Ho Jung Kang; Byoung Yoon Hwang; Jae Jeong Lee; Kyu Ho Shin; Soo Bong Hahn; Sung Jae Kim

doi:10.12671/jkfs.2010.23.2.187

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Original Article
Surgical Treatment of Pathologic Humeral Fracture: Ho Jung Kang, M.D., Byoung Yoon Hwang, M.D., Jae Jeong Lee, M.D., Kyu Ho Shin, M.D., Soo Bong Hahn, M.D., Sung Jae Kim, M.D.; Journal of the Korean Fracture Society 2010;23(2):187-193.
DOI: https://doi.org/10.12671/jkfs.2010.23.2.187
Published online: April 30, 2010

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to: Byoung Yoon Hwang, M.D. Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250, Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-5679, Fax: 82-2-361-1139, sogood95@yuhs.ac

• Received: August 24, 2009 • Revised: December 15, 2009 • Accepted: January 12, 2010

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Abstract
REFERENCES

Abstract

Purpose
To evaluate and analyze the radiographic and clinical outcomes after the surgical treatments of pathologic humeral fractures.
Materials and Methods
From October 1993 to September 2007, a retrospective investigation was conducted with a total of 13 patients who underwent operations for pathologic humeral fractures. The methods of surgical treatment were as follows-four cases of open reduction and internal fixation; eight cases of closed reduction and internal fixation with intramedullary nailing; and one of radical excision and hemiarthroplasty.
Results
Of nine patients with metastatic bone lesions, three were diagnosed with primary cancer after the incidence of pathologic humeral fracture. The mean period between the diagnosis of primary cancer and pathologic fracture in the latter six cases was 36.7 (2~144) months and the mean survival period after the surgical treatments was 22.8 (12~35) weeks in all patients with bone metastasis. Fracture unions were noted in all four cases of primary humeral bone lesion but none in metastatic cases. Pain relief and functional recovery were noted in eleven patients of this study.
Conclusion
Satisfactory clinical outcomes with sustained pain relief and functional recovery were observed after the surgical treatments of pathologic humeral fracture. Benign bone lesions require more active and early treatments in order to facilitate the functional recovery of upper extremities and fracture union. With pathologic humeral fractures originated from metastasis, palliative treatments were preferred to fracture union method for planning long-term pain relief and functional recovery.
Key words: Humerus, Pathologic fracture, Surgical treatment

REFERENCES

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Fig. 1

(A) A 51-year-old female had proximal humeral fracture from a slip down injury. Possible diagnosis was simple bone cyst, enchondroma, giant cell tumor or aneurismal bone cyst.

(B) She was treated with closed reduction and intramedullary nailing.

(C) After the surgical treatment, biopsy of fracture site was confirmed as giant cell tumor. One week after the primary operation, curettage and autoiliac bone graft were performed (Black arrow is an autologous iliac bone block).

(D) The bone union was gained at 13 months after operation.

Fig. 2

(A) A 55-year-old male, with humerus shaft fracture from car accident 3 years ago, initially had an internal fixation, but a follow-up bone graft was carried out due to the continuous mal-union.

(B) After his third operation with preoperative evaluation of lung mass, biopsy of fracture site was confirmed as pathologic fracture originated from lung cancer (White arrow is a lung mass).

(C) At 5 months after closed reduction and IM nailing with bone graft, we found persistent non-union of humeral shaft. He died at 26 weeks after operation.

Table 1

Modification of the rating system of Perez et al.

Table 2

Data of 4 cases with benign humeral lesion

Fx: Fracture, Dx: Diagnosis, IM: Intramedullary, Op: Operation.

Table 3

Data of 9 cases with metastatic humeral lesion

Fx: Fracture, Dx: Diagnosis, IM: Intramedullary, Op: Operation.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

The application of a dual-lead locking screw could enhance the reduction and fixation stability of the proximal humerus fractures: a biomechanical evaluation
Eunju Lee, Hyeon Jang Jeong, Yeon Soo Lee, Joo Han Oh
Frontiers in Surgery.2024;[Epub] CrossRef
Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor
Jeung Il Kim, Um Ji Kim, Nam Hoon Moon, Hui Taek Kim, Tae Young Ahn, In Sook Lee, You Seon Song, Kyung Un Choi
Journal of the Korean Orthopaedic Association.2016; 51(6): 509. CrossRef

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Surgical Treatment of Pathologic Humeral Fracture

J Korean Fract Soc. 2010;23(2):187-193. Published online April 30, 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.2.187

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Surgical Treatment of Pathologic Humeral Fracture

Fig. 1 (A) A 51-year-old female had proximal humeral fracture from a slip down injury. Possible diagnosis was simple bone cyst, enchondroma, giant cell tumor or aneurismal bone cyst. (B) She was treated with closed reduction and intramedullary nailing. (C) After the surgical treatment, biopsy of fracture site was confirmed as giant cell tumor. One week after the primary operation, curettage and autoiliac bone graft were performed (Black arrow is an autologous iliac bone block). (D) The bone union was gained at 13 months after operation.

Fig. 2 (A) A 55-year-old male, with humerus shaft fracture from car accident 3 years ago, initially had an internal fixation, but a follow-up bone graft was carried out due to the continuous mal-union. (B) After his third operation with preoperative evaluation of lung mass, biopsy of fracture site was confirmed as pathologic fracture originated from lung cancer (White arrow is a lung mass). (C) At 5 months after closed reduction and IM nailing with bone graft, we found persistent non-union of humeral shaft. He died at 26 weeks after operation.

Fig. 1

Fig. 2

Surgical Treatment of Pathologic Humeral Fracture

Table 1

Modification of the rating system of Perez et al.

Table 2

Data of 4 cases with benign humeral lesion

Fx: Fracture, Dx: Diagnosis, IM: Intramedullary, Op: Operation.

Table 3

Data of 9 cases with metastatic humeral lesion

Fx: Fracture, Dx: Diagnosis, IM: Intramedullary, Op: Operation.

Table 1 Modification of the rating system of Perez et al.

Table 2 Data of 4 cases with benign humeral lesion

Fx: Fracture, Dx: Diagnosis, IM: Intramedullary, Op: Operation.

Table 3 Data of 9 cases with metastatic humeral lesion

Fx: Fracture, Dx: Diagnosis, IM: Intramedullary, Op: Operation.