[Surgical treatment of humeral metastatic tumors].
OBJECTIVE
To evaluate the functional outcome and pain control in patients after resection of humeral metastases.


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.
Department of Orthopedics and Traumatology, Kaunas University of Medicine, Eiveniu 2, Kaunas 50009, Lithuania. toliusisvytautas@gmail.com
Vytautas
V
Toliusis
Romas Jonas
RJ
Kalesinskas
Mindaugas
M
Kiudelis
Almantas
A
Maleckas
D000368:Aged; D001843:Bone Cements; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D005598:Fractures, Spontaneous / Q000601:surgery*; D006225:Hand / Q000502:physiology; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D017567:Karnofsky Performance Status; D020366:Methylmethacrylate / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D001843:Bone Cements; D020366:Methylmethacrylate