Background: The purpose of this retrospective study was to analyze the results of closed intramedullary fixation of pathological humeral shaft fractures with unreamed humeral nail (UHN).

Patients & Methods: Nine patients who had ten pathological fractures of the humeral shaft secondary to metastatic disease were included in the study. All fractures were stabilized with unreamed humeral nailing with use of a closed anterograde technique. The mean patient age was sixty-three (range, fifty to 78), male to female ratio 1:8 and left humerus was involved in five, right in three patients and one patient had bilateral pathological humeral shaft fracture.

Results: The blood loss was unremarkable in seven patients (8 procedures). Two patients were given totally 3 units of pack cells after the surgery and these were the only patients who had additional surgeries during the same operation due to their additional pathological fractures. The mean duration of hospitalization after the operation was 6.5 days (range, two to 16 days). All of the ten extremities had a return to nearly normal function within 6 weeks after nailing. Relief of pain was rated as good in all but one patient. Seven patients received adjuvant therapy during the 3 months period before and after the procedure. Five patients died at a mean of 3.5 months (range, one to 9 months). There were no early or late complications related to surgery except one patient who developed cellulitis after the surgery. The fracture was united in all of the extremities in patients who survived for at least 3 months and had radiographs available.

Conclusion: Unreamed humeral nailing of the pathological humeral shaft fractures provides immediate stability and pain relief, minimum morbidity and early return of function to the extremity.

Vertebroplasty has been developed during the last decade in France as a method to relieve pain in patients suffering from a metastatic disease of the spine, that are poor surgical candidates. The indications include: mechanical pain, compression fractures, lytic bone metastasis.

Contra-indications include neurological compromise, breaching of the posterior wall, complete pedicle destruction or a large anterior soft-tissue mass. Relative contra-indications include a single resectable metastasis and a radiation sensitive tumor.

The method has been refined during the last few years by the introduction of specialized delivery systems and tailor-made bone cements.

The state of the art of this emerging technique will be discusses as well as some exciting future developments such as cements that can actively destroy tumors by physical or chemical modifications.