title: Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement.
abstract: Bone loss secondary to primary or metastatic lesions of the proximal humerus remains a challenging surgical problem. Options include preservation of the joint with stabilisation using internal fixation or resection of the tumour with prosthetic replacement. Resection of the proximal humerus often includes the greater tuberosity and adjacent diaphysis, which may result in poor function secondary to loss of the rotator cuff and/or deltoid function. Preservation of the joint with internal fixation may reduce the time in hospital and peri-operative morbidity compared with joint replacement, and result in a better functional outcome. We included 32 patients with pathological fractures of the proximal humerus in this study. Functional and radiological assessments were performed. At a mean follow-up of 17.6 months (8 to 61) there was no radiological evidence of failure of fixation. The mean revised musculoskeletal Tumour Society functional score was 94.6% (86% to 99%). There was recurrent tumour requiring further surgery in four patients (12.5%). Of the 22 patients who were employed prior to presentation all returned to work without restrictions. The use of a locking plate combined with augmentation with cement extends the indications for salvage of the proximal humerus with good function in patients with pathological and impending pathological fractures.
authors.affiliation: Section of Orthopaedic Oncology, University of Alabama at Birmingham Medical Centre, 1313 13th Street South, Birmingham, Alabama 35205, USA. herrick.siegel@ortho.uab.edu
authors.forename: H J
authors.initials: HJ
authors.lastname: Siegel
authors.forename: R
authors.initials: R
authors.lastname: Lopez-Ben
authors.forename: J P
authors.initials: JP
authors.lastname: Mann
authors.forename: B A
authors.initials: BA
authors.lastname: Ponce
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001843:Bone Cements / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D019904:Polymethyl Methacrylate; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D017006:Rotator Cuff / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate