PubMed^® Literature Review

A scoping review mapped the knowledge gaps in surgical treatment of metastatic bone disease of the extremities, including the humerus. From 385 studies published between 1969 and 2017, we included those relevant to the surgical management of metastatic fractures of the humerus. Most studies stressed the need for a rigid mechanical construct to facilitate early mobility. Techniques encompassed internal fixation with cement, segmental resection with joint reconstruction, prosthetic joint arthroplasty, and intramedullary nail stabilization.

Prophylactic stabilization of impending fractures could lower the morbidity tied to metastatic lesions. The Mirels score, with a score of ≥8, appeared promising in predicting humeral metastases fractures. Disease progression post-intramedullary nailing correlated with primary tumor type, particularly renal cell carcinoma, and patient age.

Surgical treatment of metastatic sarcoma lesions, especially via intramedullary nailing, offered short-term pain reduction and mobility maintenance. However, the prognosis for patients with metastatic humerus fractures remains bleak, due to high tumor progression and fixation failure rates.

In conclusion, surgical treatment of metastatic humerus fractures demands a multidisciplinary approach. A rigid mechanical construct is essential for early mobilization. The Mirels score can help predict fractures in humeral metastases. Despite the temporary benefits of intramedullary nailing, the prognosis remains difficult due to high tumor progression and fixation failure.