Patolojik Humerus Kırığı olan Erişkin Hastaların Tedavisi: Tek Merkez Deneyimi, Retrospektif Çalışma

Year 2022, Volume: 48 Issue: 1, 43 - 48, 01.04.2022

Ali Erkan Yenigül , Yücel Bilgin , Arif Çakar , Mühammet Sadık Bilgen

https://doi.org/10.32708/uutfd.1075605

Abstract

Patolojik humerus kırıkları; tümörlerin, enfeksiyonların, metabolik hastalıkların veya nöromüsküler hastalıkların kemik yapısı üzerindeki negatif etkileri sonucu gelişebilir. Tedavisi zordur ve özel donanımlara sahip sağlık merkezlerinde yapılabilir. Bu çalışmada son on yıl içinde kliniğimizde edindiğimiz tecrübeyi paylaşarak, patolojik humerus kırıklarının çeşitli tedavi yöntemlerini ve bunların sonuçlarını analiz etmeyi amaçladık. 2010-2020 tarihleri arasında kliniğimizde patolojik humerus kırığı nedeniyle tedavi almış olguların: yaş, cinsiyet, primer tanı, patolojik kırık yerleşimi, kırık öncesi mobilizasyonu, uygulanan cerrahi yöntem, hastanede yatış süresi, takip süreleri, Musculoskeletal Tumor Society skorları ve radyolojik görüntüleme yöntemleri incelendi. Çalışmaya 14 erkek,13 kadın olmak üzere 27 olgu katıldı. Yaş ortalaması 57 (21-77) idi. 16’sında metastaz nedenli,11’inde primer tümör nedenli kırık vardı. Kırık yerleşiminin 11 olguda humerus proksimalinde, 12 olguda humerus şaftında ve 4 olguda humerus distalinde idi. 10 olguya omuz protezi, 2 olguya plak-vidayla osteosentez, 8 olguya interkalar protez,4 olguya intramedüller çivileme,3 olguya dirsek protezi uygulandı. Olguların hastanede yatış süreleri ortalama 9(2-30) gündü. MSTS değerlerinde ameliyat sonrası artış ortalama %40 olarak belirlendi. Olguların takip süreleri ortalama 35(7-72) aydı ve 6 hastada komplikasyon gelişti. Patolojik humerus kırıkları nadir görülmesine rağmen çok farklı tanılar nedeniyle oluşabiliyorlar ve çok farklı tedavi modaliteleri gerektirebiliyorlar. Metastaz nedenli patolojik humerus kırıkları daha sık görülürken, primer tümör nedenli kırıklarda sağkalım daha uzundur.

Keywords

Patolojik kırık, humerus, metastaz, intramedüller çivi, interkalar protez, tümör protez

Supporting Institution

yok

Project Number

yok

Thanks

.

Treatment of Adult Patients with Pathologic Humerus Fracture: Single Center Experience, Retrospective Study

Abstract

Pathological humeral fractures; It can develop as a result of the negative effects of tumors, infections, metabolic diseases or neuromuscular diseases on the bone structure. It is difficult to treat and can be done in health centers with special equipment. In this study, we aimed to analyze various treatment methods of pathological humeral fractures and their results by sharing the experience we have gained in our clinic in the last ten years. The patients who received treatment for pathological humeral fracture in our clinic between 2010-2020: age, gender, primary diagnosis, pathological fracture location, mobilization before fracture, surgical method, hospitalization time, follow-up periods, Musculoskeletal Tumor Society scores and radiological images were analyzed. Twenty-seven cases, 14 males and 13 females, participated in the study. The mean age was 57 (21-77). 16 had fractures due to metastasis and 11 had fractures due to primary tumor. Fracture localization was proximal to the humerus in 11 cases, in the humeral shaft in 12 cases, and distal to the humerus in 4 cases. Shoulder prosthesis was applied in 10 cases, osteosynthesis with plate-screw in 2 cases, intercalar prosthesis in 8 cases, intramedullary nailing in 4 cases and elbow prosthesis in 3 cases. The mean hospital stay of the cases was 9(2-30) days. Postoperative increase in MSTS values was determined as 40% on average. The mean follow-up period of the cases was 35(7-72) months and complications developed in 6 patients. Although pathological humeral fractures are rare, they can occur due to different diagnoses and require very different treatment modalities. While pathological humerus fractures due to metastasis are more common, survival is longer in fractures caused by primary tumor.

Keywords

Pathological fracture, humerus, metastasis, intramedullary nail, intercalary prosthesis, tumor prosthesis

Project Number

yok

References

• 1. Yang CH, Kuo FC, Lee CH. Pathological humerus fracture due to anti-interferon-gamma autoantibodies: A case report. World J Orthop. 2021;12:938–44.
• 2. Miller F, R W. Carcinoma of the breast metastatic to the skeleton. Clin Orthop Relat Res. 1984;Apr:121–7.
• 3. Habermann E, Lopez R. Metastatic disease of bone and treatment of pathological fractures. Orthop Clin North Am. 1989;20:469–86.
• 4. Brage ME, Simon MA. Evaluation, prognosis, and medical treatment considerations of metastatic bone tumors. Orthopedics. 1992;15:589–96.
• 5. 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. Eur J Surg Oncol [Internet]. Eur J Surg Oncol; 1996 [cited 2022 Feb 8];22:621–6. Available from: https://pubmed.ncbi.nlm.nih.gov/9005151/
• 6. Frassica F, Frassica D. Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res. 2003;Oct:212–8
• 7. Piccioli A, MacCauro G, Rossi B, Scaramuzzo L, Frenos F, Capanna R. Surgical treatment of pathologic fractures of humerus. Injury [Internet]. Elsevier Ltd; 2010;41:1112–6. Available from: http://dx.doi.org/10.1016/j.injury.2010.08.015
• 8. Hoellwarth JS, Weiss K, Goodman M, Heyl A, Hankins ML, McGough R. Evaluating the reoperation rate and hardware durability of three stabilizing implants for 105 malignant pathologic humerus fractures. Injury. Elsevier Ltd; 2020;51:947–54.
• 9. Heinz T, Stoick W, Vecsei V. Behandlung und Ergebnisse von pathologischen Frakturen. Unfallchirurg. 1989;92:477–85.
• 10. Sarahrudi K, Wolf H, Funovics P, Pajenda G, Hausmann JT, Vécsei V. Surgical treatment of pathological fractures of the shaft of the humerus. J Trauma - Inj Infect Crit Care. 2009;66:789–94.
• 11. Wedin R, Bauer H, Wersa¨ll P. Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop Relat Res. 1999;Jan:128–38.
• 12. Voskuil RT, Mayerson JL, Scharschmidt TJ. Management of Metastatic Disease of the Upper Extremity. J Am Acad Orthop Surg. 2021;29:e116–25.
• 13. Pizzo RA, Hoskins T, Patel JN, Miller JM, Goyette D, Mazzei C, et al. Distally Unlocked Intramedullary Nailing with Cement Fixation for Impending and Actual Pathologic Humerus Fractures: A Retrospective Case Series. J Am Acad Orthop Surg Glob Res Rev. 2020;4.
• 14. Redmond BJ, Biermann JS, Blasier RB. Interlocking intramedullary nailing of pathological fractures of the shaft of the humerus. J Bone Jt Surg - Ser A. 1996;78:891–6.
• 15. Bauze AJ, Clayer MT. Treatment of pathological fractures of the humerus with a locked intramedullary nail. J Orthop Surg. 2003;11:34–7.
• 16. Zoccali C, Attala D, Pugliese M, di Uccio AS, Baldi J. The IlluminOss® photodynamic bone stabilization system for pathological osteolyses and fractures of the humerus: indications, advantages and limits in a series of 12 patients at 24 months of minimum follow‐up. BMC Musculoskelet Disord. BMC Musculoskeletal Disorders; 2021;22:1–11.
• 17. Collis PN, Clegg TE, Seligson D. The invisible nail: A technique report of treatment of a pathological humerus fracture with a radiolucent intramedullary nail. Injury [Internet]. Elsevier Ltd; 2011;42:424–6. Available from: http://dx.doi.org/10.1016/j.injury.2010.10.012
• 18. Anselmetti GC, Manca A, Chiara G, Tutton S, Iussich G, Gino G, et al. Painful pathologic fracture of the humerus: Percutaneous osteoplasty with bone marrow nails under hybrid computed tomography and fluoroscopic guidance. J Vasc Interv Radiol [Internet]. Elsevier Inc.; 2011;22:1031–4. Available from: http://dx.doi.org/10.1016/j.jvir.2011.02.021
• 19. Yuan Q, Zhang K, Zhang X, Li P, Wu L, Man Q, et al. Percutaneous microwave ablation with osteoplasty and interventional internal fixation for impending pathologic fracture of the proximal humerus. J Cancer Res Ther. 2020;16:17141717.
• 20. Kawai N, Sato M, Iwamoto T, Tanihata H, Minamiguti H, Nakata K. Percutaneous Osteoplasty with Use of a Cement-filled Catheter for a Pathologic Fracture of the Humerus. J Vasc Interv Radiol. 2007;18:805–9.
• 21. Hamal PK, Lamichhane B, Pokhrel N, Singh J, Yadav RK. Ultrasound-Guided Interscalene Brachial Plexus Block for Pathological Humerus Fracture due to Multiple Myeloma with Systemic Manifestation: Useful Option for Management in Low-Income Countries. Case Rep Anesthesiol. 2020;2020.
• 22. Amen TB, Varady NH, Birir A, Hayden BL, Chen AF. Morbidity and mortality of surgically treated pathologic humerus fractures compared to native humerus fractures. J Shoulder Elb Surg [Internet]. Elsevier Inc.; 2021;30:1873–80. Available from: https://doi.org/10.1016/j.jse.2020.10.024
• 23. Bayram S, Özmen E, Birişik F, Kıral D, Salduz A, Erşen A. Prognostic factors affecting survival of patients with pathologic humerus shaft fractures treated with intramedullary nailing without tumor removal. J Orthop Sci. 2019;24:1068–73.