Functional outcomes and mortality in patients with actual pathological proximal femoral fractures treated with megaprosthesis.

IF 1.6 4区 医学
Journal of Orthopaedic Surgery Pub Date : 2025-09-01 Epub Date: 2025-09-16 DOI:10.1177/10225536251380326
Ebubekir Eravsar, Ali Güleç, Fatih Durgut, Serkan Yildirim, Bahattin Kerem Aydin
{"title":"Functional outcomes and mortality in patients with actual pathological proximal femoral fractures treated with megaprosthesis.","authors":"Ebubekir Eravsar, Ali Güleç, Fatih Durgut, Serkan Yildirim, Bahattin Kerem Aydin","doi":"10.1177/10225536251380326","DOIUrl":null,"url":null,"abstract":"<p><p>PurposeThe proximal femur is a region frequently affected by pathological fractures due to metastases. Partial head megaprostheses are among the surgical options that can be preferred for treating pathological fractures in this area. The aim of this study is to evaluate the impact of various factors on the functional outcomes and mortality of patients with actual proximal femoral fractures treated with a megaprosthesis.MethodsThe study included 28 patients. None of these patients had impending fractures; all of them had actual pathological fractures. Functional outcomes were assessed using VAS improvement, MSTS, and KPS scores, in relation to factors including age, cancer diagnosis before fracture, additional fracture, bone metastasis, visceral metastases, postoperative oncological treatment, preservation of the trochanter major, and type of cancer. These same factors were also considered in the survival analysis. The impact of knowing the cancer diagnosis prior to the fracture on time to surgery was also evaluated.ResultsPatients showed a mean VAS improvement of 5.8 ± 1.3, with median postoperative MSTS and KPS scores of 18 (range:12-23) and 65 (range:40-80), respectively. Younger patients had significantly better functional outcomes (<i>p</i> < 0.05). Other clinical factors had no significant effect on functions. Visceral metastases negatively impacted survival (<i>p</i> = 0.044), while younger age (<i>p</i> = 0.029), favorable cancer type (<i>p</i> < 0.001), and receiving postoperative oncological treatment improved survival (<i>p</i> = 0.049). Time to surgery was longer in patients without a prior cancer diagnosis (<i>p</i> < 0.001), though this did not affect survival (<i>p</i> = 0.888).ConclusionMegaprostheses in the treatment of actual metastatic fractures of the proximal femur provide excellent pain relief and satisfactory functional improvement. Functional outcomes were associated with age, while survival was influenced by age, cancer type, presence of visceral metastases, and whether postoperative oncological treatment was received. Although the preoperative time to surgery was longer in patients without a prior cancer diagnosis, survival was not affected by whether the diagnosis was known before the fracture.Level of EvidenceIV.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251380326"},"PeriodicalIF":1.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10225536251380326","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/16 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

PurposeThe proximal femur is a region frequently affected by pathological fractures due to metastases. Partial head megaprostheses are among the surgical options that can be preferred for treating pathological fractures in this area. The aim of this study is to evaluate the impact of various factors on the functional outcomes and mortality of patients with actual proximal femoral fractures treated with a megaprosthesis.MethodsThe study included 28 patients. None of these patients had impending fractures; all of them had actual pathological fractures. Functional outcomes were assessed using VAS improvement, MSTS, and KPS scores, in relation to factors including age, cancer diagnosis before fracture, additional fracture, bone metastasis, visceral metastases, postoperative oncological treatment, preservation of the trochanter major, and type of cancer. These same factors were also considered in the survival analysis. The impact of knowing the cancer diagnosis prior to the fracture on time to surgery was also evaluated.ResultsPatients showed a mean VAS improvement of 5.8 ± 1.3, with median postoperative MSTS and KPS scores of 18 (range:12-23) and 65 (range:40-80), respectively. Younger patients had significantly better functional outcomes (p < 0.05). Other clinical factors had no significant effect on functions. Visceral metastases negatively impacted survival (p = 0.044), while younger age (p = 0.029), favorable cancer type (p < 0.001), and receiving postoperative oncological treatment improved survival (p = 0.049). Time to surgery was longer in patients without a prior cancer diagnosis (p < 0.001), though this did not affect survival (p = 0.888).ConclusionMegaprostheses in the treatment of actual metastatic fractures of the proximal femur provide excellent pain relief and satisfactory functional improvement. Functional outcomes were associated with age, while survival was influenced by age, cancer type, presence of visceral metastases, and whether postoperative oncological treatment was received. Although the preoperative time to surgery was longer in patients without a prior cancer diagnosis, survival was not affected by whether the diagnosis was known before the fracture.Level of EvidenceIV.

大假体治疗病理性股骨近端骨折患者的功能结局和死亡率。
目的股骨近端是肿瘤转移所致病理性骨折的多发部位。部分头部大型假体是治疗该区域病理性骨折的首选手术选择之一。本研究的目的是评估各种因素对大假体治疗股骨近端骨折患者的功能结局和死亡率的影响。方法纳入28例患者。这些患者都没有即将发生骨折;他们都有病理性骨折。功能结果通过VAS改善、MSTS和KPS评分进行评估,与年龄、骨折前癌症诊断、额外骨折、骨转移、内脏转移、术后肿瘤治疗、大转子保存和癌症类型等因素相关。在生存分析中也考虑了这些相同的因素。在骨折前了解癌症诊断对手术时间的影响也进行了评估。结果患者VAS平均改善5.8±1.3,术后MSTS和KPS中位评分分别为18分(范围:12-23)和65分(范围:40-80)。年轻患者的功能预后明显较好(p < 0.05)。其他临床因素对功能无明显影响。内脏转移对生存有负面影响(p = 0.044),而年龄较小(p = 0.029)、有利的癌症类型(p < 0.001)和接受术后肿瘤治疗可改善生存(p = 0.049)。没有癌症诊断的患者手术时间更长(p < 0.001),但这并不影响生存(p = 0.888)。结论大型假体治疗股骨近端转移性骨折具有良好的疼痛缓解和功能改善效果。功能结局与年龄相关,而生存率受年龄、癌症类型、内脏转移的存在以及术后是否接受肿瘤治疗的影响。虽然术前没有癌症诊断的患者手术时间较长,但生存率不受骨折前是否知道诊断的影响。证据水平
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
91
期刊介绍: Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. It is the official journal of the Asia Pacific Orthopaedic Association. The journal welcomes and will publish materials of a diverse nature, from basic science research to clinical trials and surgical techniques. The journal encourages contributions from all parts of the world, but special emphasis is given to research of particular relevance to the Asia Pacific region.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信