Aharram S, Amghar J, Yahyaoui M, Agoumi O and Daoudi A
Introduction: The incidence of hip fractures in patients with a history of cancer
is expected to increase, whether the fracture is pathologic or not. This
study sought to answer two decision points: (1) what is the appropriate imaging
modality to determine if the fracture is pathologic? (2) Is Osteosynthesis
(OS) an appropriate technique in the management of femoral neck fractures
in patients with a history of cancer?
Materials and Methods: We did a retrospective review of patients presenting
with femoral neck fractures that underwent OS or Hemiarthroplasty (HA) at
a single oncologic referral center. 127 patients were identified, 109 underwent
HA and 18 underwent OS. Comparison of the imaging to the histological
analysis was performed to determine the accuracy, sensitivity, specificity,
Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the
various imaging modalities.
Results: Analysis of radiographic imaging demonstrated the addition of advanced
imaging improved the accuracy, sensitivity, specificity, PPV, and NPV
compared to radiographs alone. Both HA and OS offered durable reconstructive
options.
Discussion and Conclusion: Radiographs without advanced imaging for comparison
are incorrect 26% of the time; advanced imaging improves the accuracy.
Osteosynthesis is a durable reconstructive option in patients with a
history of cancer without an underlying pathologic fracture.