Humeral pathological fracture from metastasis treated with angioembolisation and IM nail

Case contributed by Craig Hacking


Fall, painful right arm.

Patient Data

Age: 70 years
Gender: Female

There is an obliquely oriented, comminuted fracture through the distal humeral shaft with mild anterior translation and angulation. An ill-defined lucent lesion at the fracture site with wide zone of transition is highly suspicious of pathological fracture through an osseous metastasis.

The patient was subsequently found to have a history of renal cell carcinoma and a previously irradiated femoral metastasis.

Ultrasound-guided puncture right common femoral artery and a 5Fr sheath inserted. A 5Fr Vert catheter was used to select the right brachial artery and angiograms demonstrates increased vascularity around the right distal humeral pathological fracture, predominantly from two deep branches.

Microcoils were used across the area of supply to the hyperemic fracture region with a satisfactory angiographic result. A post-coiling angiogram showed decreased vascularity compared to the initial appearance.

Hemostasis was achieved with an Exoseal closure device. No acute complication encountered.

Intramedullary nail within the right humerus, with a single distal and two proximal locking screws. No evidence of hardware failure or malposition. Pathological fracture through the midshaft right humerus is now in good alignment. Two metallic embolization coils are seen adjacent to the fracture site, consistent with recent embolization.

Normal alignment of the shoulder and elbow joints. No other bony injury or suspicious osseous lesion is identified.

Multiple nodules are noted within the visualized right lung, consistent with the history of metastatic disease.

Case Discussion

Nice illustration of a metastatic pathological fracture of the humerus treated with angioembolisation and intramedullary nail internal fixation.

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