Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma
Purpose: Determine whether perioperative outcomes differ between patients who have undergone single or multi-stage IMN procedures for impending or completed pathologic fractures. Methods: Patients were classified into single-stage single-bone (SSSB), single-stage multiple-bone (SSMB), and multi-stag...
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MDPI AG
2023-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/4/1227 |
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| author | Aditya V. Maheshwari Andriy Kobryn Juhayer S. Alam Mikhail Tretiakov |
| author_facet | Aditya V. Maheshwari Andriy Kobryn Juhayer S. Alam Mikhail Tretiakov |
| author_sort | Aditya V. Maheshwari |
| collection | DOAJ |
| description | Purpose: Determine whether perioperative outcomes differ between patients who have undergone single or multi-stage IMN procedures for impending or completed pathologic fractures. Methods: Patients were classified into single-stage single-bone (SSSB), single-stage multiple-bone (SSMB), and multi-stage multiple-bone (MSMB) based on procedure timing and number of bones involved. Outcome variables compared included length of stay (LOS), in-hospital mortality and survival, initiation of rehabilitation and adjuvant therapy, and perioperative complications. Results: There were 272 IMNs placed in 181 patients (100 males, 81 females, 55.2% and 44.8%, respectively) with a mean age of 66.3 ± 12.1 years. MSMB had significantly longer LOS (24.3 ± 14.2 days) and rehabilitation initiation (3.4 ± 2.5 days) compared to SSSB (8.5 ± 7.7 and 1.8 ± 1.6 days) and SSMB (11.5 ± 7.6 and 2.0 ± 1.6 days) subjects, respectively (both; <i>p</i> < 0.01). Although total perioperative complication rates in SSMB and MSMB were comparable (33.3% vs. 36.0%), they were significantly higher than SSSB (18%) (<i>p</i> = 0.038). MSMB had significantly more (20%) cardiopulmonary complications than SSMB (11.1%) and SSSB (4.5%) (<i>p</i> = 0.027). All groups exhibited comparative survivorship (8.1 ± 8.6, 7.1 ± 7.2, and 11.4 ± 11.8 months) and in-hospital mortality (4.5%, 8.9%, and 4.0%) (all; <i>p</i> > 0.05). Conclusion: In comparison to MSMB, SSMB intramedullary nailing did not result in higher perioperative complication or in-hospital mortality rates in select patients with synchronous long-bone metastases but led to earlier postoperative discharge and initiation of rehabilitation. |
| first_indexed | 2024-03-11T09:01:33Z |
| format | Article |
| id | doaj.art-06a0c97b61a247bebc2f2c14be2b1d67 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T09:01:33Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-06a0c97b61a247bebc2f2c14be2b1d672023-11-16T19:38:02ZengMDPI AGCancers2072-66942023-02-01154122710.3390/cancers15041227Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple MyelomaAditya V. Maheshwari0Andriy Kobryn1Juhayer S. Alam2Mikhail Tretiakov3Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USADepartment of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USADepartment of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USADepartment of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USAPurpose: Determine whether perioperative outcomes differ between patients who have undergone single or multi-stage IMN procedures for impending or completed pathologic fractures. Methods: Patients were classified into single-stage single-bone (SSSB), single-stage multiple-bone (SSMB), and multi-stage multiple-bone (MSMB) based on procedure timing and number of bones involved. Outcome variables compared included length of stay (LOS), in-hospital mortality and survival, initiation of rehabilitation and adjuvant therapy, and perioperative complications. Results: There were 272 IMNs placed in 181 patients (100 males, 81 females, 55.2% and 44.8%, respectively) with a mean age of 66.3 ± 12.1 years. MSMB had significantly longer LOS (24.3 ± 14.2 days) and rehabilitation initiation (3.4 ± 2.5 days) compared to SSSB (8.5 ± 7.7 and 1.8 ± 1.6 days) and SSMB (11.5 ± 7.6 and 2.0 ± 1.6 days) subjects, respectively (both; <i>p</i> < 0.01). Although total perioperative complication rates in SSMB and MSMB were comparable (33.3% vs. 36.0%), they were significantly higher than SSSB (18%) (<i>p</i> = 0.038). MSMB had significantly more (20%) cardiopulmonary complications than SSMB (11.1%) and SSSB (4.5%) (<i>p</i> = 0.027). All groups exhibited comparative survivorship (8.1 ± 8.6, 7.1 ± 7.2, and 11.4 ± 11.8 months) and in-hospital mortality (4.5%, 8.9%, and 4.0%) (all; <i>p</i> > 0.05). Conclusion: In comparison to MSMB, SSMB intramedullary nailing did not result in higher perioperative complication or in-hospital mortality rates in select patients with synchronous long-bone metastases but led to earlier postoperative discharge and initiation of rehabilitation.https://www.mdpi.com/2072-6694/15/4/1227intramedullary nailingmetastatic long bone diseasesingle stagemultiple stagecardiopulmonary complications |
| spellingShingle | Aditya V. Maheshwari Andriy Kobryn Juhayer S. Alam Mikhail Tretiakov Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma Cancers intramedullary nailing metastatic long bone disease single stage multiple stage cardiopulmonary complications |
| title | Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma |
| title_full | Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma |
| title_fullStr | Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma |
| title_full_unstemmed | Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma |
| title_short | Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma |
| title_sort | single stage versus multi stage intramedullary nailing for multiple synchronous long bone impending and pathologic fractures in metastatic bone disease and multiple myeloma |
| topic | intramedullary nailing metastatic long bone disease single stage multiple stage cardiopulmonary complications |
| url | https://www.mdpi.com/2072-6694/15/4/1227 |
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