Pathological fracture of the humeral shaft: Antegrade intramedullary nailing versus plate osteosynthesis with bone defect cementation

Purpose Clinically, metastatic pathological fractures of the humeral shaft remain a challenging issue. Plate osteosynthesis and intramedullary nailing are common fixation methods; however, the optimal strategy remains debated, especially in patients with limited life expectancy where surgical goals include rapid pain relief, functional recovery, and fewer reoperations. Methods We retrospectively reviewed 27 patients with metastatic humeral shaft fractures treated surgically during 2009–2019. Patients were grouped by plate osteosynthesis (n = 17) and antegrade intramedullary nailing (n = 10), and operative time, intraoperative blood loss, pain relief (visual analog scale), functional outcomes (Musculoskeletal Tumor Society scoring system), postoperative survival, complications were compared. Results Intramedullary nailing was associated with significantly less blood loss (298 ± 61 vs 557 ± 124 mL, p < 0.001) and better MSTS score (22.1 ± 3.34 vs 17.41 ± 6.2, p < 0.05) compared with plating, whereas postoperative pain relief was comparable. Postoperative survival did not differ significantly between the two groups. Complication rates did not different significantly, although implant failure–mediated reoperation occurred only in the plate group. Conclusions Both fixation methods achieved pain relief and functional improvement. However, intramedullary nailing demonstrated distinct advantages, reducing surgical morbidity, minimizing reoperation and superior functional outcomes which will benefit metastatic patients with low life expectancy. Overall, these results support intramedullary nailing as a reliable first-line option for most humeral shaft pathological fractures, whereas plate fixation may be reserved for proximal or distal lesions.