Function after resection of humeral metastases: analysis of 59 consecutive patients.
Metastatic bone disease of the humerus may require surgery for treatment of an impending or existing pathologic fracture or for alleviating disabling pain. Prompt restoration of function is a main goal of surgery, although published results do not reveal if that goal is being met. We retrospectively reviewed range of motion and function of 59 patients operated on from 1986-2003 for those indications. After resection, tumors around the humeral head and condyles (n = 20) were reconstructed with a prosthesis, and tumors at the humeral diaphysis (n = 39) were reconstructed with cemented nailing. Each patient's range of motion was recorded, and functional outcome was evaluated according to the American Musculoskeletal Tumor Society system. Patients who had cemented nailing had better shoulder motion, hand positioning, lifting ability, and emotional acceptance than patients who had endoprosthetic reconstruction. Pain alleviation and dexterity were comparable in both groups. All patients had a stable extremity, and the overall function of 56 patients (95%) was greater than 68% of normal upper extremity function. An aggressive surgical approach in patients with humeral metastases who met the criteria for surgical intervention was associated with good function.


METHODS
Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
Bickels
Jacob
J
The National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Israel. jbickels@012.net.il
Kollender
Yehuda
Y
Wittig
James C
JC
Meller
Isaac
I
Malawer
Martin M
MM
D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001175:Arthrography; D019643:Arthroplasty, Replacement / Q000379:methods; D001843:Bone Cements; D001858:Bone Nails; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery; D004551:Elbow Joint / Q000503:physiopathology* / Q000601:surgery; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006811:Humerus; D007595:Joint Prosthesis; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology* / Q000601:surgery
D001843:Bone Cements