Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2010 Apr;23(2):187-193. Korean.
    Published online Apr 30, 2010.
    https://doi.org/10.12671/jkfs.2010.23.2.187
    Copyright © 2010 The Korean Fracture Society
    Original Article

    Surgical Treatment of Pathologic Humeral Fracture

    Ho Jung Kang, M.D., Byoung Yoon Hwang, M.D., Jae Jeong Lee, M.D., Kyu Ho Shin, M.D., Soo Bong Hahn, M.D. and Sung Jae Kim, M.D.
      • Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
    • Address reprint requests to: Byoung Yoon Hwang, M.D. Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250, Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-5679, Fax: 82-2-361-1139, Email: sogood95@yuhs.ac
    Received August 24, 2009; Revised December 15, 2009; Accepted January 12, 2010.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    To evaluate and analyze the radiographic and clinical outcomes after the surgical treatments of pathologic humeral fractures.

    Materials and Methods

    From October 1993 to September 2007, a retrospective investigation was conducted with a total of 13 patients who underwent operations for pathologic humeral fractures. The methods of surgical treatment were as follows-four cases of open reduction and internal fixation; eight cases of closed reduction and internal fixation with intramedullary nailing; and one of radical excision and hemiarthroplasty.

    Results

    Of nine patients with metastatic bone lesions, three were diagnosed with primary cancer after the incidence of pathologic humeral fracture. The mean period between the diagnosis of primary cancer and pathologic fracture in the latter six cases was 36.7 (2~144) months and the mean survival period after the surgical treatments was 22.8 (12~35) weeks in all patients with bone metastasis. Fracture unions were noted in all four cases of primary humeral bone lesion but none in metastatic cases. Pain relief and functional recovery were noted in eleven patients of this study.

    Conclusion

    Satisfactory clinical outcomes with sustained pain relief and functional recovery were observed after the surgical treatments of pathologic humeral fracture. Benign bone lesions require more active and early treatments in order to facilitate the functional recovery of upper extremities and fracture union. With pathologic humeral fractures originated from metastasis, palliative treatments were preferred to fracture union method for planning long-term pain relief and functional recovery.

    Keywords
    Humerus; Pathologic fracture; Surgical treatment

    Figures

    Fig. 1
    (A) A 51-year-old female had proximal humeral fracture from a slip down injury. Possible diagnosis was simple bone cyst, enchondroma, giant cell tumor or aneurismal bone cyst.

    (B) She was treated with closed reduction and intramedullary nailing.

    (C) After the surgical treatment, biopsy of fracture site was confirmed as giant cell tumor. One week after the primary operation, curettage and autoiliac bone graft were performed (Black arrow is an autologous iliac bone block).

    (D) The bone union was gained at 13 months after operation.

    Fig. 2
    (A) A 55-year-old male, with humerus shaft fracture from car accident 3 years ago, initially had an internal fixation, but a follow-up bone graft was carried out due to the continuous mal-union.

    (B) After his third operation with preoperative evaluation of lung mass, biopsy of fracture site was confirmed as pathologic fracture originated from lung cancer (White arrow is a lung mass).

    (C) At 5 months after closed reduction and IM nailing with bone graft, we found persistent non-union of humeral shaft. He died at 26 weeks after operation.

    Tables

    Table 1
    Modification of the rating system of Perez et al.

    Table 2
    Data of 4 cases with benign humeral lesion

    Table 3
    Data of 9 cases with metastatic humeral lesion

    References

      1. Bae SW, Kim WJ, Song BY, Choi NH, Lee JH. Postoperative functional assessments in adult humerus shaft fractures comparison among plates and screws, intramedullary nail and external fixatior. J Korean Soc Fract 2001;14:228–235.
      1. Brage ME, Simon MA. Evaluation, prognosis, and medical treatment considerations of metastatic bone tumors. Orthopedics 1992;15:589–596.
      1. Carlin BI, Andriole GL. The natural history, skeletal complications, and management of bone metastases in patients with prostate carcinoma. Cancer 2000;88 12 Suppl:2989–2994.
      1. Chao EYS, Sim FH, Shives TC, Pritchard DJ. Management of pathological fracture. In: Kim AH, editor. Diagnosis and management of metastatic bone disease. A multidisciplinary approach. New York: Raven Press; 1988. pp. 283-290.
      1. Chin HC, Frassica FJ, Hein TJ, et al. Metastatic diaphyseal fractures of the shaft of the humerus. The structural strength evaluation of a new method of treatment with a segmental defect prosthesis. Clin Orthop Relat Res 1989;(248):231–239.
      1. Damron TA, Sim FH, Shives TC, An KN, Rock MG, Pritchard DJ. Intercalary spacers in the treatment of segmentally destructive diaphyseal humeral lesions in disseminated malignancies. Clin Orthop Relat Res 1996;(324):233–243.
      1. Dijkstra S, Stapert J, Boxma H, Wiggers T. Treatment of pathological fractures of the humeral shaft due to bone metastases: a comparison of intramedullary locking nail and plate osteosynthesis with adjunctive bone cement. Eur J Surg Oncol 1996;22:621–626.
      1. Dijstra S, Wiggers T, van Geel BN, Boxma H. Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures. Eur J Surg 1994;160:535–542.
      1. Flemming JE, Beals RK. Pathologic fracture of the humerus. Clin Orthop Relat Res 1986;(203):258–260.
      1. Frassica FJ, Frassica DA. Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res 2003 415 Suppl:S212–S218.
      1. Friedl W. Indication, management and results of surgical therapy for pathological fractures in patients with bone metastases. Eur J Surg Oncol 1990;16:380–396.
      1. Galasko CSB. In: Skeletal metastases. London: Butterworth; 1986.
      1. Habermann ET, Lopez RA. Metastatic disease of bone and treatment of pathological fractures. Orthop Clin North Am 1989;20:469–486.
      1. Harrington KD, Sim FH, Enis JE, Johnston JO, Dick HM, Gristina AG. Methylmethacrylate as an adjunct in internal fixation of pathologic fractures. Experience with three hundred and seventyfive cases. J Bone Joint Surg Am 1976;58:1047–1055.
      1. Jacobson AF, Shapiro CL, Van den Abbeele AD, Kaplan WD. Prognostic significance of the number of bone scan abnormalities at the time of initial bone metastatic recurrence in breast carcinoma. Cancer 2001;91:17–24.
      1. Janjan N. Bone metastases: approaches to management. Semin Oncol 2001;28 4 Suppl 11:28–34.
      1. Kim JI, Yoo CI, Suh JT, Suh KT, Kim HT, Moon NH. Surgical treatment and prognostic factor for metastatic bone tumor. J Korean Orthop Assoc 2008;43:438–444.
      1. Kollender Y, Bickels J, Price WM. Metastatic renal cell carcinoma of bone: indications and technique of surgical intervention. J Urol 2000;164:1505–1508.
      1. Lancaster JM, Koman LA, Gristina AG, et al. Pathologic fractures of the humerus. South Med J 1988;81:52–55.
      1. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 1989;(249):256–264.
      1. Park SR, Lee TJ, Kim RS, Moon KH, You DS. Result of interlocking intramedullary nailing for humeral shaft fracture evaluation of post-operative shoulder function. J Korean Fract Soc 2007;20:166–171.
      1. Patel B, DeGroot H 3rd. Evaluation of the risk of pathologic fractures secondary to metastatic bone disease. Orthopedics 2001;24:612–617.
      1. Redmond BJ, Biermann JS, Blasier RB. Interlocking intramedullary nailing of pathological fractures of the shaft of the humerus. J Bone Joint Surg Am 1996;78:891–896.
      1. Sim FH, Frassica FJ, Chao EY. Orthopaedic management using new devices and prostheses. Clin Orthop Relat Res 1995;312:160–172.
      1. Sim FH, Prichard DJ. Metastatic disease in the upper extremity. Clin Orthop Relat Res 1982;(169):83–94.
      1. Townsend PW, Rosenthal HG, Smalley SR, Cozad SC, Hassanein RE. Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol 1994;12:2345–2350.
      1. Vail TP, Harrelson JM. Treatment of pathologic fractures of the humerus. Clin Orthop Relat Res 1991;(268):197–202.
      1. van der Hulst RR, van den Wildenberg FA, Vroemen JP, Greve JW. Intramedullary nailing of (impending) pathologic fractures. J Trauma 1994;36:211–215.
    Cited by
    Crossref 1
    Google Scholar 
    MeSH Terms
    Fractures, Spontaneous
    Hemiarthroplasty
    Humans
    Humeral Fractures
    Humerus
    Incidence
    Neoplasm Metastasis
    Palliative Care
    Retrospective Studies
    Upper Extremity
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide
    slide
    slide

    1 / 3

    PERMALINK