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Outcome of operative treatment of metastatic fractures of the humerus: a systematic review of twenty three clinical studies

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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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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.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Room 3.946, Yawkey building, 55 Fruit Street, Boston, MA, 02114, USA

    Stein J. Janssen, Teun Teunis, Francis J. Hornicek & Joseph H. Schwab

  2. Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Jos A. M. Bramer

Authors
  1. Stein J. Janssen
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  2. Teun Teunis
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  3. Francis J. Hornicek
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  4. Jos A. M. Bramer
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  5. Joseph H. Schwab
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Corresponding author

Correspondence to Stein J. Janssen.

Additional information

Research performed at Massachusetts General Hospital, Boston, Massachusetts, United States of America.

Appendices

Appendix 1

Table 4 Critical appraisal
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Appendix 2

Table 5 Distribution of primary tumours per study
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Appendix 3

Table 6 Operative treatment characteristics
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Appendix 4

Table 7 Local tumour progression primary tumour types
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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

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