title: Modular prostheses in the treatment of proximal humerus metastases: review of 40 cases.
abstract: BACKGROUND
  The humerus is the second most common site of metastatic bone disease involving long bones. Tumors which have a predilection for dissemination to bone are those of breast, prostate, thyroid, lung and kidney. The rationale for surgical treatment of these lesions is to prevent or treat pathological fractures in order to relieve pain and improve function.
  
  
  METHODS
  Forty patients who had resection of the proximal humerus for metastatic bone disease and reconstruction with a modular prosthesis were retrospectively reviewed.
  
  
  RESULTS
  Mean functional outcome was 73.1% (Enneking score) and better results were achieved when a reverse prosthesis was implanted. Overall survival was 70% at 1 year, 42.5% at 2 years and 20% at 5 years. Local recurrence occurred in 4 patients, each of whom had initially been treated for a pathological fracture.
  
  
  CONCLUSIONS
  It is important to follow rational guidelines, like those of Capanna and Mirels, in order to prevent pathological fractures and to give the patient a definitive treatment, as the advances in the management of cancer prolong the survival of these patients. In this series, satisfactory results were obtained, giving the patients an acceptable quality of life.
authors.affiliation: Department of Orthopaedics and Traumatology, San Raffaele Scientific Institute, Via Olgettina 60, I-20132, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Scotti
authors.forename: F
authors.initials: F
authors.lastname: Camnasio
authors.forename: G M
authors.initials: GM
authors.lastname: Peretti
authors.forename: F
authors.initials: F
authors.lastname: Fontana
authors.forename: G
authors.initials: G
authors.lastname: Fraschini