From the Guidelines
Intramedullary nailing with a left femoral intramedullary rod is the preferred operative approach for metastatic long bone disease, providing a good functional result in approximately 80% to 85% of patients. This approach is generally recommended for patients with persistent or increasing local pain despite radiation therapy, a solitary well-defined lytic lesion circumferentially involving > 50% of the cortex, or involvement of the proximal femur associated with a fracture of the lesser trochanter 1. The procedure involves inserting a metal rod into the hollow medullary canal of the femur to stabilize and align the broken bone segments during healing.
Key considerations for this procedure include:
- Post-operative radiotherapy, which is commonly recommended regardless of the surgical procedure for bony metastases, and should be performed 2 to 4 weeks following the orthopedic procedure 1
- Pain management, which typically includes acetaminophen and possibly short-term opioids, as well as monitoring for signs of infection or blood clots
- Physical therapy to regain strength and mobility, starting with protected weight-bearing as tolerated with assistive devices like crutches or a walker, gradually progressing to full weight-bearing over 6-12 weeks as healing occurs.
It is essential to note that contraindications to surgical treatment of metastatic disease to long bones include a survival expectancy < 4 weeks and a poor general condition that is an obstacle to a safe operation 1. The use of intramedullary nailing with a left femoral intramedullary rod can significantly improve functional status and quality of life in patients with metastatic long bone disease, making it a crucial treatment option for patients with this condition.
From the Research
Left Femoral Intramedullary Rod
- The use of intramedullary nailing for the treatment of femoral shaft fractures has been well established, with studies showing high healing rates and low complication rates 2.
- A study published in 2014 found that the overall healing rate for femoral shaft fractures treated with intramedullary nailing was 93.6%, with a healing time of 19.36 +/- 6.1 weeks 2.
- The same study found that there were few major complications, including nonunion, delayed union, and rotational malunion, with no cases of infection 2.
- Another study published in 2022 found that intramedullary fixation offers greater biomechanical stability and reduced non-union rates compared to plate osteosynthesis, but is more prone to fat embolism and implant failure 3.
- The study also identified risk factors for implant failure, including the application of cerclage wires at the level of the fracture, infection, and the use of an additional sliding screw alongside the femoral neck screw 3.
- A case report published in 2006 described a rare complication of intramedullary femoral guide rod breakage during total knee arthroplasty, which was successfully treated with a flexible 9-mm end-cutting reamer 4.
- A systematic review published in 2019 found that intramedullary nailing for open diaphyseal femoral fractures had a high union rate of 97%, with a deep infection rate of 6% and a malunion rate of 8.4% 5.
- The review also found that Gustilo grade III injuries had a higher deep infection rate, and that strict adherence to established surgical debridement and fixation protocols is advocated 5.
- A study published in 2003 found that retention of the intramedullary nail is a viable option for the treatment of infection after intramedullary nailing of the femur, with all fractures healing within an average period of 9 months after surgical debridement 6.