Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor

Jeung Il Kim; Um Ji Kim; Nam Hoon Moon; Hui Taek Kim; Tae Young Ahn; In Sook Lee; You Seon Song; Kyung Un Choi

doi:10.4055/jkoa.2016.51.6.509

Journal List > J Korean Orthop Assoc > v.51(6) > 1013489

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Kim, Kim, Moon, Kim, Ahn, Lee, Song, and Choi: Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(6): 509-514.

Published online: 30 December 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.6.509

Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor

Jeung Il Kim, M.D., Um Ji Kim, M.D., Nam Hoon Moon, M.D., Hui Taek Kim, M.D., Tae Young Ahn, M.D., In Sook Lee, M.D.^*, You Seon Song, M.D.^*, Kyung Un Choi, M.D.^†

Department of Orthopedic Surgery, Pusan National University School of Medicine, Busan, Korea.

^*Department of Radiology, Pusan National University School of Medicine, Busan, Korea.

^†Department of Pathology, Pusan National University School of Medicine, Busan, Korea.

Correspondence to: Jeung Il Kim, M.D. Departments of Orthopedic Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. TEL: +82-51-240-7248, FAX: +82-51-274-8395, osteokim1@gmail.com

Received 22 February 2016 Revised 9 May 2016 Accepted 26 June 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to suggest an appropriate therapeutic approach by making a comparison between conservative therapy and surgical therapy for a pathologic fractures of the humerus caused by benign bone tumor.

Materials and Methods

We selected 15 cases with a pathologic fracture of the humerus caused by benign bone tumor from January 2000 to April 2014 to evaluate the fracture union period and remission of primary bone tumor. Eight cases were treated with conservative therapy, and 7 cases by surgical therapy. The mean age was 13.1 years, and the age range was between 1 year and 19 years; there were 8 male cases and 7 female cases. The mean follow-up period was 24.9 months, with a range from 4 months to 72 months. We evaluated the remission of primary benign tumor in accordance with the ‘Modified Neer classification’ system.

Results

There was no statistically significant difference in age, sex, and mean follow-up period between the two groups. The pathologic fracture was united in all cases without secondary displacement. There was no statistically significant difference in the fracture union period (p=0.164) and remission of primary benign tumor (p=0.931) between the two groups.

Conclusion

We suggest that both conservative and surgical therapies can be a treatment for pathologic fracture of the humerus caused by benign bone tumor.

Keywords: humerus, benign bone tumor, pathologic fracture, conservative therapy

Figures and Tables

Figure 1

Cases treated with conservative therapy. (A) Initial anteroposterior and lateral radiographs show spiral type humerus shaft fracture with cystic bone tumor. (B) After 1.2 months, functional brace was applied. No significant interval change was observed. (C) After 2.4 months, fracture was healed and the patient had no pain.

Figure 2

Cases treated with surgical therapy. (A) Initial anteroposterior and lateral radiographs show proximal humerus fracture with cystic bone tumor. (B) Curettage and allogenic bone grafting was done. (C) After 1.9 months, fracture was healed. (D) After 1 year, cystic bone tumor was recurred. (E) Second curettage and allogenic bone grafting was performed. (F) After 1.9 months of the second operation, there was no sign of recurrence.

Table 1

Demographic Data of Humeral Pathologic Fracture Secondary to Benign Bone Tumor

FD, fibrous dysplasia; ABC, aneurysmal bone cyst; SBC, simple bone cyst; CRIF, closed reduction and internal fixation; B/G, bone graft; IM, intramedullary; Consv. Tx., conservative therapy.

Table 2

Modified Neer Classification of Radiologic Results8)

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

This article was announced at 2014 The Korean Orthopaedic Association Annual Fall Conference.

This article was supported by clinical research grant from Pusan National University Hospital in 2015.

References

1. Motamedi K, Seeger LL. Benign bone tumors. Radiol Clin North Am. 2011; 49:1115–1134.

2. Habermann ET, Lopez RA. Metastatic disease of bone and treatment of pathological fractures. Orthop Clin North Am. 1989; 20:469–486.

3. Casadei R, Ruggieri P, Ferraro A, Mercuri M. Indications for the treatment of pathologic fracture in tumors of bone. Chir Organi Mov. 1996; 81:21–30.

4. Ortiz EJ, Isler MH, Navia JE, Canosa R. Pathologic fractures in children. Clin Orthop Relat Res. 2005; (432):116–126.

5. Kang HJ, Hwang BY, Lee JJ, Shin KH, Hahn SB, Kim SJ. Surgical treatment of pathologic humeral fracture. J Korean Fract Soc. 2010; 23:187–193.

6. Sim FH, Pritchard DJ. Metastatic disease in the upper extremity. Clin Orthop Relat Res. 1982; (169):83–94.

7. Chuo CY, Fu YC, Chien SH, Lin GT, Wang GJ. Management strategy for unicameral bone cyst. Kaohsiung J Med Sci. 2003; 19:289–295.

8. Neer CS, Francis KC, Johnston AD, Kiernan HA Jr. Current concepts on the treatment of solitary unicameral bone cyst. Clin Orthop Relat Res. 1973; (97):40–51.

9. Hahn SB, Kim NH, Park BM, Jeon CH. Comparison between treatment methods of simple bone cyst. J Korean Orthop Assoc. 1990; 25:941–949.

10. Stephenson RB, London MD, Hankin FM, Kaufer H. Fibrous dysplasia. An analysis of options for treatment. J Bone Joint Surg Am. 1987; 69:400–409.

11. Jung ST, Kim BS, Moon ES, Lee KB, Seo HY. Femur fractures associated with benign bone tumors in children. J Korean Bone Joint Tumor Soc. 2005; 11:111–117.

12. Enneking WF. Musculoskeletal tumor surgery. New York: Churchill Livingstone;1983. p. 87–89.

13. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980; (153):106–120.

14. Dormans JP, Pill SG. Fractures through bone cysts: unicameral bone cysts, aneurysmal bone cysts, fibrous cortical defects, and nonossifying fibromas. Instr Course Lect. 2002; 51:457–467.

15. Lee SY, Chung CY, Lee KM, et al. Determining the best treatment for simple bone cyst: a decision analysis. Clin Orthop Surg. 2014; 6:62–71.

16. Enneking WF, Gearen PF. Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg Am. 1986; 68:1415–1422.

17. Wilkins RM. Unicameral bone cysts. J Am Acad Orthop Surg. 2000; 8:217–224.

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