Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions

Ricard, Marc-Antoine; Stavropoulos, Nikolaos A.; Nooh, Anas; Ste-Marie, Nathalie; Goulding, Krista; Turcotte, Robert

doi:10.7759/cureus.13788

Cited by 6 publications

(14 citation statements)

References 24 publications

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“…CFR-PEEK nails seem to be a good solution in patients with pathologic or impending fractures of the long bones [24]. No matter of life expectancy, studies suggest that either intramedullary nailing or plate fixation with bone cement augmentation and radiotherapy for pathological fractures of the humerus shaft are safe ways to improve quality of life and arm function [25][26][27][28][29][30].…”

Section: Case Reportmentioning

confidence: 99%

Treatment of Pathologic Fracture of Humerus with Internal Fixation, Abrasion of the Lytic Lesion and Cement Infusion; A Case Report and Literature Review

PA¹,

Oikonomopoulos²,

Perisynakis³

et al. 2023

Act Scie Ortho

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Introduction:The skeleton is the most common target of metastatic disease, after lungs and liver. Humerus is the third most common location for a bone metastasis. Pathologic fractures occur as a response to the compromised physiology of the bones, which has as a result poor mechanical properties due to the underlying lesion. Methods and Materials:A 59year-old woman with diagnosed and under treatment lung cancer arrived at the outpatient orthopaedic clinic due to chronic pain (three weeks) and inability to lift her right arm. The onset of pain was gradual. Radiological tests showed a fracture in the proximal third of the humerus and a lytic lesion. Results:The patient was treated with internal fixation with a locking plate, broad abrasion and ablation of the lytic lesion and cement infusion. The patient was mobilized without limitations, other than avoidance of loading, post-operatively. Conclusion:Pathological fractures are a common complication of bone metastases. Life expectancy in patients with bone metastases has been extended due to the progress in chemotherapy, radiotherapy, and other oncological therapies. At pathological fractures of the humeral shaft, the abrasion of the lytic lesion and the infusion of cement, after internal fixation, creates a more stable fixation of the fracture and gives the patient a better quality of life being able to use the arm. According to current bibliography, the use of PMMA limits the spread of cancer cells.

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Section: Case Reportmentioning

confidence: 99%

Treatment of Pathologic Fracture of Humerus with Internal Fixation, Abrasion of the Lytic Lesion and Cement Infusion; A Case Report and Literature Review

PA¹,

Oikonomopoulos²,

Perisynakis³

et al. 2023

Act Scie Ortho

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“…Díky nižší invazivitě je zaznamenáván nižší výskyt infekčních komplikací. Mezi další uváděné komplikace v literatuře patří peroperační zlomenina, nestabilita implantátu a dále pak paréza n. radialis po dlahové osteosyntéze humeru (13,17). Dle výsledků kontrolovaného souboru odpovídá výskyt a četnost komplikací údajům uváděných v recentní literatuře.…”

Section: Diskuseunclassified

Intramedullary Nailing in Managing Diaphyseal Metastases of Long Bones: Retrospective Study Comparing the Expected Survival and the Actual Survival of Patients

Valoušek¹,

Pazourek²,

Tomás³

et al. 2022

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYThe paper focuses on the potential use of nail osteosynthesis in diaphyseal metastases of long bones. The purpose of the paper is to assess the outcomes of intramedullary osteosynthesis in pathologic and impending pathologic fractures, to evaluate patient survival and potential complications. MATERIAL AND METHODSThe retrospective study evaluated a cohort of 42 patients (19 men and 23 women) in whom intramedullary osteosynthesis was performed for complete pathologic fracture (28 patients) or impending pathologic fracture (14 patients) between 2010 and 2019. Of the total number of 42 patients, 31 patients' lower limbs were affected, namely by 17 pathologic fractures and 14 impending fractures. There were 11 humerus fractures. The mean age was 61.8 years (range 41-84 years). In the followed-up cohort, the patient survival after osteosynthesis with intramedullary nails, complications occurred and post-operative mobility of the patient were assessed. The functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system. The unpaired Mann-Whitney test was used to test the significance of the difference in functional outcomes and survival between the followed-up groups. Survival longer than 6 months was evaluated using Fisher's exact test. The level of statistical significance used for the test was p 0.05. RESULTSThe investigated indicator was patient survival, which was 11.3 months (range 1-50 months) on average. In the group of impending fractures, the mean survival was 13.5 months. In the group of pathologic fractures, the survival was 10 months. The functional outcome in 16 followed-up patients at three months after intramedullary osteosynthesis according to the MSTS score was 46.9% (30-66.7%). At the level of significance of p 0.05, the statistically significant difference in the functional outcomes between the group with preventive intramedullary osteosynthesis and the group with nail osteosynthesis of the pathologic fracture was not confirmed (p=0.952). When comparing the patient survival after nail osteosynthesis with impending pathologic fracture and the survival of patients with pathologic fracture, a statistically significant difference in survival between these two groups (p=0.520) was not confirmed. The patient survival of longer than 6 months was 71% in the group of impending fractures and 40% in the group of pathologic fractures. DISCUSSIONThe occurrence of pathologic fracture is associated with increased pain, loss of function, and according to some authors, a higher risk of death. Surgical treatment options include intramedullary osteosynthesis, plate osteosynthesis with cement filling, implantation of an intercalary spacer, and implantation of tumor endoprostheses. When deciding on a surgical procedure, an account is taken of the expected survival of the patient. In patients with an expected survival of up to 6 months, intramedullary osteosynthesis is indicated as a palliative surgical intervention. The most common complications include implant failure...

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“…There is a broad agreement that limb salvage surgery enhances the quality of life of patients with limb shaft metastases owing to recent advancements in radiotherapy, chemotherapy, surgical techniques, targeted therapy, and immunotherapy for comprehensive cancer treatment ( 5 ). Following the removal of a bone tumor, several reconstruction techniques can be used, each with advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of customized modular prosthesis in the treatment of femoral shaft metastases

Shao

et al. 2023

Front. Oncol.

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PurposeTo examine clinical outcomes of a specialized modular prosthesis used to fill a bone deficiency following removal of femoral shaft metastases.MethodsEighteen patients with femoral shaft metastases who underwent en bloc resection and implantation of a personalized modular prosthesis between December 2014 and December 2019 were retrospectively analyzed. Pain, limb function, and quality of life were evaluated using the visual analog scale (VAS), Musculoskeletal Tumor Society (MSTS) scale, International Society of Limb Salvage (ISOLS) scoring system, Karnofsky Performance Status (KPS) scale, and Nottingham Health Profile (NHP) scale. The Kaplan–Meier technique was used to analyze patient survival.ResultsThe operation duration was 90–150 min (mean, 115 min), and the osteotomy length was 9–16 cm (mean, 11.72 cm). The patients were followed for 12–62 months (mean, 25.28 months). The VAS and NHP ratings were lower at 3, 6, and 12 months after surgery than before surgery, while the MSTS, ISOLS, and KPS scores were higher after surgery than they had been before. These differences were statistically significant (P<0.05). The survival period was between 7 and 62 months (mean, 20.89 months), and the rates of survival at 1-year and 2-year were 72.22% and 27.78%, respectively. Except for two patients with aseptic prosthesis loosening during the follow-up period, there were no problems.ConclusionEn bloc excision and implantation of a personalized modular prosthesis can reduce pain and improve the ability of patients with femoral shaft metastases to perform daily activities, thereby improving their quality of life.

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Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions

Cited by 6 publications

References 24 publications

Treatment of Pathologic Fracture of Humerus with Internal Fixation, Abrasion of the Lytic Lesion and Cement Infusion; A Case Report and Literature Review

Treatment of Pathologic Fracture of Humerus with Internal Fixation, Abrasion of the Lytic Lesion and Cement Infusion; A Case Report and Literature Review

Intramedullary Nailing in Managing Diaphyseal Metastases of Long Bones: Retrospective Study Comparing the Expected Survival and the Actual Survival of Patients

Clinical efficacy of customized modular prosthesis in the treatment of femoral shaft metastases

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