Outcome Based on Metastatic Humerus and Surgical Fixation: Finding of a Systematic Review

Background: As for treating metastatic humerus, open reduction with internal fixation (ORIF), intramedullary nail fixation as well as reconstruction of endoprosthesis act as the approaches with highest frequency in surgeries. In the current study, the postoperative complications and functional outcomes were compared after 3 operating treatments for metastatic humerus by performing a meta-analysis. Methods: An electronic search of relevant studies was done on December 29, 2015 and rigorously screened them according to inclusion and exclusion criteria. The summary results of the included studies were pooled using a random-effects mode. Results: A total of 21 studies were included for analysis. we evaluated the functional outcome according to the MSTS score, found that the upper limb function apparently returned after surgery. For local complications, the overall reoperation rate after endoprosthetic reconstruction (95%CI 0.06-0.11) ranged from 0-14%, 0-9% after intramedullary nailing (95%CI 0.04-0.08), and 0-8% after ORIF (95%CI 0.05- 0.24). The rate of re-operation for failed fixations ranged from zero to 10% after reconstruction of endoprosthesis (95%CI 0.03-0.07), 0-6% after intramedullary nailing (95%CI 0.01-0.04), and was 0-19% in all studies after ORIF (95%CI 0.02-0.19), while that for dislocations ranged from 0% to 8% after reconstruction of endoprosthesis (95%CI 0.02-0.05), and 0-5% after intramedullary nailing (95%CI 0.01- 0.04). Conclusions: Compared with the high rate of reoperation due to ORIF, those of intramedullary nail fixation and endoprosthetic construction are of comparability. The findings in the current study is applicable for aiding to make appropriately surgical decision to improve the living quality of patients in the remainder of their lives.