![]() ![]() The American Society of Anesthesiologist (ASA) physical status grade was used for evaluation of the general medical condition and tolerance of anesthesia. All patients consulted with medical oncologists and anesthesiologists regarding life expectancy and perioperative risks. We conducted a retrospective review of 46 consecutive patients with an impending or complete pathological fracture involving the proximal humerus between May 2007 and June 2011. The aims of the current study were to evaluate the reliability of interlocking IM nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess the functional outcomes of the patients. 12, 13) In our patients, we applied an IM nailing technique, interlocking IM nailing with additional augmentation of the skeletal defect with bone cement, for pathological fractures of the proximal humerus. They provide rigid fixation without extensive soft-tissue dissection. 1, 4, 6, 8, 9, 10, 11) Recently, several reports have been published on IM nail fixation techniques for proximal humerus fractures using devices that provide screw stabilization of the humeral head and tuberosity. 3) Accordingly, IM nailing for pathological fractures has so far been confined to diaphyseal lesions. 1) However, there is some controversy over the application of IM nailing for fractures of the proximal humerus due to the risk of loss of fixation. ![]() ![]() In general, stabilization with IM nailing for pathological fractures of the humeral diaphysis has the advantage of a small incision, less soft tissue dissection, short operative time, and early rehabilitation. Even if rotator cuff tendons are securely attached to the prosthesis using various methods, the joint motion is markedly limited after surgery. On the other hand, endoprosthetic reconstruction may be accompanied by perioperative morbidity, functional impairment of the shoulder, and especially by sacrifice of the rotator cuff insertion onto the greater tuberosity. In addition, it has shown a notable effect on pain relief, local control of the tumor, and stability. 1, 5, 7, 8) Endoprosthetic reconstruction has the advantage of providing resistance to bending and rotational forces. 6) Endoprosthetic reconstruction is usually employed for lesions in the proximal humerus, IM nailing for diaphysis, and plating for the distal humerus. ![]() 2, 3, 4, 5) Determination of the stabilization method is dependent on several conditions, including the location and extent of the metastatic lesion in the humerus, quality of the bone surrounding the lesion, and the patient's general status and life expectancy. Various surgical options have been proposed for stabilization of pathological humerus fractures, including flexible nailing, intramedullary (IM) nailing, plating, and prosthesis placement. Because pathological fractures of the humerus severely restrict the use of the involved arm and hand, surgical stabilization of symptomatic impending or pathological fractures is frequently recommended for patients with a reasonable general condition and long life expectancy. 1) Although the humerus is not a weight-bearing bone, patients with skeletal metastasis often have lower extremity involvement resulting in a greater dependence on the arms in transfer and ambulation. The humerus is the second most common site for long bone metastases following the femur. ![]()
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