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Pathological Femoral Shaft Fracture from Follicular Thyroid Carcinoma Managed with Cemented Spacer and Nailing: A Rare Case with 2-Year Follow-Up

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Case Report | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 125-128 | Suyog Wagh, Pradeep Nair, Shaligram Purohit, Arvind Goregaonkar, Aibin B Michael, Tushar Ramteke

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.800

Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 17 Aug 2025, Review Date: 12 Sep 2025, Accepted Date: 28 Nov 2025 & Published Date: 10 Dec 2025

Author: Suyog Wagh [1], Pradeep Nair [1], Shaligram Purohit [1], Arvind Goregaonkar [1], Aibin B Michael [1], Tushar Ramteke [1]

[1] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India

Address of Correspondence
Dr. Suyog Wagh,
Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
E-mail: suyogwagh6159@gmail.com

Abstract

Differentiated thyroid carcinoma (DTC) accounts for a small proportion of all malignancies but is among the cancers most frequently associated with bone metastasis, especially in the axial skeleton. Metastatic involvement of the appendicular skeleton is rare, and pathological fractures of the femoral shaft are even more uncommon. Follicular thyroid carcinoma (FTC), due to its angioinvasive nature, shows a markedly higher propensity for hematogenous spread to bone than papillary thyroid carcinoma. These lesions significantly impair mobility and quality of life, often necessitating surgical intervention when life expectancy is reasonable. We describe a rare case of a 45-year-old male with metastatic FTC who presented with a pathological fracture of the femoral shaft. After multidisciplinary evaluation, the patient underwent wide segmental resection of the diseased femur, followed by intramedullary interlocking nailing with polymethylmethacrylate (PMMA) cement augmentation. This strategy provided immediate structural stability, allowed early weight-bearing, and offered potential cytoreductive benefit from PMMA-induced thermal effects. Postoperative recovery was uneventful, with significant pain relief and restoration of full function within 6 weeks. At 2-year follow-up, the patient remained ambulatory without limitations, with stable local control and ongoing oncological management. This case highlights that aggressive surgical management with stable reconstruction can yield excellent functional outcomes in selected patients with metastatic FTC, particularly when presenting with pathological fractures of weight-bearing bones. Durable fixation, early mobilization, and individualized multidisciplinary planning are crucial in optimizing quality of life in advanced thyroid carcinoma with skeletal metastases.
Keywords: Follicular Thyroid Carcinoma, Bone Metastasis, Pathological Fracture, Intramedullary Nailing, Cement Augmentation

References

1. Nervo A, Ragni A, Retta F, Gallo M, Piovesan A, Liberini V, et al. Bone metastases from differentiated thyroid carcinoma: Current knowledge and open issues. J Endocrinol Invest 2021;44:403-19.
2. Pal P, Singh B, Kane S, Chaturvedi P. Bone metastases in follicular carcinoma of thyroid. Indian J Otolaryngol Head Neck Surg 2018;70:10-4.
3. Satcher RL, Lin P, Harun N, Feng L, Moon BS, Lewis VO. Surgical management of appendicular skeletal metastases in thyroid carcinoma. Int J Surg Oncol 2012;2012:417086.
4. Bernier MO, Leenhardt L, Hoang C, Aurengo A, Mary JY, Menegaux F, et al. Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas. J Clin Endocrinol Metab 2001;86:1568-73.
5. Stojadinovic A, Shoup M, Ghossein RA, Nissan A, Brennan MF, Shah JP, et al. The role of operations for distantly metastatic well-differentiated thyroid carcinoma. Surgery 2002;131:636-43.

How to Cite this Article: Wagh S, Nair P, Purohit S, Goregaonkar A, Michael AB, Ramteke T. Pathological Femoral Shaft Fracture from Follicular Thyroid Carcinoma Managed with Cemented Spacer and Nailing: A Rare Case with 2-Year Follow-UpJournal of Clinical Orthopaedics. July-December 2025;10(2):125-128.

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A systematic review and meta-analysis: Postoperative outcome comparison of intramedullary nailing and external fixation in charcot neuroarthropathy

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 60-63 | Cok Gde Oka Dharmayuda, Dewa Gede Bracika, Kenji Arnaya, Sri Mahadana, Putu Teguh Aryanugraha, Benedictus Deriano, Nariswati Anggapadmi Wiraputri, I Ketut Gede Surya Pranata

DOI:10.13107/jcorth.2022.v07i01.473

Author: Cok Gde Oka Dharmayuda [1], Dewa Gede Bracika [2], Kenji Arnaya [2], Sri Mahadana [2], Putu Teguh Aryanugraha [2], Benedictus Deriano [2], Nariswati Anggapadmi Wiraputri [2], I Ketut Gede Surya Pranata [2]

[1] Consultant of Orthopaedic and Traumatogy Department, Faculty of Medicine Udayana University, Indonesia.

[2] Resident of Orthopaedic and Traumatogy Department, Faculty of Medicine Udayana University, Indonesia.

Address of Correspondence
Dr. Cok Gde Oka Dharmayuda,
Diponegoro St., Dauh Puri Klod, Kec. Denpasar Bar., Kota Denpasar, Bali 80113, Indonesia.
E-mail: suthenoandrew@gmail.com

Abstract

Charcot neuropathic osteoarthropathy or neuroarthropathy of the foot and ankle is due to sensory and motor neuropathies which lead to a chronic and progressive destruction of the foot architecture involving bones, joints, and soft tissues. The aim of the present study was to compare the results of EF and retrograde IMN in ankle arthrodesis for patients with Charcot neuroarthropathy of the ankle joint. This study conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Literature Search was done on using the databases of PubMed, EMBASE, and Cochrane Library were systematically retrieved. From the selected databases, 205 references were obtained. By screening the titles and abstracts, 48 references were excluded The remaining potentially relevant 12 studies underwent a detailed and comprehensive evaluation. Finally, five studies were included in our meta-analysis. Based on the report in this meta-analysis, IMN could showed better results compared to EF for Charcot joint arthrodesis, with IMN showing higher rate of fusion, and lesser risk of complication.

Keywords: Systematic Review, Meta-analysis, Charcot Neuroarthropathy, Intramedullary Nailing, External Fixation

References

  1. Yammine K, Assi C. Intramedullary nail versus external fixator for ankle arthrodesis in Charcot neuroarthropathy: A meta-analysis of comparative studies. J Orthop Surg (Hong Kong) 2019;27:1-7.
  2. Cianni L, Bocchi MB, Vitiello R, Greco T, de Marco D, Masci G, et al. Arthrodesis in the Charcot foot: A systematic review. Orthop Rev (Pavia) 2020;12 Suppl 1:8670.
  3. Dayton P, Feilmeier M, Thompson M, Whitehouse P, Reimer RA. Comparison of complications for internal and external fixation for charcot reconstruction: A systematic review. J Foot Ankle Surg 2015;54:1072-5.
  4. Almaadany FS, Samadov E, Namazov I, Jafarova S, Ramshorst GH, Pattyn P, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study. Lancet 2020;396:27-38.
  5. Devries JG, Berlet GC, Hyer CF. A retrospective comparative analysis of charcot ankle stabilization using an intramedullary rod  with or without application of circular external fixator-utilization of the retrograde arthrodesis intramedullary nail database. J  Foot Ankle Surg 2012;51:420-5.
  6. Ettinger S, Plaass C, Claassen L, Stukenborg-Colsman C, Yao D, Daniilidis K. Surgical management of charcot deformity for the  Foot and ankle-radiologic outcome after internal/external fixation. J Foot Ankle Surg 2016;55:522-8.
  7. Richman J, Cota A, Weinfeld S. Intramedullary nailing and external ring fixation for tibiotalocalcaneal arthrodesis in charcot arthropathy. Foot Ankle Int 2017;38:149-52.
  8. Elalfy B, Ali AM, Fawzy SI. Ilizarov external fixator versus retrograde intramedullary nailing for ankle joint arthrodesis in diabetic charcot neuroarthropathy. J Foot Ankle Surg 2017;56:309-13.

 

How to Cite this article: Dharmayuda CGO, Bracika DG, Arnaya K, Mahadana S, Aryanugraha PT, Deriano B, Wiraputri NA, Pranata IKGS. A systematic review and meta-analysis: Postoperative outcome comparison of intramedullary nailing and external fixation in charcot neuroarthropathy. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):60-63.

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