Clin Orthop Surg.  2016 Dec;8(4):458-464. 10.4055/cios.2016.8.4.458.

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

• Choi ES
• Han I
• Cho HS
• Park IW
• Park JW
• Kim HS

• KMID: 2412330
• DOI: http://doi.org/10.4055/cios.2016.8.4.458

Abstract

BACKGROUND
Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes.
METHODS
We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes.
RESULTS
The mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up.
CONCLUSIONS
Proximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction.

Keyword

Humerus; Metastasis; Intrameullary nailing; Pathologic fracture

MeSH Terms

Adult
Aged
Aged, 80 and over
Bone Neoplasms
Female
Fracture Fixation, Intramedullary/*methods
Fractures, Spontaneous/diagnostic imaging/*surgery
Humans
Humeral Fractures/diagnostic imaging/*surgery
Humerus/diagnostic imaging/*surgery
Kaplan-Meier Estimate
Male
Middle Aged
Retrospective Studies

Figure

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  Fig. 1 (A) The anteroposterior (AP) radiograph of the humerus shows a lytic destructive lesion (arrow) with an impending fracture. (B) The coronal view of a T2-weighted magnetic resonance imaging scan shows a metastatic lesion extending to the humeral head. (C) The AP radiograph shows intramedullary rod fixation with cement augmentation and multiple proximal screws are used as a scaffold of cement.

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  Fig. 2 Change of preoperative and postoperative visual analogue scale (VAS) scores in proximal humerus metastasis. The mean improvement of VAS score (*) after surgery was 6.2.

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  Fig. 3 Kaplan-Meier survival analysis. Forty-eight percent of patients survived more than 1 year after surgical treatment of metastasis.

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  Fig. 4 Reconstruction of a long metastatic lesion using an intramedullary nail and cement. (A) A 69-year-old female with multiple myeloma presented with a long metastatic lesion ranging from the humeral head to the diaphysis. (B) The segmental defect was reconstructed using an intramedullary nail and cement. (C) Stable fixation was maintained for 18 months after reconstruction.

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