Taking into consideration the conflicting information in the literature, it is the authors opinion that the orthopedic surgeon treating metastatic skeletal lesions should have a relatively low threshold for prophylactic fixation of proximal femur lesions. Any lesion between the lesser trochanter and the femoral head causing functional pain or larger than 2.5 cm should be fixed prophylactically. Pathologic fractures in this location produce serious morbidity. The operative procedures applicable to the proximal femur are familiar to all practicing orthopedic surgeons. The benefit of prophylactic fixation significantly outweigh the risks of surgery.
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