Surg Oncol Clin Pract J | Volume 2, Issue 1 | Research Article | Open Access

Flexible Nail Capable of Bone Cement Injection for Minimally Invasive Surgery of Metastatic Bone Cancer

Hyun-Guy Kang1*, Yong-Il Kim2, June Hyuk Kim1, Jong Woong Park1, Patrick P Lin4 and Han Soo Kim3

1Department of Orthopaedic Oncology Clinic, National Cancer Center, Gyeonggi-do 10408, Korea
2Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
3Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
4Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 04750, Korea

*Correspondance to: Hyun-Guy Kang 

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Purpose: Surgical treatment for metastatic bone cancer is often performed using a minimally invasive technique considering the patient’s general health condition. Intramedullary nailing has been widely used for long bone metastases in limbs. However, intramedullary nailing may progress to bone destruction postoperatively due to intramedullary spreading of the tumor during the surgery.
Methods: We developed a titanium hollow flexible nail with multiple side holes in the tip to prevent this situation. This new implant is capable of injecting drug or bone cement while inserting a percutaneous nail. When the nail tip is located in the metastatic cancer lesion, the bone cement injection is started and continued until the nail is seating completely.
Results: The mean operative time from skin incision to closure was 42 min (range, 36 min to 52 min). The mean length of the injection nail was 23.0 cm (range, 18.0 cm to 33.0 cm), and mean volume of cement used was 28.0 ml (range, 14.0 ml to 40.0 ml). Marked pain palliation was verified 1 week postoperatively and had improved after 6 weeks (P=0.001). The mean MSTS functional score improved significantly from 12.5 (41.7%) at 6 weeks preoperatively to 24.9 (83.0%) postoperatively. No thromboembolism or cement embolism was encountered. No multi-holed injection nails breakage and no further intramedullary osteolysis of operative bone was observed. Conclusions: This minimally invasive surgical method with a multi-holed injection nail could be useful for earlier stabilization of long bone metastases in patients with advanced cancer.


Multi-holed injection nail; Bone cement; Minimally invasive surgery; Bone metastasis


Kang H-G, Kim Y-I, Kim JH, Park JW, Lin PP, Kim HS. Flexible Nail Capable of Bone Cement Injection for Minimally Invasive Surgery of Metastatic Bone Cancer. Surg Oncol Clin Pract J. 2017;2(1):1006.

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