Metastatic Disease Upper Extremity

Abstract

Metastatic disease of the upper extremity is uncommon. Non-operative management is very effective in treating the majority of the lesions and/ or fractures related to metastatic disease in this location. However, surgical intervention may be required to address some of these pathologic or impending fractures. The humerus is the most common bone to have metastatic involvement in the upper extremity. The location of the disease involvement in the humerus influences operative intervention surgical treatment options. For the proximal humerus if there an absence of intraarticular involvement, plate/screw stabilization has been found to very effective. When intraarticular involvement is present, arthroplasty is the best option. Reverse shoulder arthroplasty has been proved to be a very effective reconstruction option after proximal humeral resection if warranted. For shaft humeral fractures, intramedullary nailing is the most popular means of stabilization and associated with very good outcomes. However, plate stabilization with bone cement has been demonstrated to be a very effective treatment option as well. However, distal humerus fractures have been shown to be difficult to treat and the best routine treatment is still being determined. For all upper extremity fractures requiring surgical intervention, the goal of the operation should be the creation of a durable construct with good function and low complications rates for the long-term survival in this patient population is poor.