title: Fixation of pathological humeral fractures by the cemented plate technique.
abstract: Pathological fractures of the humerus are associated with pain, morbidity, loss of function and a diminished quality of life. We report our experience of stabilising these fractures using polymethylmethacrylate and non-locking plates. We undertook a retrospective review over 20 years of patients treated at a tertiary musculoskeletal oncology centre. Those who had undergone surgery for an impending or completed pathological humeral fracture with a diagnosis of metastatic disease or myeloma were identified from our database. There were 63 patients (43 men, 20 women) in the series with a mean age of 63 years (39 to 87). All had undergone intralesional curettage of the tumour followed by fixation with intramedullary polymethylmethacrylate and plating. Complications occurred in 14 patients (22.2%) and seven (11.1%) required re-operation. At the latest follow-up, 47 patients (74.6%) were deceased and 16 (25.4%) were living with a mean follow-up of 75 months (1 to 184). A total of 54 (86%) patients had no or mild pain and 50 (80%) required no or minimal assistance with activities of daily living. Of the 16 living patients none had pain and all could perform activities of daily living without assistance. Intralesional resection of the tumour, filling of the cavity with cement, and plate stabilisation of the pathological fracture gives immediate rigidity and allows an early return of function without the need for bony union. The patient's local disease burden is reduced, which may alleviate tumour-related pain and slow the progression of the disease. The cemented-plate technique provides a reliable option for the treatment of pathological fractures of the humerus.
authors.affiliation: Department of Orthopaedic Surgery, Division of Musculoskeletal Oncology, Shadyside Medical Center, 5200 Centre Avenue, Suite 415, Pittsburgh, Pennsylvania 15232, USA. weiskr@upmc.edu
authors.forename: K R
authors.initials: KR
authors.lastname: Weiss
authors.forename: R
authors.initials: R
authors.lastname: Bhumbra
authors.forename: D J
authors.initials: DJ
authors.lastname: Biau
authors.forename: A M
authors.initials: AM
authors.lastname: Griffin
authors.forename: B
authors.initials: B
authors.lastname: Deheshi
authors.forename: J S
authors.initials: JS
authors.lastname: Wunder
authors.forename: P C
authors.initials: PC
authors.lastname: Ferguson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery; D001860:Bone Plates; D002484:Cementation; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019904:Polymethyl Methacrylate