Treatment of impending pathological fractures of the femur with flexible intramedullary nails.

Thirty-nine patients with fifty impending pathological fractures of the femur were prophylactically stabilized with flexible intramedullary nails. Indications included lesions causing unremitting pain and either measuring greater than 2.5 cm in diameter or involving more than 50% cortical destruction. Painful lesions not meeting these radiographic criteria were also considered for prophylactic nailing if radiation therapy failed to relieve pain. Ninety-five percent of patients experienced marked pain relief after nailing, and 92% were ambulatory with or without assistive devices at discharge. Complications included one fracture at the nail insertion site and three cases with nondisabling knee pain. There were no infections.