• A pathological fracture increases the suffering of a patient, makes nursing care more difficult, predisposes the patient to hypostatic pneumonia and decubitus ulcers, and sometimes interferes with necessary treatment of the underlying disease. The insertion of an intramedullary nail contributes to the comfort and prolongs the life of the patient in some cases of this sort. Occasionally it is possible to anticipate a pathological fracture, as in cases of metastasis to the femur from tumors in the kidney, breast, or prostate. In one case of familial splenic anemia (lipid histocytosis of the kerasin type) intramedullary fixation was used prophylactically in each femur to control the patient's disabling pain in the thigh, and by this means pathological fracture was circumvented and the patient again made ambulatory. In two other cases of pathological fractures representing metastases of tumors elsewhere, the patients were not rendered ambulatory but their treatment was facilitated. Intramedullary fixation has its risks and limitations, but when it is applicable, it saves the patient much hospital time, confinement, and pain.
Johnson EW. INTRAMEDULLARY FIXATION OF PATHOLOGICAL FRACTURES. JAMA. 1957;163(6):417–419. doi:10.1001/jama.1957.02970410007003
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