{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:25:25Z","timestamp":1792736725067,"version":"4.5.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Subtrochanteric pathological fractures (PFs) occur in approximately one-third of femur bone metastases. We seek to analyze surgical treatment strategies for subtrochanteric metastatic PFs and their revision rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review was performed using the PubMed and Ovid databases. Reoperations as a result of complications were analyzed according to initial treatment modality, primary tumor site, and type of revision procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We identified a total of 544 patients, 405 with PFs and 139 with impending fractures. The study population's mean age was 65.85 years with a male\/female ratio of 0.9. Patients with subtrochanteric PFs who underwent an intramedullary nail (IMN) procedure (75%) presented a noninfectious revision rate of 7.2%. Patients treated with prosthesis reconstruction (21%) presented a noninfectious revision rate of 8.9% for standard endoprostheses and 2.5% for tumoral endoprostheses (p &lt; 0.001). Revision rates because of infection were 2.2% for standard and 7.5% for tumoral endoprostheses. There were no infections within the IMN and plate\/screws group (p = 0.407). Breast was the most common primary tumor site (41%) and had the highest revision rate (14.81%). Prosthetic reconstructions were the most common type of revision procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>No consensus exists regarding the optimal surgical approach in patients with subtrochanteric PFs. IMN is a simpler, less invasive procedure, ideal for patients with a shorter survival. Tumoral prostheses may be better suited for patients with longer life expectancies. Treatment should be tailored considering revision rates, patient's life expectancy, and surgeon's expertise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.22.00232","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T14:30:07Z","timestamp":1683210607000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":24,"title":["Surgical Management of Metastatic Pathologic Subtrochanteric Fractures"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0303-4903","authenticated-orcid":false,"given":"Maria L.","family":"Inchaustegui","sequence":"first","affiliation":[{"name":"Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7118-2353","authenticated-orcid":false,"given":"Kim","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3352-6362","authenticated-orcid":false,"given":"Marcos R.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4893-0341","authenticated-orcid":false,"given":"Juan","family":"Pretell-Mazzini","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Oncology, Miami Cancer Institute, Baptist Health System South Florida, Plantation, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,5]]},"reference":[{"key":"r1-20240731","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF00393714","article-title":"Prediction of pathological subtrochanteric fractures due to metastatic lesions","volume":"116","author":"Dijkstra","year":"1997","journal-title":"Arch Orthop Trauma Surg"},{"issue":"4","key":"r2-20240731","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S0020-1383(00)00218-7","article-title":"The treatment of impending and existing pathological femoral fractures using the long gamma nail","volume":"32","author":"Edwards","year":"2001","journal-title":"Injury"},{"issue":"S3","key":"r3-20240731","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1016\/S0020-1383(17)30658-7","article-title":"Is endoprosthesis safer than internal fixation for metastatic disease of the proximal femur? 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