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. 2016 Dec;8(4):458-464.
doi: 10.4055/cios.2016.8.4.458. Epub 2016 Nov 4.

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

Eun-Seok Choi  1 , Ilkyu Han  1 , Hwan Seong Cho  2 , In Woong Park  1 , Jong Woong Park  1 , Han-Soo Kim  1
Affiliations

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

Eun-Seok Choi et al. Clin Orthop Surg. 2016 Dec.

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.

Keywords: Humerus; Intrameullary nailing; Metastasis; Pathologic fracture.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
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.
Fig. 2
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.
Fig. 3
Fig. 3. Kaplan-Meier survival analysis. Forty-eight percent of patients survived more than 1 year after surgical treatment of metastasis.
Fig. 4
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.
See this image and copyright information in PMC

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