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Abstract
Purpose
To evaluate and analyze the radiographic and clinical outcomes after the surgical treatments of pathologic humeral fractures.
Materials and Methods
From October 1993 to September 2007, a retrospective investigation was conducted with a total of 13 patients who underwent operations for pathologic humeral fractures. The methods of surgical treatment were as follows-four cases of open reduction and internal fixation; eight cases of closed reduction and internal fixation with intramedullary nailing; and one of radical excision and hemiarthroplasty.
Results
Of nine patients with metastatic bone lesions, three were diagnosed with primary cancer after the incidence of pathologic humeral fracture. The mean period between the diagnosis of primary cancer and pathologic fracture in the latter six cases was 36.7 (2~144) months and the mean survival period after the surgical treatments was 22.8 (12~35) weeks in all patients with bone metastasis. Fracture unions were noted in all four cases of primary humeral bone lesion but none in metastatic cases. Pain relief and functional recovery were noted in eleven patients of this study.
Conclusion
Satisfactory clinical outcomes with sustained pain relief and functional recovery were observed after the surgical treatments of pathologic humeral fracture. Benign bone lesions require more active and early treatments in order to facilitate the functional recovery of upper extremities and fracture union. With pathologic humeral fractures originated from metastasis, palliative treatments were preferred to fracture union method for planning long-term pain relief and functional recovery.
Figures and Tables
Fig. 1
(A) A 51-year-old female had proximal humeral fracture from a slip down injury. Possible diagnosis was simple bone cyst, enchondroma, giant cell tumor or aneurismal bone cyst.
(B) She was treated with closed reduction and intramedullary nailing.
(C) After the surgical treatment, biopsy of fracture site was confirmed as giant cell tumor. One week after the primary operation, curettage and autoiliac bone graft were performed (Black arrow is an autologous iliac bone block).
(D) The bone union was gained at 13 months after operation.
Fig. 2
(A) A 55-year-old male, with humerus shaft fracture from car accident 3 years ago, initially had an internal fixation, but a follow-up bone graft was carried out due to the continuous mal-union.
(B) After his third operation with preoperative evaluation of lung mass, biopsy of fracture site was confirmed as pathologic fracture originated from lung cancer (White arrow is a lung mass).
(C) At 5 months after closed reduction and IM nailing with bone graft, we found persistent non-union of humeral shaft. He died at 26 weeks after operation.
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