What is Prophylactic Femoral Nailing?
Benign or malignant tumors can develop in or spread to the femoral bone (thigh bone) causing progressive bone tissue destruction that can lead to a fracture. Prophylactic femoral nailing is a procedure to stabilize the femoral bone that has become weak due to the presence of a tumor. The procedure involves passing a nail or rod through the intramedullary canal or central canal of the bone to reinforce the bone along its entire length. Prophylactic femoral nailing can help treat pain and prevent loss of function.
Indications for Prophylactic Femoral Nailing
Your doctor will recommend prophylactic femoral nailing after considering a number of factors including the size and type of the tumor, its location, its radiographic features, the underlying diagnosis, your level of pain, and expected survival.
Diagnosis
To diagnose your condition, your symptoms and medical history are reviewed and a history and physical examination is performed. Diagnostic tests that may be ordered include X-rays, a bone scan, MRI, or CT scan. In certain cases, a biopsy of the lesion may be needed to make a clear diagnosis. If the tumor is a metastatic lesion, tests are performed to identify the primary site of the tumor. Tumors in the femur often originate in the prostate or the breast.
A proper diagnosis can influence how treatment is carried out. Some tumors are highly vascular and carry a risk of increased bleeding during surgery. Preoperative embolization (blocking off the supplying blood vessels) may be considered in such cases. Radiation may be recommended prior to surgery in other cases. Intramedullary femoral nailing may not be considered in certain types of bone tumors such as a sarcoma.
Treatment is coordinated with other specialists managing your care.
Procedure for Prophylactic Femoral Nailing
You will be lying on your back for the procedure and the leg to be operated is suitably positioned for access and imaging procedures. A full-length nail is introduced into the central femoral canal from the hip end of the bone through an incision made a little above the greater trochanter. An opening is made in the greater trochanter and the bone is reamed to allow insertion of the nail. The nail is guided into the canal under image guidance and supported by screws that extend into the femoral head and neck. Bonereamingsare sent to the laboratory for evaluation and confirmation of the diagnosis. The tissues are then closed and the incision is sutured.
Following the procedure, you will be evaluated and allowed to bear as much weight as tolerated on the leg. You will undergo precautionary measures to avoid the formation of blood clots that can travel to the lungs (pulmonary embolism).
Risks of Prophylactic Femoral Nailing
As with any procedure, prophylactic femoral nailing may be associated with certain risks and complications including:
- Infection
- Blood clots
- Pulmonary embolism
- Fat embolism (entry of bone marrow into the blood supply)
- Nerve and vessel injury
- Irritation from hardware
Benefits of the Procedure
Prophylactic femoral nailing fortifies the weakened bone with impending fracture. Stabilizing the bone in this manner also provides pain relief and is thus a palliative measure to improve quality of life.