Distally Unlocked Intramedullary Nailing With Cement Fixation for Impending and Actual Pathologic Humerus Fractures: A Retrospective Case Series.

Abstract

The humerus is a common site of metastatic tumor involvement and pathologic fracture. Intramedullary nailing is a treatment option that offers the benefit of protecting a long segment of diseased bone, but it is not without complications. This study aims to examine the survival, functional outcomes, and complications of patients treated with cement-augmented unlocked intramedullary nailing for actual and impending pathologic fractures of the humeral shaft. From 2014 to 2019, 26 patients were treated with this technique. Functional outcomes were assessed using the Musculoskeletal Tumor Society scoring system. Outcome scores, complications, reoperations, and mortality were determined by retrospective chart reviews and direct patient examinations. The mean age at the time of surgery was 66.8 years. The mean follow-up was 20.2 months. Patients reported significant improvement in the mean Musculoskeletal Tumor Society score from 10.5 preoperatively to 26.1 after surgery (<i>P</i> < 0.001). Five patients died of disease during the follow-up period. One patient had intraoperative fracture propagation during implant placement, and one patient experienced a postoperative rotator cuff tear. Unlocked intramedullary nailing with cement augmentation is a reliable treatment method for actual and impending pathologic fractures of the humerus that results in favorable outcomes, including consistent pain relief and restoration of function.