Intramedullary nail fixation seen as ‘excellent choice’ for pathologic humerus fractures
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Intramedullary nail fixation is an “excellent choice” for patients with pathologic humeral shaft fractures, according to published results.
Researchers from the University of South Carolina School of Medicine and the Greenville Health System retrospectively reviewed findings for 16 patients who underwent intramedullary nail (IMN) fixation for pathologic humeral shaft fractures from 2009 to 2017. Patients were categorized based on whether they underwent IMN fixation with a reamed technique (five patients) or IMN fixation with an unreamed technique (11 patients), according to the study.
Patient demographics and clinical characteristics were recorded including type of cancer or bony lesion, site of involvement, chemoradiation therapy status, nail diameter and intraoperative blood loss.
According to the study, four patients (80%) in the reamed group showed evidence of union, with an average time to union of 80.5 days, while eight patients (72.7%) in the unreamed group showed evidence of union, with an average time to union of 109.1 days. Researchers found no statistical difference between the two cohorts.
Overall, two nonunions were recorded. One patient in the reamed group had a fracture that did not require reoperation, and one patient in the unreamed group had a fracture that required revision fixation. Four additional complications were reported in the unreamed group, which consisted of one delayed union, one nonunion treated with revision IMN fixation and two cases of disease progression that required reoperation, according to the study.
“The use of IMN fixation of pathologic humeral shaft fractures achieves rates of union that are parallel to those seen with fixation by any method in a healthy population, regardless of the use of a reamed vs. an unreamed technique,” the researchers wrote in the study. “The authors consider this technique to be an excellent choice for the management of displaced pathologic humerus fractures in the setting of neoplastic disease,” they added.
“As the life expectancy of patients with metastatic bone cancer continues to lengthen, it is important to continue to evaluate treatment for both short-term stabilization and long-term function,” the researchers concluded.
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