Comparative surgical invasiveness of internal fixation for pathological fractures in metastatic bone disease versus traumatic fractures: A quantitative analysis of operative time and blood loss

Objective The primary aim of this study was to compare the surgical invasiveness of internal fixation for pathological fractures caused by metastatic bone tumors with that for traumatic fractures. The secondary aim was to identify factors contributing to the complexity of surgeries for metastatic bone disease and provide insights for improving surgical strategies by analyzing operative time and blood loss. Methods Patients undergoing internal fixation for femoral fractures at 10 institutions between January 2021 and December 2023 were included. Traumatic and metastatic pathological fractures were analyzed, excluding patients aged <18 years and those with benign or atypical fractures. Factors influencing blood loss and operative time were assessed using univariate regression and multivariate modeling (P < 0.05). Results A total of 275 patients (male = 97, female = 178) with a mean age of 76 years were included. Patients had 230 traumatic and 45 metastatic fractures, with proximal fractures being the most common (n = 225). Intramedullary nailing was the predominant fixation method (n = 231). Blood loss and operative times were significantly affected by the fracture cause, site, and reduction procedures (P < 0.05). Metastatic, distal, or diaphyseal fractures and reduction procedures resulted in higher blood loss and longer operative times. Multivariate analysis confirmed these factors as significant predictors. Conclusions Surgeries for metastatic fractures are more invasive than those for traumatic fractures because of compromised bone integrity and procedural complexity. Operative time is a key indicator of surgical invasiveness, highlighting the need for tailored surgical approaches to manage metastatic bone disease effectively.