Abstract
The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications with this procedure have been reported. This study reports on the results of using a new humeral nail for the treatment of pathological fracture or impending fracture of the humerus. Twenty nine patients had 31 Austofix humeral nails, 25 for pathological fracture and 6 for impending fracture. Twenty-four nails were inserted anterograde and 7 retrograde. Cement augmentation was used in 4 patients. Adjuvant therapy was used in 26 patients. One patient was lost to follow-up. Fixation failed in six patients, two due to intra-operative fractures during retrograde insertion, one due to fracture through screw holes postoperatively, and three due to local progression of disease. Difficulties in locking the nail distally were encountered in an additional 3 patients. In conclusion, in the majority of patients, nailing of the humerus with metastatic disease resulted in a stable humerus. Retrograde nailing of the humerus was associated with an increased risk of intra-operative fracture. Adjuvant therapy cannot be relied upon to prevent loss of fixation due to local progression of disease. The longest possible nail should be inserted through the antegrade route and locked to minimise the risk of loss of fixation.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
