title: Intramedullary Nailing for Pathological Fractures of the Proximal Humerus.
abstract: BACKGROUND
  Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes.
  
  
  METHODS
  We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes.
  
  
  RESULTS
  The mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up.
  
  
  CONCLUSIONS
  Proximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Choi
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ilkyu
authors.initials: I
authors.lastname: Han
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hwan Seong
authors.initials: HS
authors.lastname: Cho
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: In Woong
authors.initials: IW
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jong Woong
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Han-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006811:Humerus / Q000000981:diagnostic imaging / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Humerus; Intrameullary nailing; Metastasis; Pathologic fracture