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Treatment of Pathological Humeral Shaft Fractures with Unreamed Humeral Nail

¹ Department of Orthopaedic Surgery, Hebrew University, Hadassah Medical Center, P.O. Box 12000, Jerusalem, 91120, Israel
² Department of Oncology, Hebrew University, Hadassah Medical Center, Jerusalem, Israel

Correspondence: Address correspondence and reprint requests to: Amos Peyser, MD; E-mail: peysera{at}hadassah.org.il

Purpose: The purpose of this study is to analyze the results of intramedullary fixation of pathological humeral shaft fractures using an unreamed humeral nail (UHN).

Patients & Methods: Twenty-one consecutive patients with 24 humeri fractured secondary to metastatic disease were retrospectively reviewed. The primary tumors included carcinomas of breast (11), kidney (2), multiple myeloma (2), colon (2), prostate (1), thyroid (1), lymphoma (1) and unknown origin (1). All fractures were stabilized with antegrade unreamed humeral nailing. Cemented technique was performed in 5 procedures. The mean age was 64 (range, 40–86), male to female ratio 6:15.

Results: Blood loss was unremarkable in 19 patients (22 procedures). Two patients who underwent fixation of additional pathological fractures during the same operation were given a total of 3 units of PC perioperatively. Mean postoperative hospitalization period due to one UHN procedure alone was 3 days (range, 2–7 days). Two patients died of their disease within 3 weeks of surgery. The remaining 19 patients returned to nearly normal function within 6 weeks after nailing. One patient developed postoperative local wound cellulitis. Relief of pain was rated as good in all but one patient. Adjuvant therapy was given in 20 procedures. Bony union was achieved in 88% (15/17) of all the cases where the patient had survived a minimum of 3 months.

Conclusion: Unreamed humeral nailing of the pathological humeral shaft fractures provides immediate stability and pain relief, minimum morbidity and early return of function to the extremity.

Key Words: Pathological humeral shaft fractures • unreamed humeral nailing • perioperative morbidity • pain relief • function