Name of the Procedure:

Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft

Summary

This procedure involves stabilizing the humerus (upper arm bone) using metal hardware such as nails, pins, plates, or wires, sometimes with the addition of bone cement (methylmethacrylate), to prevent or treat fractures in the humeral shaft.

Purpose

The procedure is designed to address conditions that weaken the humerus, such as bone tumors, metastatic disease, or severe osteoporosis. The goal is to provide structural support to prevent fractures, ensure proper healing, and restore arm function.

Indications

• Presence of bone tumors or metastatic lesions in the humerus
• Severe osteoporosis or other conditions leading to weakened bones
• Incomplete or impending fractures of the humerus

Patient criteria:

• Diagnosed conditions that significantly weaken the bone
• Risk of fracture based on medical imaging
• Overall health allowing for surgery

Preparation

• Fasting for at least 8 hours prior to surgery
• Discontinuation or adjustment of certain medications, as advised by the surgeon
• Preoperative imaging studies (X-rays, MRI, or CT scans)
• Blood tests to ensure patient is fit for surgery

Procedure Description

1. Anesthesia: General anesthesia is typically administered.
2. Incision: The surgeon makes an incision over the humerus.
3. Stabilization: Depending on the method chosen, the humerus is stabilized using nails, pins, plates, or wires.
4. Cementation: If necessary, methylmethacrylate (bone cement) may be used to further secure the hardware and provide additional support.
5. Closing: The incision is closed with sutures or staples.
6. Dressing: A sterile dressing is applied to the surgical site.

Tools and equipment:

• Surgical drills and saws
• Internal fixation devices (nails, pins, plates, wires)
• Methylmethacrylate (bone cement), if used

Duration

The procedure typically takes 1 to 2 hours.

Setting

This procedure is performed in a hospital operating room or specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologist

Risks and Complications

Common risks:

• Infection
• Bleeding
• Pain at the surgical site Rare risks:
• Hardware failure or displacement
• Non-union or delayed healing of the bone
• Nerve or blood vessel injury

Benefits

• Prevention of fractures in weakened bones
• Restoration of arm function
• Reduced pain and improved quality of life

Improvements are usually noticeable within weeks to a few months.

Recovery

• Pain management with medications
• Physical therapy to restore arm strength and mobility
• Follow-up appointments for X-rays to monitor healing
• Avoiding heavy lifting or strenuous activities for several weeks
• Incision care instructions

Full recovery may take several months, depending on the patient's overall health and adherence to rehabilitation.

Alternatives

• Conservative management with medications and physical therapy
• External bracing or splinting
• Radiation therapy for bone tumors

Pros and cons:

• Conservative options carry fewer surgical risks but may not provide sufficient stabilization.
• Radiation therapy is non-invasive but may not immediately address structural weakening.

Patient Experience

During the procedure:

• Patients are under general anesthesia, so they are unconscious and will not feel pain.

After the procedure:

• Postoperative pain is managed with medications.
• Patients may feel some discomfort and limited mobility initially.
• Gradual improvement in pain and function with adherence to recovery instructions and physical therapy.