Treatment of pathological humeral shaft fractures with a distally threaded unreamed humeral nail

Abstract

BackgroundBone metastasis is a severe complication in patients with cancer. Not only does it cause intractable pain and other clinical problems such as fracture after a trivial injury, it also signifies that the malignant process is incurable. Since the life expectancy of metastasized cancer patients has improved because of advanced oncological treatment, although still limited, appropriate surgical interventions have increased.ObjectiveTo analyze the results of intramedullary fixation of pathological humeral shaft fractures using a distally threaded unreamed locked humeral nail.Patients and methodsBetween November 2004 and November 2009, seven patients with seven humeri fractures secondary to metastatic disease were treated in Benha University and Benha Teaching Hospitals. The primary tumors included carcinomas of the breast (two), kidney (one), prostate (one), and unknown origin (three). All fractures were stabilized with antegrade distally threaded unreamed locked humeral nailing. The mean age of the patients was 65 years (range 55-82 years); the male to female ratio was 2 : 5. The mean follow-up duration was 14 months (range 3-24 months).ResultsA Likert scale was used to assess the level of satisfaction; overall, there was a good outcome. Four of six patients reported a good result of 'satisfied' and two of six patients reported an unsatisfactory outcome. Bony union was achieved in 67% (four of six patients) of all the cases.ConclusionDistally threaded unreamed humeral nailing led to a high rate of satisfaction and should be considered a palliative treatment for patients with pathological humeral shaft fractures because of metastatic disease. It provides immediate stability and pain relief, short operative time, no blood loss, and avoids complication of distal locking screws.