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Complications and survival after surgical treatment of 214 metastatic lesions of the humerus

Wedin, Rikard; Hansen, Bjarne H.; Laitinen, Minna; Trovik, Clement; Zaikova, Olga; Bergh, Peter; Kalen, Anders; Schwarz-Lausten, Gunnar; Vult von Steyern, Fredrik LU and Walloe, Anders, et al. (2012) In Journal of Shoulder and Elbow Surgery 21(8). p.1049-1055
Abstract
Background: The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus. Materials and methods: This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10. Results: The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis,... (More)
Background: The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus. Materials and methods: This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10. Results: The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosynthesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P < 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years. Conclusions: Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral fractures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. (Less)
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subject
keywords
Complications, humerus, metastases, pathologic fracture, surgery, survival
in
Journal of Shoulder and Elbow Surgery
volume
21
issue
8
pages
1049 - 1055
publisher
Mosby
external identifiers
  • wos:000307805600015
  • scopus:84863878419
ISSN
1058-2746
DOI
10.1016/j.jse.2011.06.019
language
English
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yes
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91a61583-f5eb-45a2-af9a-a9d619003eb4 (old id 3059778)
date added to LUP
2012-10-05 07:10:28
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2017-10-22 04:17:51
@article{91a61583-f5eb-45a2-af9a-a9d619003eb4,
  abstract     = {Background: The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus. Materials and methods: This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10. Results: The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosynthesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P &lt; 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years. Conclusions: Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral fractures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.},
  author       = {Wedin, Rikard and Hansen, Bjarne H. and Laitinen, Minna and Trovik, Clement and Zaikova, Olga and Bergh, Peter and Kalen, Anders and Schwarz-Lausten, Gunnar and Vult von Steyern, Fredrik and Walloe, Anders and Keller, Johnny and Weiss, Rudiger J.},
  issn         = {1058-2746},
  keyword      = {Complications,humerus,metastases,pathologic fracture,surgery,survival},
  language     = {eng},
  number       = {8},
  pages        = {1049--1055},
  publisher    = {Mosby},
  series       = {Journal of Shoulder and Elbow Surgery},
  title        = {Complications and survival after surgical treatment of 214 metastatic lesions of the humerus},
  url          = {http://dx.doi.org/10.1016/j.jse.2011.06.019},
  volume       = {21},
  year         = {2012},
}