Tuesday, May 20, 2014

Intramedullary nailing of bilateral pathologic humerus fractures

This a female patient in her seventies who presented in the office with arm pain. She has been diagnosed with multiple myeloma (most common bone tumor for that age group). She has lytic bone lesions to bilateral humeri as demonstrated in the images below with a pathologic humerus fracture on the left. On the left side there is a lytic lesion at the proximal metaphysis and a pathologic fracture at the distal metaphysis of the bone.

As demonstrated by these preoperative films there is an impending pathologic fracture on the R at the proximal metaphysis and a pathologic fracture on the left at the distal metaphysis.

The patient had no contraindications to surgery and for this reason the fractures were stabilized with antegrade humeral nailing. At one year she is pain free to bilateral arms. Xrays are shown below.

We prefer to use IM nailing for pathologic humerus fracture, however there is a risk of shoulder pain after placement of the nails. For this reason this implant is avoided in the young active healthy individuals. In addition, placement of the distal locking screw requires good surgical exposure and technique to avoid injury to the radial nerve or nerve structures at the distal aspect of the humerus.