• A J Bauze and M T Clayer.
• The Queen Elizabeth Hospital, South Australia. adrianbauze@hotmail.com
• J Orthop Surg (Hong Kong). 2003 Jun 1; 11 (1): 34-7.

ObjectiveThe humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications occur. This study aimed to assess the use of a new humeral nail to treat pathological fractures and impending pathological fractures of the humerus.Methods29 patients received 31 Austofix locked intramedullary humeral nails: 25 for pathological fractures and 6 for impending fractures; 24 nails were inserted anterograde and 7 retrograde. Cement augmentation was applied in 4 patients, and adjuvant therapy was used in 28 patients. Complications occurred in 12 patients.ResultsFixation failed in 6 patients: 2 due to intraoperative fractures during retrograde nailing, one due to a fracture through screw holes postoperatively, and 3 due to local progression of disease. Difficulty in distal locking of the nail was encountered in 4 patients. Locked intramedullary nailing resulted in a stable humerus in 80% of patients.ConclusionRetrograde insertion of the nail is associated with an increased risk of intra-operative fracture, and disease progression can occur, despite the administration of adjuvant therapy.

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