Faculty Collaboration Database

Retrograde intramedullary nailing is an appropriate approach to pathologic femur fracture fixation: a retrospective analysis. Eur J Orthop Surg Traumatol 2025 Jul 08;35(1):295

Date

07/08/2025

Pubmed ID

40627028

DOI

10.1007/s00590-025-04424-z

Scopus ID

2-s2.0-105010206549 (requires institutional sign-in at Scopus site)

Abstract

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.

Author List

Sinkler MA, Adelstein JM, Fortier LM, Strony JT, Good LM, Mahenthiran A, Qi A, Patel R, Jonard B

Author

Rohan K. Patel MPH, MD Assistant Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Bone Nails
Female
Femoral Fractures
Fracture Fixation, Intramedullary
Fractures, Spontaneous
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome