Outcome of operative treatment of metastatic fractures of the humerus: a systematic review of twenty three clinical studies

Janssen, Stein J.; Teunis, Teun; Hornicek, Francis J.; Bramer, Jos A. M.; Schwab, Joseph H.

doi:10.1007/s00264-014-2584-7

Cited by 20 publications

(15 citation statements)

References 45 publications

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“…Endoprosthetic reconstruction has been advocated because it offers instant stability and fast functional restoration 8 . However, prolonged life expectancies of patients result in increased revision risk (70%) of this procedure 22,23 . Henderson et al found that implant failures occurred in 25% of prostheses and reoperations can present a tremendous challenge to surgeons 24,25 .…”

Section: Efficacy Of Devitalized Bone Replantation For Diaphyseal Mal...mentioning

confidence: 99%

Efficacy of a Modified Scoring System to Facilitate Surgical Decision‐making for Diaphyseal Malignancies: When is Devitalized Tumor‐bearing Autograft of Value?

Yu¹,

2019

Orthopaedic Surgery

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Objectives To evaluate the validity of a modified scoring system (MSS) for inferring the bony quality of tumor‐bearing diaphyses and predicting the risk of reconstructive failure after devitalized bone replantation (DBR). Methods In this retrospective cohort study, we reviewed the records of 30 patients surgically treated for diaphyseal malignancies between 1996 and 2015. There were 18 male and 12 female subjects; the average age was 34.0 ± 24.5 years (8–82 years). Tumor locations comprised the femur (21), the humerus (4), the tibia (3), the radius (1), and the fibula (1). Histological diagnoses included osteosarcoma (13), metastases (4), Ewing sarcoma (3), chondrosarcoma (3), malignant fibrohistiocytoma (2), periosteal osteosarcoma (1), Langerhans cell sarcoma (1), lymphoma (1), rhabdomyosarcoma (1), and malignant giant cell tumor (1). All primary tumors were rated as stage IIB. Twenty patients underwent DBR. Prosthetic procedures and segmental autografting/allografting were performed in 7 and 3 cases, respectively. MSS (comprising 5 elements: pain, tumor location, bone destruction, localized dimension, and longitudinal dimension) for each patient was calculated in accordance with their preoperative presentations. Outcome measurements included oncological results, outcomes of reconstructions, complications, and functional preservation, presented using the musculoskeletal tumor society (MSTS) scale. Results Follow up was available in 29 cases for an average duration of 61.0 ± 49.9 months (12–152 months). Infection occurred in 2 patients (6.9%), primary nonunion in 6 (27.3%), metastases in 9 (31.9%), recurrences in 4 (13.8%), and deaths in 7 (24.1%); 1 subject underwent amputation due to recurrence following endoprosthetic replacement (3.4%). In the DBR group, fractures occurred in 4 cases (21.1%) and nonunion in 5 (25%); internal fixation was related to nonunion (nails, 44.4% vs plates, 9.1%, P = 0.02). MSS was associated with fractures of devitalized autografts (11.0 ± 1.2 vs 8.3 ± 1.8, P = 0.01); the system was efficacious in predicting chances of fractures of these grafts ( P = 0.02). MSS ≥ 10 (with false positive rate ≤ 6.7%) suggested increased fracture probability (≥22.7%) after DBR; therefore, 10 was considered a cutoff value. Conclusions Diaphyseal malignancies with MSS ≥10 may contraindicate DBR for increased chances of reconstructive failure. In this situation, alternative procedures are advisable. Further investigations are warranted to assess the efficacy of MSS in implying the validity of DBR for diaphyseal malignancies.

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Section: Efficacy Of Devitalized Bone Replantation For Diaphyseal Mal...mentioning

confidence: 99%

Efficacy of a Modified Scoring System to Facilitate Surgical Decision‐making for Diaphyseal Malignancies: When is Devitalized Tumor‐bearing Autograft of Value?

Yu¹,

2019

Orthopaedic Surgery

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“…We believe however that cement, used mostly with plates (seven out of eight plates and two out of 10 IM nails) has an important role in minimizing fixation failure. This goes along with many other studies that showed benefits to cementing [18,[21][22][23][24]. In Table 2, we listed the publications and patient's characteristics on metastatic humeral fractures available in the literature.…”

Section: Discussionmentioning

confidence: 97%

Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions

Ricard

Stavropoulos²,

Nooh

et al. 2021

Cureus

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In the event of surgical management of metastases to the humeral shaft, intramedullary nailing (IMN) is often preferred to plate osteosynthesis (PO) fixation despite a lack of consensus. In this study, we hypothesized that plate osteosynthesis will be associated with better functional and pain outcomes, thus better quality of life. Eighteen patients with the diagnosis of humeral shaft metastatic fracture or impending fracture were extracted from a prospective database of 140 metastatic patients collected across three hospitals over a five-year period. Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), Quality of Life (QOL) and Brief Pain Inventory (BPI) score were gathered during the year following the surgery. Statistical analysis was performed to compare the mean score differences between the two surgical options at baseline and five follow-up visits. Both treatment options were associated with an increase in functional outcomes based on both MSTS and TESS, and a decrease in pain level. However, no significant difference was found in quality of life and between the two treatment modalities. Thus, based on our results, a similar improvement in functional status and pain level can be achieved surgically by either intramedullary nailing or plating osteosynthesis.

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“…A 2014 systematic review on the surgical management of bone metastases identified high rates of peri-operative complications and mortality associated with surgical intervention (17% complication rate, 4% mortality rate), large study heterogeneity in methodology and patient inclusion, and all 45 studies included were of level IV evidence [ 14 ]. Another systematic review in 2015 by Janssen et al .. assessed the evidence for operative treatment of metastatic humeral fractures [ 15 ]. They also identified an overall low level of evidence (six level III and 17 level IV studies included), substantial study heterogeneity in design and intervention, selection bias and poor data reporting on adjuvant treatments and outcome measures such as quality of life, function, and pain.…”

Section: Introductionmentioning

confidence: 99%

A scoping review on the surgical management of metastatic bone disease of the extremities

Kendal

Abbott

Kooner

et al. 2018

BMC Musculoskelet Disord

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BackgroundManagement of metastatic bone disease of the extremities (MBD-E) is challenging, and surgical directions pose significant implications for overall patient morbidity and mortality. Recent literature reviews on the surgical management of MBD-E present a paucity of high-level evidence and global inconsistencies in study design. In order to steer productive research, a scoping review was performed to map and assess critical knowledge gaps.MethodsThe Arksey and O’Malley framework for scoping studies was followed. A comprehensive literature search identified a large body of literature pertaining to the surgical management of MBD-E. Study data and meta-data was extracted and presented using descriptive analytics and a thematic framework. Literature gaps were identified and analyzed.ResultsThree hundred eighty five studies from 1969 to 2017 were included. Studies were categorized into 11 separate themes, with the majority (63%) falling into the “surgical fixation strategies” theme, followed by “complications” at 7% and “prognosis and survival” at 6.2%. Less than 3% of studies were categorized in “patient related outcomes” or “epidemiology” themes. 89% of studies were retrospective and only 6 studies were of level 1 or 2 evidence. We identified a temporal increase in publication by decade, and all studies published on interventional radiology techniques or economic analyses were published after 2007 or 2009, respectively. 64.9% of studies were published in Europe and 20.3% were published in North America. Average patient age was 62 (± 5.2 years), and breast was the most common primary tumour (28%), followed by lung (17%) and kidney (15%). In terms of surgical location, 75% of operations involved the femur, followed by the humerus at 22% and tibia at 3%.ConclusionsWe present a descriptive overview of the current published literature on the surgical management of MBD-E. Critical knowledge gaps have been identified through the development of a thematic framework. Consolidation of literary gaps must involve bolstered efforts towards patient and family-engaged research initiatives and assessment of patient-related surgical outcomes. Multi-disciplinary engagement in developing prospective research will also help guide evidence-based personalized practice for these patients. By building on existing comprehensive patient databases and registries, knowledge on survival and prognostic parameters can be greatly improved.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2210-8) contains supplementary material, which is available to authorized users.

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Outcome of operative treatment of metastatic fractures of the humerus: a systematic review of twenty three clinical studies

Abstract: Reported complication rates help surgeons inform their patients and could aid in surgical decision making. Functional outcome, pain and quality of life were poorly reported. Patient reported outcomes are therefore an important direction for future research.

Cited by 20 publications

References 45 publications

Efficacy of a Modified Scoring System to Facilitate Surgical Decision‐making for Diaphyseal Malignancies: When is Devitalized Tumor‐bearing Autograft of Value?

Efficacy of a Modified Scoring System to Facilitate Surgical Decision‐making for Diaphyseal Malignancies: When is Devitalized Tumor‐bearing Autograft of Value?

Intramedullary Nailing Versus Plate Osteosynthesis for Humeral Shaft Metastatic Lesions

A scoping review on the surgical management of metastatic bone disease of the extremities

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