Long-Term Functional Outcomes and Survival Following Intramedullary Nailing of Pathological Diaphyseal Tibial Fractures

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