Background: Pathological humeral shaft fracture occurs late in the evolution of tumoral,
and it is an important negative prognostic and morbidity factor, causing pain, as well as
loss of limb function and independent living. This study aimed to evaluate functional,
oncological outcome following internal fixation for pathological humeral fractures.
Methods: This prospective cohort study included 20 patients who were candidate for
internal fixation of pathological humeral fractures (metabolic, benign & pathological
causing humerus fracture). All studied cases were subjected to general examination,
radiological assessment (x-ray CT scan, magnetic resonance imaging (MRI) with contrast,
technetium bone scan, biopsy in case of 1ry lesion unknown, and PET scan in metastasis,
and tumor markers). Results: The MSTS score had a median value of 5, with a narrow
range between 4 and 5. Regression was observed in 60% of the cases. However,
progression of the disease was noted in 40% of the cases. A high incidence of metastasis
was reported, with chest metastasis occurring in 70% of the patients and visceral metastasis
in 75%. Time of presentation significantly differed according to oncological outcome (P =
0.045). No significant differences were observed regarding age, gender, risk factor, site,
approach, method of fixation, and augmentation by cement, operation time, blood loss,
radial nerve injury, mechanical failure, non-union, infection, hospital stay and MSTS
according to oncological outcome. Conclusion: Both intramedullary nailing and plating
are safe and effective surgical methods for treating metastatic lesions in humeral shaft
fractures. The INF group demonstrated a significantly lower incidence of postoperative
radial nerve palsy than the PF group. |
