Management of upper extremity bone metastases

Abstract

Metastatic bone disease represents a significant burden of disease. Metastatic disease can seed in any bone of the body, but one of the most common long bones affected is the humerus. Although painful and often disabling, metastatic bone disease of the upper extremity often can be treated more conservatively than the lower extremity because of lower weight-bearing demands. However, the surgical management of upper extremity metastatic bone disease is an evolving field, and recent clinical studies have demonstrated several key principles. Intramedullary nailing and whole bone irradiation may be an optimal combination for prophylactic fixation. The addition of polymethyl methacrylate cement adds immediate stabilization to internal fixation and decreases postoperative pain. Plate and screw fixation can be used in lesions that cannot be treated with intramedullary nailing, but caution is necessary to avoid complications related to surgical technique. Finally, periarticular and intraarticular lesions may be managed with a hemi-or total-joint prosthesis for both the shoulder and elbow to provide the maximal functional outcome. Surgical intervention together with appropriate adjunctive therapies can decrease patient-important pain and skeletal-related events while improving quality of life in patients living with metastatic bone disease of the upper extremity. 1. Li S, Peng Y, Weinhandl ED, et al. Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol. 2012; 4:87--93. 2. von Moos R, Sternberg C, Body JJ, et al. Reducing the burden of bone metastases: Current concepts and treatment options.

Current concepts in metastatic carcinoma: a review of the literature

“…Surgical technique and approach are largely dependent on the lesion location, are beyond the scope of this review article, and can be reviewed in depth in other texts. 19,[27][28][29][30][31] Medical therapy should be used synergistically with surgical treatment and radiation to the entire bone, and postoperatively bisphosphonate therapy is important. 27 Radiation therapy usually is administered to the entire operative field beginning 2 to 3 wk after surgery once the surgical wound has healed.…”

“…In general, an attempt should be made to debulk the tumor before fixation, methacrylate should be used to augment the fixation, and the entire bone should be protected. Surgical technique and approach are largely dependent on the lesion location, are beyond the scope of this review article, and can be reviewed in depth in other texts 19,27–31. Medical therapy should be used synergistically with surgical treatment and radiation to the entire bone, and postoperatively bisphosphonate therapy is important 27.…”