[Ortho] Pathologic Femur Fracture

[Pavel]

В дополнение к Роквуду я бы процитировал Malawer M. Musculoskeletal Cancer Surgery 2001, (Treatment of Metastatic Bone Disease, Femoral Shaft): "Generally, the most appropriate means of stabilizing impending or actual pathologic fractures of the femoral shaft is second-generation IM nails with locking capabilities proximally and distally. Combined osteosynthesis (i.e. plate-and-screw fixation and PMMA) may be successful; however, it is not preferred because of the risk of fracture proximal and distal to the plate, increased operative time, and the need for more extensive surgical exposure. IM rod fixation is generally done by the “open” method, i.e. the tumor/fracture site is exposed, the tumor is curetted, PMMA is injected proximal and distal, and the IM rod is inserted. The proximal and distal fragments are reamed of all gross disease to permit easy insertion of the PMMA and rod. A uniform cement mantle should be obtained around the rod. The need to open and visualize the tumor and augment it with PMMA is dependent on the size and degree of cortical destruction. Immediate ambulation with full weight-bearing is permitted within a few days after surgery. Pain relief is almost universal and approximately 90% of patients maintain ambulation."
Pavel