CENTROMEDULLARY NAILING OF THE METASTATIC FRAIL OR FRACTURED FEMUR: PATIENT BENEFIT AND PROGNOSIS SCORE

Purpose: Pluridisciplinary therapeutic management is well defined for metastatic long bones. There are few prognostic criteria enabling an evidence-based choice between palliative surgery or abstention. We report a series of 24 metastatic femurs treated by palliative surgery and evaluated with the Tokuyashi score.Material and methods: Sixteen women and eight men, mean age 71 years (5!-89) underwent centromedullary nailing of a metastatic femur (13/16 breast cancer in women, 20.24 other metastases. The Toskuhashi score was > 6 for 16/24 patients with pain unresponsive to morphine. Thirteen patients had fractured femurs and eleven had frail femurs due to the metastasis. Mean time to surgery was six days (1–15).Results: A solid nail was used for four patients and a reconstruction nail for twenty. Operative time was 93 minutes (57–123). Blood loss was 200 l (150–350). There no intraoperative complications (fat embolus) excepting one tulip femur. Hospital stay was 23 days (8–55). Survival was 148 days (8–510) ...