Abstract
BACKGROUND: The proximal humerus is an easily overlooked site for metastatic bone tumors, and pathological fractures here can cause severe pain and functional impairment. The selection of surgical regimens should take into account the location of bone metastases, the patient's physical status, and other relevant factors. Therefore, the optimal surgical strategy remains controversial. This study aimed to investigate and compare the clinical efficacy of two surgical approaches-tumor resection combined with prosthesis implantation versus plate fixation combined with bone cement augmentation-in patients with pathological fractures of the proximal humerus induced by metastatic tumors. By evaluating functional recovery, local tumor control, complications, and survival rate, this study clarified the applicable scenarios of the two surgical modalities, thereby providing a reference for clinical treatment decision-making. METHODS: A retrospective analysis was performed on 40 patients with metastatic pathological fractures of the proximal humerus who were admitted to our institution from July 2017 to May 2025 (24 males and 16 females, with a mean age of 57 years). According to the surgical procedures, the patients were divided into two groups: the prosthesis group (n = 15) underwent tumor resection combined with modular anatomical hemiarthroplasty, while the plate-cement group (n = 25) was treated with open reduction, plate internal fixation plus bone cement augmentation. Baseline data and perioperative indicators including operation time, intraoperative blood loss, and incision length were collected and compared between the two groups. In addition, postoperative pain assessed by the Visual Analogue Scale (VAS), functional outcomes evaluated via the Musculoskeletal Tumor Society (MSTS) score, postoperative complications, and survival rate were also compared between the two cohorts. The mean follow-up duration was 13.03 ± 19.59 months. RESULTS: A total of 40 patients were enrolled in this study, consisting of 15 cases in the prosthesis group and 25 cases in the plate-cement group. No significant differences were observed in gender, primary tumor type and fracture type between the two groups (p > 0.05). With respect to perioperative indicators, the plate-cement group showed significantly superior outcomes to the prosthesis group in terms of intraoperative blood loss (374.00 ± 100.13 mL vs. 973.33 ± 749.49 mL, p < 0.05) and operation duration (93.40 ± 20.19 min vs. 146.87 ± 17.65 min, p < 0.05). At the 3-month postoperative follow-up, the plate-cement group achieved significantly lower VAS pain scores (0.72 ± 0.80 vs. 1.27 ± 0.80, p < 0.001) and significantly higher MSTS functional scores (27.20 ± 1.38 vs. 21.53 ± 1.19, p < 0.001) compared with the prosthesis group. Regarding complications during the short-term follow-up, two cases of shoulder instability occurred in the prosthesis group, whereas the plate-cement group presented with one case of humeral head collapse and two cases of transient radial nerve injury. CONCLUSION: Plate fixation with bone cement augmentation provides superior short-term functional recovery and pain relief for metastatic proximal humeral fractures. However, these findings must be interpreted with caution due to the selection bias inherent in our non-randomized surgical approach.