Evaluating the reoperation rate and hardware durability of three stabilizing implants for 105 malignant pathologic humerus fractures

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 mangement, but current data suggests fragility must be thoughtfully considered.