Treatment of pathological humerus shaft fractures with intramedullary nails with or without cement fixation

Bone metastasis is a severe complication for patients with cancer. Not only does it cause intractable pain and other clinical problems such as fracture after trivial injury, it also signifies that the malignant process is incurable. Since life expectancy of metastasised cancer patients has improved due to advanced oncological treatment but is still limited, appropriate surgical intervention has increased. This is a retrospective control study of 21 patients who underwent cemented intramedullary nailing for pathological fractures in the humeral shaft between 2005 and 2009 as compared to a historical control group of 19 patients that underwent locked intramedullary nailing for pathological fractures in the humeral shaft between 1999 and 2004. Four major outcomes were assessed, namely, pain relief, use of analgesics, recovery of function and rate of complication. Patients treated with cemented intramedullary nailing had better pain relief, less use of analgesics and better functional restoration immediately after surgical procedure when compared to the patients without cement fixing. The rate of complication did not differ between these two groups. Since surgery for metastases does not prolong life but improves the quality of life, the aim towards a short postoperative rehabilitation time is recommended. Cement fixation gives immediate stabilisation to the fracture site and thus allows less pain but full range of motion from the first postoperative day.