title: Complications and survival after surgical treatment of 214 metastatic lesions of the humerus.
abstract: BACKGROUND
  The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus.
  
  
  METHODS
  This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10.
  
  
  RESULTS
  The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosynthesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P < 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years.
  
  
  CONCLUSIONS
  Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral fractures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate.
authors: Department of Orthopaedics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. rikard.wedin@karolinska.se
authors: Rikard
authors: R
authors: Wedin
authors: Bjarne H
authors: BH
authors: Hansen
authors: Minna
authors: M
authors: Laitinen
authors: Clement
authors: C
authors: Trovik
authors: Olga
authors: O
authors: Zaikova
authors: Peter
authors: P
authors: Bergh
authors: Anders
authors: A
authors: Kalén
authors: Gunnar
authors: G
authors: Schwarz-Lausten
authors: Fredrik
authors: F
authors: Vult von Steyern
authors: Anders
authors: A
authors: Walloe
authors: Johnny
authors: J
authors: Keller
authors: Rüdiger J
authors: RJ
authors: Weiss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001858:Bone Nails; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D001860:Bone Plates; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000401:mortality; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006811:Humerus / Q000473:pathology* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D019736:Prostheses and Implants; D011859:Radiography; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013548:Sweden