Evidence map›Paper›PMID 40627028›Full record

ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025

Retrograde intramedullary nailing is an appropriate approach to pathologic femur fracture fixation: a retrospective analysis.

Margaret A Sinkler, Jeremy M Adelstein, Luc M Fortier, John T Strony, Logan M Good, Ajay Mahenthiran, Andrew Qi, Rohan Patel, Brandon Jonard

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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9 authors.

Margaret A SinklerDepartment of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, Cleveland, USA.
Jeremy M AdelsteinDepartment of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, Cleveland, USA. jeremy.adelstein2@UHhospitals.org.
Luc M FortierDepartment of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, Cleveland, USA.
John T StronyDepartment of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, Cleveland, USA.
Logan M GoodDepartment of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, Cleveland, USA.
Ajay MahenthiranCase Western Reserve University School of Medicine, Cleveland, USA.
Andrew QiCase Western Reserve University School of Medicine, Cleveland, USA.
Rohan PatelDepartment of Radiology, University Hospitals, Case Western Reserve University, Cleveland, USA.
Brandon JonardDepartment of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, Cleveland, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo present the clinical outcomes of pathologic femur fractures treated with retrograde intramedullary nails (rIMNs) and to compare outcomes to a matched antegrade IMN (aIMN) cohort.

methodsWe retrospectively reviewed pathologic femur fractures that underwent IMNs from 2014-2021. Clinical outcomes of patients undergoing rIMN were collected. The patients who received a rIMN were then propensity matched to aIMNs based on age, BMI, smoking status, pre-operative concomitant therapy, and post-operative concomitant therapy. Univariate analysis was conducted with Chi-square or Mann-Whitney U tests.

results19 patients who received rIMN for pathologic lesions were identified. 17 patients had complete fractures mostly in the distal diaphysis (15). No patients had local recurrence and six had progression of their disease. The 19 rIMN patients were matched to 19 patients who received an aIMN. The primary lesions included breast (n = 9, 24%), lung (n = 6, 16%), and kidney (n = 4, 11%). The rIMN cohort had more complete fractures compared to the aIMN cohort (17 vs. 5, p < 0.001). There were no differences in rates of post-operative concomitant therapy. Six patients who underwent rIMN (32%) received peri-operative radiation therapy which included knee joint at an average dose of 28.6 Gy. There were no documented cases of arthrofibrosis in the patients who received knee radiation. There were no differences in local recurrence, progression of disease, or revision surgeries across the cohorts (p > 0.05).

conclusionThe minimally invasive approach of rIMN for fixation of more distal lesions may have benefits of restoration of range of motion with low morbidity and mortality. LEVEL OF EVIDENCE III: Retrospective Cohort Study.

Indexed as

Bone NailsFemoral FracturesFracture Fixation, IntramedullaryFractures, SpontaneousAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeIntramedullary fixationIntramedullary nailingIntramedullary rodPathologic femur fracturesRetrograde

Identifiers

PMID40627028

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.