Intralesional curettage, cement augmentation and fixation with Synthes Philos plate for pathological humeral fracture
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The humerus is the second most appendicular common site of osseous metastatic disease after the femur. Metastatic bone disease causes pain, swelling, fracture and subsequent dysfunction. The management of such patients needs to be pragmatic, balancing multiple conflicting patient and technical factors including but not limited to the age, fitness and willingness of a patient to have surgery, estimated prognosis, extent of osseous or visceral metastatic disease, severity of symptoms and dysfunction, impending or pathological fracture, curative or palliative intent.
There are multiple surgical options although optimal use of non-operative interventions should not be overlooked by orthopaedic oncologists.
The present case is a fairly typical presentation of a patient with multiple osseous sites of metastatic prostate carcinoma with a pathological humeral fracture and an impending femoral fracture, who, after discussion with his oncology team, underwent stabilisation of his humerus first to enable the use of crutches after femoral reconstruction. The use of cement augmented plate stabilisation was selected in favour of resection and endoprosthetic replacement as surgery was palliative (i.e. a non-curative intervention to alleviate pain & increase function) and because the bone destruction was minimal. You can read about the technique for proximal humeral endoprosthetic replacement here: https://www.orthoracle.com/library/proximal-humeral-replacement-mutars-reverse-geometry-shoulder-implantcast/
Jonathan Stevenson FRCS (Tr&Orth)
Author:Jonathan Stevenson FRCS (Tr & Orth).
Institution: Royal Orthopaedic Hospital, Birmingham,UK.