Complications and survival after surgical treatment of 214 metastatic lesions of the humerus Rikard Wedin, MD, PhD a, *, Bjarne H. Hansen, MD b , Minna Laitinen, MD, PhD c , Clement Trovik, MD, PhD d , Olga Zaikova, MD e , Peter Bergh, MD, PhD f , Anders Kal  en, MD, PhD g , Gunnar Schwarz-Lausten, MD h , Fredrik Vult von Steyern, MD, PhD i , Anders Walloe, MD, PhD j , Johnny Keller, MD, DMSc b ,R € udiger J. Weiss, MD, PhD a a Department of Orthopaedics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden b Department of Orthopaedics, University Hospital, Aarhus, Denmark c Department of Orthopaedics, University Hospital, Tampere, Finland d Department of Orthopaedics, Haukeland University Hospital, Bergen, Norway e Department of Oncological Surgery, Norwegian Radium Hospital, Oslo, Norway f Department of Orthopaedics, Sahlgren University Hospital, Gothenburg, Sweden g Department of Orthopaedics, University Hospital, Link€ oping, Sweden h Department of Orthopaedics, University Hospital, Herlev, Denmark i Department of Orthopaedics, Lund University Hospital, Lund, Sweden j Department of Orthopaedics, Ullevaal Hospital, Oslo, Norway Background: The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skel- etal metastases of the humerus. Materials and methods: This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10. Results: The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the prox- imal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosyn- thesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P < 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years. Conclusions: Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral frac- tures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate. This study is based on data from the Scandinavian Sarcoma Group Skeletal Metastasis Register and approval from the local Ethics Committee is not required. *Reprint requests: Rikard Wedin, MD, PhD, Department of Ortho- paedics, Karolinska University Hospital, Karolinska Institutet, 171 76 Stockholm, Sweden. E-mail address: rikard.wedin@karolinska.se (R. Wedin). J Shoulder Elbow Surg (2012) 21, 1049-1055 www.elsevier.com/locate/ymse 1058-2746/$ - see front matter Ó 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. doi:10.1016/j.jse.2011.06.019