Complications, reoperations, and revisions after surgical treatment of humeral metastases with modular prosthesis, intramedullary nailing or plate fixation: a retrospective analysis

Purpose: Modular prosthesis, intramedullary nailing and plate fixation are surgical options for humeral metastasis, but the optimal treatment for pathological or impending fractures remains controversial. This study evaluated complications, reoperations, and revisions in patients with humeral metastases treated with these surgical techniques. Methods: We retrospectively analyzed 115 patients with humeral metastases treated with modular prosthesis (n = 33), intramedullary nailing (n = 69) or plate fixation (n = 13). We evaluated complications, reoperations without implant removal and revisions requiring implant removal. Cumulative incidence of complications and death was estimated using competing risk analysis. Results: In modular prosthesis group, 5/33 patients had complications (15.1%): three had subluxations or instability treated conservatively, one had local disease progression treated with embolization and radiotherapy, and one had deep infection who required revision. In intramedullary nailing group, 8/69 patients had complications (11.6%): seven had local disease progression and one had mechanical implant failure. Two patients required reoperation due to local disease progression, and none required revision. In plate fixation group, 4/13 patients had complications (30.7%): two had mechanical implant failure, one had local disease progression, and one had deep infection. Reoperation was required in one patient due to infection, while revision was required in two patients: one patient due to local disease progression and one patient due to mechanical implant failure. Conclusion: Modular prosthesis, intramedullary nailing and plate fixation were associated with distinct complication profiles. Modular prostheses were most commonly associated with instability, intramedullary nails with local disease progression, and plate fixation with a relatively high proportion of complications and revisions. Given the heterogeneity of anatomical location and treatment indications, these findings should be interpreted descriptively rather than as evidence of superiority of one technique over another.