Pathologic fractures

A 70-year-old male slipped and fell while skiing landing on his outstretched right arm. Radiographs at the local hospital revealed a right-sided pathologic mid-shaft humeral fracture and evidence of lytic lesions on the humeral head.

His right arm was placed in a fracture splint and he was referred to David L. Helfet, MD at the Orthopaedic Trauma Service at the Hospital for Special Surgery for definitive fracture management. Additional tests were performed to further evaluate the pathologic fracture and metastatic lytic lesions.

Fracture reduction and fixation was planned and performed using an expandable retrograde intramedullary humeral nail. He followed up with an oncologist for further evaluation and treatment. He returned for regular follow-up and his pathologic humeral fracture healed uneventfully.

At his latest follow-up appointment at 6 months he presents with excellent radiographic and clinical results including a healed pathologic humerus fracture in excellent alignment with maintenance of reduction and fixation and he returned to his activities of daily living with resolution of pain.

  • Figure A

    Figure A

    Anteroposterior (AP) and lateral radiographs reveal a right-sided pathologic mid-shaft humeral fracture and evidence of lytic lesions on the humeral head

    Enlarge

  • Figure B, C

    Figure B, C

    (B) Preoperative plan

    (C) AP and lateral radiographs at 6 months illustrating a healed mid-shaft pathologic humeral fracture in excellent alignment.

    Enlarge

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