Surgical treatment of humeral metastatic tumors

Vytautas Toliušis, Romas Jonas Kalesinskas, Mindaugas Kiudelis¹, Almantas Maleckas¹

Department of Orthopedics and Traumatology, ¹Department of Surgery, Kaunas University of Medicine, Lithuania

Key words: metastatic bone tumors; fixation of pathologic fractures; bone cement; methylmethacrylate.

Summary. Objective. To evaluate the functional outcome and pain control in patients after resection of humeral metastases.

Material and methods. A prospective randomized study of 24 cases of metastatic disease of the humerus with an associated pathologic fracture was carried out. The selected cases were divided into two groups based on the using methylmethacrylate cement for fracture fixation. Group 1 (n=12) included all cases in which the fracture was treated with bone cement augmentation. Group 2 (n=12) included all cases in which the fracture was treated without bone cement augmentation. Functional outcome was evaluated according to the American Musculoskeletal Tumor Society system.

Results. Good and excellent pain control was achieved in 95% of cases in both groups. Functional outcome after resection of humeral metastases and pathological fracture fixation was significantly better in Group 1. Total function in five patients (45%) accounted for 86% and in three patients (25%) for 83% of full normal upper extremity function, whereas in Group 2, total function in six patients (50%) accounted for 70% and in three patients (25%) for 83% of full normal upper extremity function. The rate of fixation failure was significantly greater in Group 2, where fixation instability was observed in 50% (n=6) of cases (P=0.03). There were no significant differences in complication rate (in 50% of cases, mechanical instability occurred after fixation with intramedullary nail and in 50% of cases after fixation with plates).

Conclusions. The introduction of bone cement as an adjunct to fixation of pathologic fracture improved clinical results and reduced the rate of fixation failure.

Correspondence to V. Toliušis, Department of Orthopedics and Traumatology, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: toliusisvytautas@gmail.com

Received 8 October 2008, accepted 6 August 2009