JAAOS - 2026-07-01 - Journal Article
Long-Term Functional Outcomes and Survival Following Intramedullary Nailing of Pathological Diaphyseal Tibial Fractures.
Sood H, Gonzalez MR, Ubong SE, Lozano-Calderon SA
Topics
Key Takeaway
IMN for pathologic diaphyseal tibial fractures achieved 1-year survival of 48.7% and reduced median VAS pain scores from 38 to 6 at one month, with 73% achieving full weight-bearing by 3 months.
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Summary
This study asked whether IMN provides durable functional benefit for pathologic diaphyseal tibial fractures, a site representing only 3-7% of pathologic long bone fractures with historically poor survival. Thirty patients underwent IMN at two tertiary centers over 24 years; primary outcomes included survival, revision rates, VAS pain, weight-bearing status, ECOG scores, and Combined Pain and Ambulatory Function scale. Median survival was 8.9 months, 1-year survival was 48.7%, revision surgery was required in 10%, and full weight-bearing increased from 29% preoperatively to 73% at 3 months with sustained pain reduction at all follow-up intervals.
Key Limitation
The 24-year accrual window (2000–2024) means patients received markedly different systemic oncologic therapies across the cohort, making it impossible to isolate the effect of IMN from improvements in cancer management on survival and functional outcomes.
Original Abstract
BACKGROUND
Pathologic fractures of the tibia represent only 3% to 7% of all pathologic long bone fractures, with reported 12-month survival rates below 30%. Although intramedullary nailing (IMN) has become the preferred fixation strategy for pathologic fractures, data specific to tibial lesions remain limited, with existing studies including fewer than 10 patients and focusing primarily on survival or implant failure rather than functional outcomes.
METHODS
We conducted a retrospective review of 30 patients who underwent IMN for pathologic tibial fractures at two tertiary care academic medical centers between January 2000 and December 2024. Primary outcomes included overall survival, revision surgery rates, pain scores (visual analogue scale), weight-bearing status, Eastern Cooperative Oncology Group scores, and Combined Pain and Ambulatory Function scale measurements assessed longitudinally through 2-year follow-up.
RESULTS
Overall survival was 48.7% at 1 year and 38.3% at 2 years, with a median survival of 8.9 months. Three patients (10%) required revision surgery at a median of 13 months, with two patients (7%) ultimately requiring implant revision. Median pain visual analogue scale scores decreased markedly from 38 preoperatively to six at 1 month ( P = 0.005), with sustained improvement at all subsequent time points ( P < 0.01). The proportion of patients achieving full weight-bearing increased from 29% preoperatively to 73% at 3 months, whereas patients with good functional status (Eastern Cooperative Oncology Group 0 to 1) increased from 40% preoperatively to 75% at 6 months and 100% at 2 years.
CONCLUSION
IMN for pathologic tibial fractures provides durable pain relief, low complication rates, and meaningful functional recovery. These results support IMN as an effective palliative intervention that can markedly enhance the quality of life in this population.
LEVEL OF EVIDENCE
III.