Abstract

Radiotherapy and chemotherapy will result in an increase in the number of pathological fractures that occur, principally as a consequence of metastatic disease. Especially at the level of the femur, these lesions are painful and are apt to make the patient invalid. Aggressive surgery is often the only possible treatment for such patients, who in many cases may live on for several weeks, months or years. Contra-indications, however are: a survival expectancy of less than 4 weeks, a poor general condition that is an obstacle to a safe operation, or complete mental deterioration. If possible, internal fixation should be performed prophylactically before the real fracture occurs. From January 1980 to December 1990, 65 patients (53 women and 12 men) with 77 pathological fractures of the femur were operated on in the department of traumatology and emergency surgery of the Leuven University Hospital. The average age was 65 years. Metastatic spread from breast cancer was by far the most frequent pathology (75%). Sixty fractures out of the 77 (78%) occurred at the level of the proximal end of the femur in 29 cases (38%) the fracture was in the subtrochanteric region. In 6 cases a "prophylactic" osteosynthesis was performed because of an impending fracture. Endoprosthetic surgery was performed in 36 cases (47%). In 41 cases we performed osteosynthesis: 34 times a compound double-plate fixation, 5 times a gamma nail, 2 times an interlocking nail. Fourty-six patients (71%) obtained very reasonable functional results: they were able to walk again independently or with the help of sticks and crutches.(ABSTRACT TRUNCATED AT 250 WORDS)