Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2022; 10(11): 3518-3526
Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3518
Intramedullary nailing for pathological fractures of the proximal humerus caused by multiple myeloma: A case report and review of literature
Guo-Qiang Xu, Gang Wang, Xiao-Dong Bai, Xin-Jia Wang
Guo-Qiang Xu, Gang Wang, Xiao-Dong Bai, Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Xin-Jia Wang, Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Xu GQ wrote and edited the article; Wang G reviewed the literature; Bai XD collected information on the current case; Wang XJ revised the manuscript for important intellectual content; and All authors gave final approval of the version to be submitted.
Informed consent statement: The patient consented to the publication of this report. Written consent for publication was obtained for all potentially identifying data and accompanying images and these are available for review from the editor of this journal.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Jia Wang, BMed, Doctor, Associate Chief Physician, Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, 95 Yonganlu, Xicheng District, Beijing 100050, China. docxjwang@163.com
Received: September 3, 2021
Peer-review started: September 3, 2021
First decision: December 17, 2021
Revised: February 9, 2022
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 16, 2022
Processing time: 216 Days and 19.4 Hours
Abstract
BACKGROUND

Multiple myeloma (MM) bone disease is indicative of MM, and reduces patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM is an essential treatment within the framework of supportive therapy measures and involves orthopedic tumor surgery. Nevertheless, there are few reports on intramedullary (IM) nailing in the treatment of MM-induced proximal humeral fracture to prevent fixation loss. We here describe a case of pathological fracture of the proximal humerus caused by MM successfully treated with IM nailing without removal of tumors and a review of the current literature.

CASE SUMMARY

A 64-year-old male patient complaining of serious left shoulder pain and limited movement was admitted. The patient was finally diagnosed with MM (IgAλ, IIIA/II). After treatment of the pathological fracture with IM nailing, the patient's function recovered and his pain was rapidly relieved. Histopathological examination demonstrated plasma cell myeloma. The patient received chemotherapy in the Hematology Department. The humeral fracture displayed good union during the 40-mo follow-up, with complete healing of the fracture, and the clinical outcome was satisfactory. At the most recent follow-up, the patient's function was assessed using the Musculoskeletal Tumor Society score, which was 29.

CONCLUSION

Early surgery should be performed for the fracture of the proximal humerus caused by MM. IM nailing can be used without removal of tumors. Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.

Keywords: Multiple myeloma; Bone disease; Pathological fractures; Intramedullary nailing; Surgical therapy; Case report

Core Tip: We report a case of a patient who was eventually diagnosed with multiple myeloma (MM). After treatment of the pathological fracture with intramedullary (IM) nailing and chemotherapy in the Hematology Department, the humeral fracture displayed good union during the 40-mo follow-up, with complete healing of the fracture, and the clinical outcome was satisfactory. This case report and review of the literature demonstrates early surgery should be performed for the fracture of the proximal humerus caused by MM. IM nailing can be used without removal of tumors. Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.