Three lower quality studies were included and examined for this portion of the clinical practice guideline. These studies were retrospective and included low numbers of patients. Further, these studies included varied outcomes measured in terms of surgical complications and clinical function.
When treating pathologic diaphyseal humerus fractures in the setting of metastatic disease, the available evidence does not appear to show a significant difference in clinical outcomes (pain relief, upper extremity function, complication rates) between these constructs. However, with the low numbers available there was noted an increased failure rate with photodynamic polymer fixation compared to intramedullary nail fixation. Despite this potential difference, there does not appear to be a significant difference in reoperation rate between plating/internal fixation, intramedullary fixation, and photodynamic polymer.
Based on the low-level evidence of the articles analyzed, any of the constructs, including intramedullary nailing, photodynamic polymer, or plating/internal fixation, constitutes a reasonable and safe option when treating realized or impending pathologic diaphyseal humerus fractures. However, caution is advised regarding the use of photodynamic polymer fixation until further evidence is available due to the potential higher failure rates with this construct.
Further research is needed to better elucidate any potentially undetected outcome difference among the various constructs. The best study design to help determine this would be a collaborative, multicenter, randomized controlled trial.
- Dijkstra, S., Stapert, J., Boxma, H., Wiggers, T. Treatment of pathological fractures of the humeral shaft due to bone metastases: a comparison of intramedullary locking nail and plate osteosynthesis with adjunctive bone cement. European Journal of Surgical Oncology 1996; 6: 621-6
- Hoellwarth, J. S., Weiss, K., Goodman, M., Heyl, A., Hankins, M. L., McGough, R., 3rd Evaluating the reoperation rate and hardware durability of three stabilizing implants for 105 malignant pathologic humerus fractures. Injury 2020; 4: 947-954
- Sarahrudi, K., Wolf, H., Funovics, P., Pajenda, G., Hausmann, J. T., Vecsei, V. Surgical treatment of pathological fractures of the shaft of the humerus. Journal of Trauma-Injury Infection & Critical Care 2009; 3: 789-94