Abstract
Purpose
This systematic review aims to provide an overview of functional outcome and complications after surgery for metastatic humerus fractures.
Methods
A literature search was performed in September 2013 using the Pubmed, Embase and Cochrane database. We included 23 studies reporting on 29 treatment arms: intramedullary nailing (19 studies, 596 cases), plate-screw fixation (five studies, 150 cases), endoprosthetic reconstruction (three studies, 81 cases), and diaphysis prosthesis (two studies, 82 cases), totalling 909 fractures. There were 414 pathological and 56 impending fractures. In 439 cases the type of fracture was not specified. Four studies reported functional outcome.
Results
Average Musculoskeletal Tumor Society score ranged from 64 to 79 (three studies, 100 patients) after intramedullary nailing, was 90 (one study, 24 patients) after plate-screw fixation, and 73 (one study, 30 patients) after endoprosthetic reconstruction. Re-operation rate varied from 0 to 10 % after intramedullary nailing (overall 4.4 %), 5–14 % after plate-screw fixation (overall 9.3 %), 14–16 % after diaphysis prosthesis (overall 14.6 %), and 0–6 % after endoprosthetic reconstruction (overall 2.5 %). Systemic complication rate varied between 0 and 26 % after intramedullary nailing (overall 2.2 %), between 0 and 6 % after plate-screw fixation (overall 4.8 %), was 0 % after endoprosthetic reconstruction, and varied between 0 and 16 % after diaphysis prosthesis (overall 9.7 %).
Conclusions
Reported complication rates help surgeons inform their patients and could aid in surgical decision making. Functional outcome, pain and quality of life were poorly reported. Patient reported outcomes are therefore an important direction for future research.
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References
Ratasvuori M, Wedin R, Keller J et al (2013) Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol 22:132–138
Toma CD, Dominkus M, Nedelcu T et al (2007) Metastatic bone disease: a 36-year single centre trend-analysis of patients admitted to a tertiary orthopaedic surgical department. J Surg Oncol 96:404–410
Bickels J, Dadia S, Lidar Z (2009) Surgical management of metastatic bone disease. J Bone Joint Surg Am 91:1503–1516
Steensma M, Healey JH (2013) Trends in the surgical treatment of pathologic proximal femur fractures among Musculoskeletal Tumor Society members. Clin Orthop Relat Res 471:2000–2006
Weiss KR, Bhumbra R, Biau DJ et al (2011) Fixation of pathological humeral fractures by the cemented plate technique. J Bone Joint Surg Br 93:1093–1097
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100
Gebhart M, Dequanter D, Vandeweyer E (2001) Metastatic involvement of the humerus: a retrospective study of 51 cases. Acta Orthop Belg 67:456–463
Dijkstra S, Stapert J, Boxma H et al (1996) 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 22:621–626
Dijkstra S, Wiggers T, van Geel BN et al (1994) 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 160:535–542
Flinkkila T, Hyvonen P, Lakovaara M et al (1999) Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases. Acta Orthop Scand 70:133–136
Flinkkila T, Hyvonen P, Leppilahti J et al (1998) Pathological fractures of the humeral shaft. Ann Chir Gynaecol 87:321–324
Sarahrudi K, Hora K, Heinz T et al (2006) Treatment results of pathological fractures of the long bones: a retrospective analysis of 88 patients. Int Orthop 30:519–524
Sarahrudi K, Wolf H, Funovics P et al (2009) Surgical treatment of pathological fractures of the shaft of the humerus. J Trauma 66:789–794
Vandeweyer E, Gebhart M (1997) Treatment of humeral pathological fractures by internal fixation and methylmetacrylate injection. Eur J Surg Oncol 23:238–242
Bickels J, Kollender Y, Wittig JC, Meller I, Malawer MM (2005) Function after resection of humeral metastases: analysis of 59 consecutive patients. Clin Orthop Relat Res 437:201–208
Kumta SM, Quintos AD, Griffith JF et al (2002) Closed retrograde nailing of pathological humeral fractures. Int Orthop 26:17–19
Piccioli A, Maccauro G, Rossi B et al (2010) Surgical treatment of pathologic fractures of humerus. Injury 41:1112–1116
Schurmann M, Gradl G, Andress HJ, Kauschke T, Hertlein H, Lob G (2000) Metastatic lesions of the humerus treated with the isoelastic diaphysis prosthesis. Clin Orthop Relat Res 380:204–214
Scotti C, Camnasio F, Peretti GM et al (2008) Modular prostheses in the treatment of proximal humerus metastases: review of 40 cases. J Orthop Traumatol 9:5–10
Siegel HJ, Lopez-Ben R, Mann JP et al (2010) Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement. J Bone Joint Surg Br 92:707–712
Talbot M, Turcotte RE, Isler M et al (2005) Function and health status in surgically treated bone metastases. Clin Orthop Relat Res 438:215–220
Thai DM, Kitagawa Y, Choong PF (2006) Outcome of surgical management of bony metastases to the humerus and shoulder girdle: a retrospective analysis of 93 patients. Int Semin Surg Oncol 3:5
Laitinen M, Nieminen J, Pakarinen TK (2011) Treatment of pathological humerus shaft fractures with intramedullary nails with or without cement fixation. Arch Orthop Trauma Surg 131:503–508
Ofluoglu O, Erol B, Ozgen Z et al (2009) Minimally invasive treatment of pathological fractures of the humeral shaft. Int Orthop 33:707–712
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246
Atesok K, Liebergall M, Sucher E et al (2007) Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol 14:1493–1498
Franck WM, Olivieri M, Jannasch O et al (2002) An expandable nailing system for the management of pathological humerus fractures. Arch Orthop Trauma Surg 122:400–405
Ingman AM, Waters DA (1994) Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results. J Bone Joint Surg Br 76:23–29
Lancaster JM, Koman LA, Gristina AG et al (1988) Pathologic fractures of the humerus. South Med J 81:52–55
Muller-Farber J, Muller KH (1997) The treatment of metastatic humeral lesions with the diaphyseal prosthesis. Aktuelle Traumatol 27:105–111
Redmond BJ, Biermann JS, Blasier RB (1996) Interlocking intramedullary nailing of pathological fractures of the shaft of the humerus. J Bone Joint Surg Am 78:891–896
Pretell J, Rodriguez J, Blanco D et al (2010) Treatment of pathological humeral shaft fractures with intramedullary nailing. A retrospective study. Int Orthop 34:559–563
Alvi HM, Damron TA (2013) Prophylactic stabilization for bone metastases, myeloma, or lymphoma: Do we need to protect the entire bone? Clin Orthop Relat Res 471:706–714
Bauze AJ, Clayer MT (2003) Treatment of pathological fractures of the humerus with a locked intramedullary nail. J Orthop Surg (Hong Kong) 11:34–37
Hunt KJ, Gollogly S, Randall RL (2006) Surgical fixation of pathologic fractures: an evaluation of evolving treatment methods. Bull Hosp Jt Dis 63:77–82
Piatek S, Westphal T, Bischoff J et al (2003) Intramedullary stabilisation of metastatic fractures of long bones. Zentralbl Chir 128:131–138
Wedin R, Hansen BH, Laitinen M et al (2012) Complications and survival after surgical treatment of 214 metastatic lesions of the humerus. J Shoulder Elbow Surg 21:1049–1055
Cheng EY (2003) Prospective quality of life research in bony metastatic disease. Clin Orthop Relat Res 415(Suppl):S289–297
Gibbons CER, Pope SJ, Murphy JP et al (2000) Femoral metastatic fractures treated with intramedullary nailing. Int Orthop 24:101–103
Kerr PS, Jackson M, Atkins RM (1993) Cardiac arrest during intramedullary nailing for femoral metastases. J Bone Joint Surg Br 75:972–973
Peter RE, Schopfer A, Le Coultre B et al (1997) Fat embolism and death during prophylactic osteosynthesis of a metastatic femur using an unreamed femoral nail. J Orthop Trauma 11:233–234
Beaton DE, Wright JG, Katz JN (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 87:1038–1046
Kennedy CA, Beaton DE, Smith P, Van Eerd D, Tang K, Inrig T, Hogg-Johnson S, Linton D, Couban R (2013) Measurement properties of the QuickDASH (Disabilities of the Arm, Shoulder and Hand) outcome measure and cross-cultural adaptations of the QuickDASH: a systematic review. Qual Life Res 22(9):2509–2547
Davis AM, Wright JG, Williams JI et al (1996) Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res Int J Qual Life Asp Treat Care Rehab 5:508–516
Clayer M, Davis A (2011) Can the Toronto Extremity Salvage Score produce reliable results when used online. Clin Orthop Relat Res 469:1750–1756
Slankamenac K, Graf R, Barkun J et al (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
Hawker GA, Mian S, Kendzerska T et al (2011) Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res 63(Suppl 11):S240–S252
Group. E (1990) EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 16:199–208
Conflict of interest
Dr. Janssen received funding from Stichting Anna Fonds and the Stichting Michael van Vloten Fonds during the conduct of the study. Dr. Schwab has received payments or benefits from Stryker and Biom’up, outside the submitted work. The other authors have nothing to disclose.
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Research performed at Massachusetts General Hospital, Boston, Massachusetts, United States of America.
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Janssen, S.J., Teunis, T., Hornicek, F.J. et al. Outcome of operative treatment of metastatic fractures of the humerus: a systematic review of twenty three clinical studies. International Orthopaedics (SICOT) 39, 735–746 (2015). https://doi.org/10.1007/s00264-014-2584-7
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DOI: https://doi.org/10.1007/s00264-014-2584-7