Metastatic Bone Disease: Humerus and Scapula

The humerus is the second most common long bone affected by metastatic bone disease. Many of these lesions can be successfully treated with a combination of radiation, systemic therapy, and activity modifications. A variety of surgical options are recommended for pathologic fractures and can be individualized for patients based on a constellation of factors such as fracture location, the burden of local disease, articular integrity, tumor histology, and patient functional status. Intramedullary nails and plate fixation are popular treatment options, which are associated with predictable improvements in pain scores and functional outcomes. Cement augmentation should be considered, especially with plate fixation or in cases with large cortical defects. Prosthetic joint reconstruction options are ideal for cases with proximal or distal articular compromise or large periarticular bone loss. In contrast, metastatic lesions of the scapula are infrequent and best managed using a combination of radiation, activity modification, and percutaneous procedures such as cementoplasty, radiofrequency ablation, and cryotherapy. Scapular resections can be highly morbid procedures and have a very limited role in the management of metastatic lesions of the scapula.