Cement augmentation of bone defect in pathological humeral diaphyseal fracture treated with retrograde intramedullary nail

BacKGRoUnD Pathological fractures of long bones secondary to metastatic lesions are common.1 Management of pathological humeral diaphyseal fractures with bone loss is challenging. Palliative internal fixation improves pain and quality of life.2 We describe a simple technique to address bone loss of the distal humerus (Fig 1) using Palacos® bone cement (Heraeus, Wehrheim, Germany) following retrograde humeral internal fixation (Fig 2). techniQUe The patient was placed in a lateral position with the operative limb over an armrest. The posterior approach was taken to the elbow with an incision through the triceps aponeurosis down to the bone. A tumour involving soft tissue was debulked and curettage of the lesion performed. There was a 6cm bone defect involving the distal third of the humerus (Fig 3). The fracture was reduced and a retrograde Halder intramedullary nail (7mm x 270mm) introduced with distal locking screws.