Evaluating the reoperation rate and hardware durability of three stabilizing implants for 105 malignant pathologic humerus fractures. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Hoellwarth, Jason S.; Weiss, Kurt; Goodman, Mark; Heyl, Alma; Hankins, Margaret L.; McGough, Richard
• Is Part Of: Injury. Volume 51:Issue 4(2020)
• Page Start: 947
• Page End: 954
• Publication Date: 2020-04
• Subjects: Pathologic humerus fracture -- IlluminOss -- Photodynamic bone stabilization -- Hardware failure -- Broken implant; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.02.124
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: -Patients with malignant pathologic humerus fractures live long and active enough to require long term durable implants. -Reoperation may occur in 6–16% of patients by two years, for multiple different reasons, and appears not to be statistically significantly impacted by implant choice. -Titanium intramedullary nails locked at both ends are more resistant to breaking than photodynamic stabilization and likely also cemented plates. - Photodynamic bone stabilization may potentially offer benefits in the management of pathologic fractures but current implant design and technique appears insufficiently durable. Abstract: Introduction: Many patients sustaining a malignant pathologic humerus fracture (MPHF) elect for surgical stabilization. Complications prompting reoperation can occur, leading to additional quality of life and financial cost. One common event preceding reoperation is a broken implant (BI). The purpose of this study was to identify the rate of reoperation following surgical stabilization of MPHF with three techniques – photodynamic bone stabilization (PBS), intramedullary nail (IMN), and cemented plate fixation (CPF) – and estimate to what extent improved implant durability might prevent reoperation. Materials and methods: Retrospective data collection was performed, identifying 105 procedures (100 patients) who underwent non-articular MPHF surgery from 2010–2016: 19 PBS, 65 IMN, 21 CPF. All patients were followed for at least two years or until death. Results: Reoperation rates were similar at one year (10.5%, 6.2%, 4.8%, p = 737), two years (15.8%, 6.2%, 9.5%, p = 375), and final evaluation (15.8%, 7.7%, 14.3%, p = 248). The rate of BI for PBS, IMN, and CPF was 10.5%, 0%, and 4.8% ( p = 049 PBS/IMN) at one year, 15.8%, 0%, and 9.5% ( p = 010 PBS/IMN) at two years, and 15.8%, 0%, and 14.3% ( p = 010 IMN/PBS, p = 013 IMN/CPF) at final evaluation. Conclusions: Reoperation rate was not significantly different at any time point. However, IMN surgery resulted in the lowest rate of broken implants (zero), statistically significant versus PBS at all time periods and versus CPF at final follow-up. PBS may eventually offer selected advantages for MPHF management, but current data suggests fragility must be thoughtfully considered.