The surgical management of pathological fractures of the humerus

Abstract

In recent years it has become increasingly common to treat pathological fractures of the humerus by operation. Previously most patients were treated by immobilisation of the arm in a sling with or without a simple external splint. In general this conservative approach was very unsatisfactory; the patients continued to have troublesome pain and even if bed-ridden it was difficult to move even a limited amount in comfort. Union of the fracture was slow and uncertain. Ten per cent of bony metastases occur in the humerus so that the problem of pathological fracture or imminent fracture in this bone is quite common. The surgical treatment of these fractures depends very much on the level of the lesion. An important consideration is that most of these patients will require deep X-ray therapy immediately post-operatively so that achievement of fracture stability and of primary wound healing is very important. Before operation the patient should be assessed carefully to confirm the diagnosis, to define the precise anatomy of the metastatic lesion and to document the presence of other metastatic deposits. In general this requires plain high-quality X-rays and isotope bone scan. C.T. scan of the lesion can be very helpful to define its full extent. On occasions a solitary secondary deposit is seen from renal carcinoma.