HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Frassica, F. J. Articles by Frassica, D. A. Search for Related Content PubMed PubMed Citation Articles by Frassica, F. J. Articles by Frassica, D. A.

Metastatic Bone Disease of the Humerus

Dr. F. Frassica is Chairman and Robert A. Robinson Professor, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD. Dr. D. Frassica is Assistant Professor of Oncology, Department of Radiation Oncology, Johns Hopkins University.

Reprint requests: Dr. Frank J. Frassica, c/o Elaine P. Henze, Room A672, 4940 Eastern Avenue, Baltimore, MD 21224-2780.

Metastatic bone disease is the most common cause of destructive bone lesions in adults, and involvement of the humerus is common. Patients with destructive lesions involving <50% of the cortex are treated nonsurgically with external beam irradiation. Patients with diaphyseal lesions involving 50% of the cortex or those with pain after irradiation can be treated with intramedullary nailing to achieve rigid fixation. Although closed intramedullary nailing is used most often, open nailing with methylmethacrylate is appropriate for destructive lesions in which rigid fixation cannot be achieved with closed nailing. Plate fixation is acceptable when adequate proximal and distal cortical bone is present for screw purchase, although proximal humeral lesions usually are treated with prosthetic arthroplasty. Postoperative external beam irradiation can help prevent disease progression and subsequent loss of fixation. However, when disease progression persists or rigid internal fixation is not feasible because of extensive bone destruction, wide resection and reconstruction with a custom prosthesis can be done.

This article has been cited by other articles:

				K. Atesok, M. Liebergall, E. Sucher, M. Temper, R. Mosheiff, and A. Peyser Treatment of Pathological Humeral Shaft Fractures with Unreamed Humeral Nail Ann. Surg. Oncol., April 1, 2007; 14(4): 1493 - 1498. [Abstract] [Full Text] [PDF]