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Intramedullary Nailing pp 543–554Cite as

Pathological Fractures

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Abstract

Pathological fractures, which are suitable for nailing, are the result of disseminated metastatic disease. The femur and the humerus show the highest incidence of bone metastasis. The goal of treatment is not primarily curative. The implant is inserted in the biomechanical loading axis. The fracture site needs not always to be opened; surgical approach and technique are less invasive. The procedure mostly is well tolerated. Proximal and distal interlocking has to be done in healthy and strong bone to assure optimal stability. Tumor reduction at the fracture site should be considered to reduce the risk of embolization. The longest possible implant should be chosen. In the humerus, antegrade nailing is the procedure of choice. In the femur, implants with a femoral neck screw are the most appropriate. Simultaneous nailing of several pathological or impending fractures seems possible with a reasonable risk, but strict precautions should be taken in order to prevent systemic side effects. After nailing, a lower rate of hardware or fixation failure has been documented than in plate osteosynthesis. After successful nailing, the patients experience an important improvement of function with adequate pain relief.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Academic Teaching Hospital Fulda, Pacellialllee 4, Fulda, D-36043, Germany

    Martin H. Hessmann MD, PhD

  2. Center of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany

    Pol M. Rommens MD, PhD

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  1. Martin H. Hessmann MD, PhD
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  2. Pol M. Rommens MD, PhD
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Correspondence to Martin H. Hessmann MD, PhD .

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Editors and Affiliations

  1. Center for Orthopedics &Traumatology, University Medical Center Johannes Gutenberg University, Mainz, Germany

    Pol M. Rommens

  2. Academic Teaching Hospital Fulda, Fulda, Germany

    Martin H. Hessmann

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Hessmann, M.H., Rommens, P.M. (2015). Pathological Fractures. In: Rommens, P., Hessmann, M. (eds) Intramedullary Nailing. Springer, London. https://doi.org/10.1007/978-1-4471-6612-2_31

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  • DOI: https://doi.org/10.1007/978-1-4471-6612-2_31

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