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Expandable IM nail speeds recovery in patients with impending pathologic femoral fractures
Pain relief was comparable among patients who received the nail and those treated with a trochanteric nail.
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SAN DIEGO —Treating impending pathologic femoral fractures using an expandable nail may reduce postop hospitalization and speed functional recovery, according to a study presented here. Researchers also saw a trend for reduced pain levels during the immediate postoperative period, although the difference did not reach statistical significance, one of the study authors said.
Herrick Siegel, MD, and colleagues evaluated the impact of the intramedullary (IM) nail choice on stabilizing impending pathologic femoral fractures. The study included 50 patients randomly assigned to receive either the Synthes trochanteric locking femoral nail (28 patients) or the expandable Fixion proximal femoral nail (22 patients).
Siegel presented the results at the American Academy of Orthopaedic Surgeons annual meeting.
Patients included in the study had impending fractures located between the central trochanteric region and the distal diaphysis. Patients also had an osteolytic component and required narcotic medication to control pain, Siegel said.
"Our results show that there is significantly less postoperative narcotic requirements. It didn't reach statistical significance; we did see a trend, however, [with] 95.4% on postop day 1 ambulating with the expandable nail and only 28.6% with the locking nail," he said.
All patients treated with the expandable nail could be discharged by 3 days postop, compared with 61% of those treated with the trochanteric femoral nail, Siegel noted.
Length of hospitalization was also significantly shorter with the expandable nail and ranged from 1 to 3 days, compared to 2 to 6 days for patients treated with the trochanteric nail, he said.
Pain relief was not statistically significantly different between groups during the immediate postoperative period, "though we did see a reduction in the trend towards less requirements in the expandable nail group," Siegel said. However, a significance difference in narcotic requirements was noted at 2 weeks postop, which was also seen at 3 days postop.
"At 4 weeks postop, however, the groups were [similar] in terms of pain medication requirements, although there was a higher percentage of ambulating patients in the expandable nail group," Siegel said.
For more information:
- Siegel H, Kindl BT, Johnson C, Baird R. Impending pathologic fractures of the femur: the impact of intramedullary nail choice. #256. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18. 2007. San Diego.