Pathologic Humerus Fracture

Description: Pathologic Humerus Fracture Reuben Gobezie MD, Brent A. Ponce MD, John Ready MD DEPARTMENT OF ORTHOPAEDICS, BRIGHAM AND WOMEN'S HOSPITAL, BOSTON MA Introduction Bony lesions may result in pathologic fractures. These lesions, when not of mesenchymal origin, commonly include myeloma, lymphoma, and most commonly metastastic carcinoma. The axial skeleton is the third most common site of bony metastasis, after the lung and liver. Of the 1.2 million new cases of cancer each year in the United States, one half will metastasize to the skeleton1. The tumors most likely to metastasize to bone are prostate (32%), breast (22%), kidney (16%), lung and thyroid1. Metastatic disease to the axial skeleton occurs much more frequently in the spine, pelvis, ribs, and lower extremities than in the humerus. Yet, metastasis to the humerus accounts for 20% of osseous metastasis. The humerus is the second most common site for long bone metastases, behind only the femur in its frequency of involvment. In multiple myeloma, the majority of patients have pathologic fractures at the time of diagnosis, and up to 30% of patients present with non-vertebral fractures2. Metastasis to the long bones usually reflects an advanced disease state. It has been recommended that the majority of patients with metastatic bone tumors receive multidisciplinary care from a team including orthopaedic oncologists, radiotherapists, and oncologists.