OPERATIVE TREATMENT OF SKELETAL METASTASI S OF THE LOWER-LIMB USING THE AO-INTERLOCKING NAIL

Between January 1991 and June 1995 we have operated on 19 patients (9 male, 10 female) with 22 skeletal metastases of the lower limb (19 fem ora, 3 tibiae) using a static interlocking nail. Closed intramedullary nailing without resection of the metastasis has been established as o ur standard procedure. We have stabilized 15 patients with advanced os teolysis and seven pathological fractures. Sixteen patients underwent postoperative local radiation therapy with 40 Gy. As intraoperative co mplications we have observed one fracture of an osteolysis and one dea th due to fat embolism. Postoperatively there were observed one seroma , one haematoma and one patient with non fatal pulmonary embolism foll owing DVT. Two patients died within the first 30 postoperative days be cause of tumor progression. All patients surviving longer than 30 days could be mobilized under full weight-bearing Morphine like analgetics for metastasis related pain were no longer needed. A secondary instab ility has not been observed within a mean survival time of 199 days (8 11 longest follow up). Closed intramedullary nailing in combination wi th postoperative local radiation therapy seems to be an appropriate an d technically non demanding procedure to stabilize skeletal metastases of the lower limb in patients with a short or medium-term expectation of life.