures that underwent IMNs from 2014–2021. Clinical outcomes of patients undergoing rIMN were collected. The patients who received a rIMN were then propensity matched to aIMNs based on age, BMI, smoking status, pre-operative concomitant therapy, and post-operative concomitant therapy. Univariate analysis was conducted with Chi-square or Mann–Whitney U tests.

Results

19 patients who received rIMN for pathologic lesions were identified. 17 patients had complete fractures mostly in the distal diaphysis (15). No patients had local recurrence and six had progression of their disease. The 19 rIMN patients were matched to 19 patients who received an aIMN. The primary lesions included breast (n = 9, 24%), lung (n = 6, 16%), and kidney (n = 4, 11%). The rIMN cohort had more complete fractures compared to the aIMN cohort (17 vs. 5, p < 0.001). There were no differences in rates of post-operative concomitant therapy. Six patients who underwent rIMN (32%) received peri-operative radiation therapy which included knee joint at an average dose of 28.6 Gy. There were no documented cases of arthrofibrosis in the patients who received knee radiation. There were no differences in local recurrence, progression of disease, or revision surgeries across the cohorts (p > 0.05).

Conclusion

The minimally invasive approach of rIMN for fixation of more distal lesions may have benefits of restoration of range of motion with low morbidity and mortality.

Level of evidence III

Retrospective Cohort Study.