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Treatment of pathological humerus shaft fractures with intramedullary nails with or without cement fixation

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Bone metastasis is a severe complication for patients with cancer. Not only does it cause intractable pain and other clinical problems such as fracture after trivial injury, it also signifies that the malignant process is incurable. Since life expectancy of metastasised cancer patients has improved due to advanced oncological treatment but is still limited, appropriate surgical intervention has increased.

Method

This is a retrospective control study of 21 patients who underwent cemented intramedullary nailing for pathological fractures in the humeral shaft between 2005 and 2009 as compared to a historical control group of 19 patients that underwent locked intramedullary nailing for pathological fractures in the humeral shaft between 1999 and 2004. Four major outcomes were assessed, namely, pain relief, use of analgesics, recovery of function and rate of complication.

Results

Patients treated with cemented intramedullary nailing had better pain relief, less use of analgesics and better functional restoration immediately after surgical procedure when compared to the patients without cement fixing. The rate of complication did not differ between these two groups.

Conclusion

Since surgery for metastases does not prolong life but improves the quality of life, the aim towards a short postoperative rehabilitation time is recommended. Cement fixation gives immediate stabilisation to the fracture site and thus allows less pain but full range of motion from the first postoperative day.

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References

  1. Mundy GR (1997) Mechanisms of bone metastasis. Cancer 80(8 Suppl):1546–1556

    Article  PubMed  CAS  Google Scholar 

  2. 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(6):891–896

    PubMed  CAS  Google Scholar 

  3. Flemming JE, Beals RK (1986) Pathologic fracture of the humerus. Clin Orthop Relat Res (203):258–260

  4. Sarahrudi K, Greitbauer M, Platzer P, Hausmann JT, Heinz T, Vecsei V (2009) Surgical treatment of metastatic fractures of the femur: a retrospective analysis of 142 patients. J Trauma 66(4):1158–1163

    Article  PubMed  Google Scholar 

  5. Sarahrudi K, Wolf H, Funovics P, Pajenda G, Hausmann JT, Vecsei V (2009) Surgical treatment of pathological fractures of the shaft of the humerus. J Trauma 66(3):789–794

    Article  PubMed  Google Scholar 

  6. Frassica FJ, Frassica DA (2003) Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res (415 Suppl):S212–S218

    Google Scholar 

  7. 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

  8. Damron TA, Sim FH, Shives TC, An KN, Rock MG, Pritchard DJ (1996) Intercalary spacers in the treatment of segmentally destructive diaphyseal humeral lesions in disseminated malignancies. Clin Orthop Relat Res (324):233–243

  9. Ofluoglu O, Erol B, Ozgen Z, Yildiz M (2009) Minimally invasive treatment of pathological fractures of the humeral shaft. Int Orthop 33(3):707–712

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Potter BK, Adams SC, Pitcher JD Jr, Malinin TI, Temple HT (2009) Proximal humerus reconstructions for tumors. Clin Orthop Relat Res 467(4):1035–1041

    Article  PubMed  Google Scholar 

  12. Katzer A, Meenen NM, Grabbe F, Rueger JM (2002) Surgery of skeletal metastases. Arch Orthop Trauma Surg 122(5):251–258

    Article  PubMed  Google Scholar 

  13. Hunt KJ, Gollogly S, Randall RL (2006) Surgical fixation of pathologic fractures: an evaluation of evolving treatment methods. Bull Hosp Jt Dis 63(3–4):77–82

    PubMed  Google Scholar 

  14. Aboulafia AJ, Levine AM, Schmidt D, Aboulafia D (2007) Surgical therapy of bone metastases. Semin Oncol 34(3):206–214

    Article  PubMed  Google Scholar 

  15. Bauze AJ, Clayer MT (2003) Treatment of pathological fractures of the humerus with a locked intramedullary nail. J Orthop Surg (Hong Kong) 11(1):34–37

    CAS  Google Scholar 

  16. Atesok K, Liebergall M, Sucher E, Temper M, Mosheiff R, Peyser A (2007) Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol 14(4):1493–1498

    Article  PubMed  Google Scholar 

  17. Clain A (1965) Secondary malignant disease of bone. Br J Cancer 19:15–29

    Article  PubMed  CAS  Google Scholar 

  18. Higinbotham NL, Marcove RC (1965) The management of pathological fractures. J Trauma 5(6):792–798

    Article  PubMed  CAS  Google Scholar 

  19. Harrington KD (1997) Orthopedic surgical management of skeletal complications of malignancy. Cancer 80(8 Suppl):1614–1627

    Article  PubMed  CAS  Google Scholar 

  20. Hansen BH, Keller J, Laitinen M, Berg P, Skjeldal S, Trovik C, Nilsson J, Walloe A, Kalen A, Wedin R (2004) The Scandinavian Sarcoma Group Skeletal Metastasis Register Survival after surgery for bone metastases in the pelvis and extremities. Acta Orthop Scand Suppl 75(311):11–15

    PubMed  CAS  Google Scholar 

  21. Wedin R, Bauer HC, Rutqvist LE (2001) Surgical treatment for skeletal breast cancer metastases: a population-based study of 641 patients. Cancer 92(2):257–262

    Article  PubMed  CAS  Google Scholar 

  22. Zekri J, Ahmed N, Coleman RE, Hancock BW (2001) The skeletal metastatic complications of renal cell carcinoma. Int J Oncol 19(2):379–382

    PubMed  CAS  Google Scholar 

  23. Gainor BJ, Buchert P (1983) Fracture healing in metastatic bone disease. Clin Orthop Relat Res (178):297–302

  24. Yazawa Y, Frassica FJ, Chao EY, Pritchard DJ, Sim FH, Shives TC (1990) Metastatic bone disease. A study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin Orthop Relat Res (251):213–219

  25. Healey JH, Brown HK (2000) Complications of bone metastases: surgical management. Cancer 88(12 Suppl):2940–2951

    Article  PubMed  CAS  Google Scholar 

  26. Fuchs B, Ossendorf C, Leerapun T, Sim FH (2008) Intercalary segmental reconstruction after bone tumor resection. Eur J Surg Oncol 34(12):1271–1276

    PubMed  CAS  Google Scholar 

  27. Noger M, Berli MC, Fasel JH, Hoffmeyer PJ (2007) The risk of injury to neurovascular structures from distal locking screws of the unreamed humeral nail (UHN): a cadaveric study. Injury 38(8):954–957

    Article  PubMed  CAS  Google Scholar 

  28. Dijkstra S, Stapert J, Boxma H, Wiggers T (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(6):621–626

    Article  PubMed  CAS  Google Scholar 

  29. Harrington KD, Johnston JO, Turner RH, Green DL (1972) The use of methylmethacrylate as an adjunct in the internal fixation of malignant neoplastic fractures. J Bone Joint Surg Am 54(8):1665–1676

    PubMed  CAS  Google Scholar 

  30. Harrington KD (1975) The use of methylmethacrylate as an adjunct in the internal fixation of unstable comminuted intertrochanteric fractures in osteoporotic patients. J Bone Joint Surg Am 57(6):744–750

    PubMed  CAS  Google Scholar 

  31. Sim FH, Kruse RL, Johnson EW Jr (1974) Problems in pathologic fractures. Minn Med 57(4):266–269

    PubMed  CAS  Google Scholar 

  32. Jacofsky DJ, Haidukewych GJ (2004) Management of pathologic fractures of the proximal femur: state of the art. J Orthop Trauma 18(7):459–469

    Article  PubMed  Google Scholar 

  33. Lin J, Hou SM, Hang YS, Chao EY (1997) Treatment of humeral shaft fractures by retrograde locked nailing. Clin Orthop Relat Res (342):147–155

  34. Onufrey V, Mohiuddin M (1985) Radiation therapy in the treatment of metastatic renal cell carcinoma. Int J Radiat Oncol Biol Phys 11(11):2007–2009

    Article  PubMed  CAS  Google Scholar 

  35. Kijima T, Fujii Y, Suyama T, Okubo Y, Yamamoto S, Masuda H, Yonese J, Fukui I (2009) Radiotherapy to bone metastases from renal cell carcinoma with or without zoledronate. BJU Int 103(5):620–624

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Unit of Musculoskeletal Surgery, Department of Orthopaedics, University Hospital of Tampere, P.O. Box 2000, 33521, Tampere, Finland

    Minna Laitinen & Toni-Karri Pakarinen

  2. Coxa, Hospital for Joint Replacement, Tampere, Finland

    Jyrki Nieminen

Authors
  1. Minna Laitinen
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  2. Jyrki Nieminen
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  3. Toni-Karri Pakarinen
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Correspondence to Minna Laitinen.

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Laitinen, M., Nieminen, J. & Pakarinen, TK. Treatment of pathological humerus shaft fractures with intramedullary nails with or without cement fixation. Arch Orthop Trauma Surg 131, 503–508 (2011). https://doi.org/10.1007/s00402-010-1172-6

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  • DOI: https://doi.org/10.1007/s00402-010-1172-6

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