Two hundred eighty-three
pathologic fractures and 23 impending fractures of the hip and femur were analyzed and compared after surgical treatment. One hundred ninety-six fractures were treated by internal fixation or prosthetic replacement and the adjunctive use of
methylmethacrylate, and 110 were treated by surgery without the use of
methylmethacrylate.
Pain relief, ambulatory activities and survival rates were all enhanced in the
methylmethacrylate group. The six failures of fixation in the nonacrylic group might have been prevented by the use of
bone cement.
Breast carcinoma was the most common
metastasis, comprising 56% of the series. Kidney
metastases, when treated aggressively, showed many long-term survivors. Lung
metastases gave the worst prognoses. The overall series survival rates were 59% at six months and 48% at 12 months. The incidence of complications including
infection were not related to the use of
methylmethacrylate or preoperative radiation. Although many authors have reported the advantages of
methylmethacrylate in stabilization of
pathological fractures, none have compared the results by analyzing
pain relief, ambulatory ability and survival times in those treated with and without
bone cement. This study appears to clearly indicate that
methylmethacrylate enhances the stability of the
pathological fracture and contributes to achieving the goals of treatment in these severely compromised patients.