Intercalary prosthetic reconstruction for pathological humeral diaphyseal fractures due to metastatic tumors:outcomes and improvements
ZHAO Jie
YU Xiu-chun
XU Ming
ZHENG Kai
HU Yong-cheng
WANG Feng
LUN Deng-xing
Abstract：Objective To evaluate recent clinical outcomes of intercalary prosthetic reconstruction for pathological humeral diaphyseal fractures due to metastatic tumors. And to report the application of additional plates, which can prevent the early aseptic loosening of the prosthesis. Methods We retrospectively analyzed 9 patients [ 4 males and 5 females; average ( 62.9 ± 11.1 ) years old at diagnosis ], who received medical care at our institutions from March 2011 to September 2017. All underwent intercalary prosthetic reconstruction for pathological humeral diaphyseal fractures secondary to metastatic diseases. Pathological fracture locations: 6 cases in the middle segment, 1 case in the proximal segment, and 2 cases in the distal segment. Primary tumors: 1 case of liver tumors, 2 cases of thyroid tumors, 2 cases of breast tumors, 2 cases of renal tumors, and 2 cases of lung tumors. After a wide resection according to the tumor-free principle, 4 patients had intercalary prosthetic reconstruction ( Group A ), and 5 patients had intercalary prosthesis implantation with an additional extracortical plate ( Group B ). All 9 patients were followed up for 1 - 25 months ( average: 8.6 months ). Operation time, blood loss volume, postoperative MSTS score, postoperative ASES score and complications were noted. Two-sample t-test was used to compare the results of the 2 groups. Results All surgeries were successful. Group A: the mean bone removal length ( 7.75 ± 0.96 ) cm; the mean operation time ( 80 ± 14 ) minutes; the mean blood loss ( 115 ± 26 ) ml; the mean postoperative MSTS score for the upper extremity ( 24.50 ± 2.38 ); the mean postoperative ASES score ( 85.50 ± 4.20 ). Group B: the mean bone removal length ( 7.80 ± 1.30 ) cm; the mean operation time ( 94 ± 5 ) minutes; the mean blood loss ( 120 ± 31 ) ml, the mean postoperative MSTS score for the upper extremity ( 26.20 ± 0.84 ); the mean postoperative ASES score ( 87.00 ± 2.55 ). At the final follow-up, 2 patients ( 1 was followed-up for 1 month, 1 was followed-up for 2 months ) were alive; 7 patients ( 6 with lung metastases, 1 with aggravated lung cancer ) died; yielding a mean survival of ( 10.6 ± 6.6 ) months; The mean MSTS score and ASES score were 25.4 and 86.3 respectively in 2 groups. The range of motion and functions of the shoulder and elbow joints returned to the normal. Two patients ( 22.2% ) developed complications ( both were from Group A; 1 aseptic loosening, 1 radial nerve injury ). Conclusions Intercalary prosthetic reconstruction achieves satisfactory outcomes in patients with pathological humeral diaphyseal fractures due to metastatic tumors, and addition of an additional plate to the prosthesis stem can prevent early aseptic loosening.
Keywords：Prosthesis implantationHumeral fracturesCarcinoma metastaticumInterdcalary prosthesis
Publication Date：2018-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 342-348 )