All included patients were followed until reconstructive failure or death.
The function of the upper extremities was assessed by the Musculoskeletal Tumor Society (MSTS) score and American Shoulder and Elbow Surgeons (ASES) score. The operative time, intraoperative blood loss, and postoperative complications were noted. Intramedullary nailing (IMN) was performed in 16 lesions, plate fixation (PF) in 33 lesions, and prosthetic replacement in 17 lesions. Sixty-three patients treated surgically for 66 metastatic fractures of the humerus shaft were retrospectively reviewed. The purposes of this study were to critically evaluate the effectiveness of intercalary endoprostheses in treating metastatic humeral shaft fractures and to clarify the surgical indications for this technique. Treatments for metastatic fracture of the humeral shaft continue to evolve as advances are made in both oncological and operative management. This finding highlights the need for improved collection of prospective data in this population to identify patients with favourable survival outcomes who may benefit from personalized oncologic surgical interventions.
Orthopedic intervention remains a poor prognostic variable for patients with MBD. There was no significant improvement in overall survival between 19 for patients with A-MBD who underwent orthopedic surgery. There was no effect of the weighted average of tumour severity scores for each study on 1-year survival over time. Meta-regression analysis showed no significant effect of midpoint study year on survival across all time points. Of the 5747 studies identified, 103 were retained for analysis. We categorized primary tumour types into a tumour severity score according to prognosis for a further meta-regression analysis. The midpoint year of patient inclusion for each study was used for analysis. We used a meta-regression model to assess the longitudinal trends in 1-, 2- and 5-year overall survival between 19. We conducted a study to evaluate the trend in overall survival for patients who underwent orthopedic surgery for A-MBD between 19.Ī systematic search of Embase and Medline to identify studies published since 1968 evaluating patients treated with orthopedic surgery for A-MBD was conducted for a previously published scoping review. 86 Lin et al.Īdvances in systemic cancer therapies have improved survival for patients with metastatic carcinoma however, it is unknown whether these advances have translated to improved survival for patients with appendicular metastatic bone disease (A-MBD) after orthopedic interventions. ORIF are preferable to IM fixations for the treatment of metaphyseal fractures and for those patients with a solitary metastasis in the humerus or those with a better prognosis.
Intramedullary stabilization is a reliable method for fixation of pathologic fractures of the humerus diaphysis for patients in the advanced stage of metastatic disease. The 1- and 2-year survival rates were 0.35 and 0.2 in ORIF and 0.07 and 0 in patients with IM fixation retrospectively. Two failures were observed in 21 patients with open reductions and plate fixations, compared with three failures in 20 procedures involving closed reductions and intramedullary stabilization. The overall rate of osteosynthesis failure was 12.2% (5 of 41). Radial nerve injury was the only local complication and was exclusively observed in patients who underwent open reduction and plate fixation. The rate of local complications was 14.6% (6 of 41). This report deals with the advantages and disadvantages associated with the most commonly used methods of stabilization after a pathologic fracture of the humerus shaft.Ī total of 39 patients with 41 metastatic lesions and pathologic fractures of the humerus, treated surgically between 19, were retrospectively analyzed.
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