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

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

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

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