{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T20:00:29Z","timestamp":1770753629106,"version":"3.50.0"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 \u00b1 12.1 years. MSMB had significantly longer LOS (24.3 \u00b1 14.2 days) and rehabilitation initiation (3.4 \u00b1 2.5 days) compared to SSSB (8.5 \u00b1 7.7 and 1.8 \u00b1 1.6 days) and SSMB (11.5 \u00b1 7.6 and 2.0 \u00b1 1.6 days) subjects, respectively (both; p &lt; 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%) (p = 0.038). MSMB had significantly more (20%) cardiopulmonary complications than SSMB (11.1%) and SSSB (4.5%) (p = 0.027). All groups exhibited comparative survivorship (8.1 \u00b1 8.6, 7.1 \u00b1 7.2, and 11.4 \u00b1 11.8 months) and in-hospital mortality (4.5%, 8.9%, and 4.0%) (all; p &gt; 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.<\/jats:p>","DOI":"10.3390\/cancers15041227","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T02:31:23Z","timestamp":1676428283000},"page":"1227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma"],"prefix":"10.3390","volume":"15","author":[{"given":"Aditya V.","family":"Maheshwari","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9569-9285","authenticated-orcid":false,"given":"Andriy","family":"Kobryn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juhayer S.","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikhail","family":"Tretiakov","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2334","DOI":"10.1002\/cncr.22678","article-title":"Economic burden of metastatic bone disease in the U.S","volume":"109","author":"Ma","year":"2007","journal-title":"Cancer"},{"key":"ref_2","first-page":"1518","article-title":"Metastatic bone disease: Diagnosis, evaluation, and treatment","volume":"91","author":"Biermann","year":"2009","journal-title":"J. Bone Jt. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"87","DOI":"10.2147\/CLEP.S28339","article-title":"Estimated number of prevalent cases of metastatic bone disease in the US adult population","volume":"4","author":"Arneson","year":"2012","journal-title":"Clin. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1007\/s11999-011-2038-0","article-title":"Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases","volume":"470","author":"Harvey","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.injury.2013.09.025","article-title":"Intramedullary nailing for treatment of pathologic femoral fractures due to metastases","volume":"45","author":"Piccioli","year":"2014","journal-title":"Injury"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s11999.0000000000000065","article-title":"Early Improvement in Pain and Functional Outcome but Not Quality of Life After Surgery for Metastatic Long Bone Disease","volume":"476","author":"Nooh","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/CORR.0000000000001036","article-title":"Thirty-day Postoperative Complications After Surgery For Metastatic Long Bone Disease Are Associated With Higher Mortality at 1 Year","volume":"478","author":"Bindels","year":"2020","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cappellari, A., Trovarelli, G., Crim\u00ec, A., Pala, E., Angelini, A., Berizzi, A., and Ruggieri, P. (2020). New concepts in the surgical treatment of actual and impending pathological fractures in metastatic disease. Injury.","DOI":"10.1016\/j.injury.2020.11.025"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S230","DOI":"10.1097\/01.blo.0000093849.72468.82","article-title":"Metastatic Disease of the Femur: Surgical Treatment","volume":"415","author":"Ward","year":"2003","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_10","first-page":"302","article-title":"Mortality and complications following stabilization of femoral metastatic lesions: A population-based study of regional variation and outcome","volume":"52","author":"Ristevski","year":"2009","journal-title":"Can. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s00264-013-2108-x","article-title":"Benefits of early intramedullary nailing in femoral metastases","volume":"38","author":"Arvinius","year":"2014","journal-title":"Int. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e709","DOI":"10.5435\/JAAOS-D-18-00345","article-title":"Prophylactic Versus Postfracture Stabilization for Metastatic Lesions of the Long Bones","volume":"27","author":"Raad","year":"2019","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/000164700317413111","article-title":"The incidence of acute cardiorespiratory and vascular dysfunction following intramedullary nail fixation of femoral metastasis","volume":"71","author":"Barwood","year":"2000","journal-title":"Acta Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S245","DOI":"10.1097\/01.blo.0000093058.96273.1f","article-title":"Cardiopulmonary Complications of Intramedullary Fixation of Long Bone Metastases","volume":"415","author":"Choong","year":"2003","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/01.TA.0000082157.29723.16","article-title":"Pressurization of the Metastatic Femur During Prophylactic Intramedullary Nail Fixation","volume":"57","author":"Roth","year":"2004","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1097\/TA.0b013e3181622bca","article-title":"Surgical Treatment of Metastatic Fractures of the Femur: A Retrospective Analysis of 142 Patients","volume":"66","author":"Sarahrudi","year":"2009","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.2106\/JBJS.N.01067","article-title":"Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions","volume":"97","author":"Shallop","year":"2015","journal-title":"J. Bone Jt. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12957-016-0836-2","article-title":"Intramedullary nailing has sufficient durability for metastatic femoral fractures","volume":"14","author":"Tanaka","year":"2016","journal-title":"World J. Surg. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s00590-016-1857-9","article-title":"Treatment for long bone metastases based on a systematic literature review","volume":"27","author":"Errani","year":"2017","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.suronc.2018.05.028","article-title":"Predictors of survival after intramedullary nail fixation of completed or impending pathologic femur fractures from metastatic disease","volume":"27","author":"Kotian","year":"2018","journal-title":"Surg. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1007\/s11999.0000000000000201","article-title":"What Factors Are Associated With Implant Breakage and Revision After Intramedullary Nailing for Femoral Metastases?","volume":"476","author":"Willeumier","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3112","DOI":"10.1007\/s11999-015-4446-z","article-title":"2015 Marshall Urist Young Investigator Award: Prognostication in Patients With Long Bone Metastases: Does a Boosting Algorithm Improve Survival Estimates?","volume":"473","author":"Janssen","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1302\/0301-620X.75B6.8245094","article-title":"Cardiac arrest during intramedullary nailing for femoral metastases","volume":"75","author":"Kerr","year":"1993","journal-title":"J. Bone Jt. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1302\/0301-620X.76B3.8175873","article-title":"Cardiac arrest during nailing","volume":"76","author":"Charnley","year":"1994","journal-title":"J. Bone Jt. Surg."},{"key":"ref_25","first-page":"451","article-title":"Acute lung damage after bilateral insertion of femoral intramedullary interlocking nails for metastatic bone disease","volume":"161","author":"Roumen","year":"1995","journal-title":"Br. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/00005131-199704000-00018","article-title":"Fat Embolism and Death During Prophylactic Osteosynthesis of a Metastatic Femur Using an Unreamed Femoral Nail","volume":"11","author":"Peter","year":"1997","journal-title":"J. Orthop. Trauma"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1016\/j.injury.2006.08.037","article-title":"Fat embolism: Special situations Bilateral femoral fractures and pathologic femoral fractures","volume":"37","author":"Kontakis","year":"2006","journal-title":"Injury"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1007\/s11999-011-1814-1","article-title":"Simultaneous Nailing of Skeletal Metastases: Is the Mortality Really that High?","volume":"469","author":"Moon","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2","DOI":"10.4172\/2472-016X.1000125","article-title":"The Effects of Simultaneous Versus Staged Bilateral Femoral Intramedullary Nailing for Metastatic Disease on Survival Time and Perioperative Complications: A Systematic Review","volume":"4","author":"Raasck","year":"2018","journal-title":"J. Orthop. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3109\/17453679909000953","article-title":"Unreamed intramedullary nailing for pathological femoral fractures: Good results in 30 cases","volume":"70","author":"Giannoudis","year":"1999","journal-title":"Acta Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S0020-1383(99)00195-3","article-title":"Femoral nailing for metastatic disease of the femur: A comparison of reamed and unreamed femoral nailing","volume":"31","author":"Cole","year":"2000","journal-title":"Injury"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00003086-198912000-00027","article-title":"Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures","volume":"249","author":"Mirels","year":"1989","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/S0030-5898(05)70171-1","article-title":"Incidence, location, and diagnostic evaluation of metastatic bone disease","volume":"31","author":"Hage","year":"2000","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_34","first-page":"663","article-title":"An approach to the management of the patient with metastatic bone disease","volume":"53","author":"Weber","year":"2004","journal-title":"Instr. Course Lect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21590","article-title":"Cancer statistics, 2020","volume":"70","author":"Siegel","year":"2020","journal-title":"CA Cancer J. Clin."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1097\/BOT.0b013e31819f258a","article-title":"Intramedullary Nailing of the Femur: Current Concepts Concerning Reaming","volume":"23","author":"Rudloff","year":"2009","journal-title":"J. Orthop. Trauma"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3109\/17453671003635884","article-title":"Plate fixation or intramedullary fixation of humeral shaft fractures","volume":"81","author":"Heineman","year":"2010","journal-title":"Acta Orthop."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1097\/BOT.0000000000000287","article-title":"Reducing Subtrochanteric Femur Fractures","volume":"29","author":"Yoon","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.rbo.2017.10.012","article-title":"Tratamento de fraturas patol\u00f3gicas tumorais diafis\u00e1rias do \u00famero com haste intramedular r\u00edgida bloqueada est\u00e1tica\u2014Experi\u00eancia de 22 anos","volume":"54","author":"Moura","year":"2019","journal-title":"Rev. Bras. Ortop."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/BOT.0000000000002055","article-title":"Single-Stage versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients with Bilateral Femur Fractures: A Multicenter Retrospective Review","volume":"35","author":"Flagstad","year":"2021","journal-title":"J. Orthop. Trauma"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/4\/1227\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:35:59Z","timestamp":1760121359000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/4\/1227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,15]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["cancers15041227"],"URL":"https:\/\/doi.org\/10.3390\/cancers15041227","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,15]]}}}