Management of Metastatic Humeral Disease

Publication Date: April 12, 2023
Last Updated: September 29, 2023

Summary of Action Statements

Plating/Internal Fixation, Intramedullary Fixation, and/or Photodynamic Polymer

When treating pathologic diaphyseal humerus fractures, clinicians can consider either the use of plating/internal fixation, intramedullary fixation, and/or photodynamic polymer, as there does not appear to be a significant difference in clinical outcomes or reoperation rate between these constructs based on limited available evidence. (Limited)

En Bloc Resection, Curettage, Internal Fixation, or Intramedullary Nailing

No studies met inclusion criteria comparing survivorship or other oncologic outcomes between en bloc resection, curettage, internal fixation, or intramedullary nailing. Based on the lack of evidence, no recommendations can be made for or against en bloc resection pertaining to metastatic disease of the humerus. (Inconclusive)

Patient Selection for Nonoperative Techniques Versus Operative Techniques

No studies met inclusion criteria to compare nonoperative vs operative treatment in the setting of metastatic disease of the humerus. Based on the lack of definitive evidence, no recommendations can be made for or against patient selection or indication for nonoperative vs. operative treatment pertaining to metastatic disease of the humerus. (Inconclusive)

Cementation Vs No Cementation

In patients undergoing surgical fixation of the humerus for metastatic bone disease, clinicians may consider cement augmentation. One low quality study meeting inclusion criterion suggested the addition of cement to surgical fixation of pathologic fractures of the humerus may provide short-term improvements in pain relief and functional mobility, however no difference in surgical complications were observed when compared to fixation alone. (Limited)

Reconstruction Approach

In patients undergoing arthroplasty to reconstruct the proximal humerus for metastatic bone disease, clinicians may consider reverse total shoulder arthroplasty over conventional shoulder arthroplasty and hemiarthroplasty in order to decrease shoulder instability and improve range-of-motion. (Limited)

Prognostic Markers

Based on low levels of evidence, clinicians should consider the following potential negative socioeconomic prognostic markers when caring for patients with metastatic malignancy of the humerus:
  • Age > 60 years
  • Have Medicaid insurance compared to commercial insurance
  • Black race compared to white race
  • Lower income status
  • Lower initial performance status
  • Male sex
  • Rapidly growing tumor histologies versus slow growing

VTE Prophylaxis

No studies met inclusion criteria to make a specific recommendation on VTE prophylaxis for metastatic bone disease of the humerus. In the absence of direct evidence, we refer clinicians to the ASCO, ASH, and ICM-VTE guidelines which indicate that oncology patients are at a higher risk for VTE, and prophylaxis should be considered during the peri-operative period. (Inconclusive)

Recommendation Grading


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



Management of Metastatic Humeral Disease

Authoring Organization

Endorsing Organization

Publication Month/Year

April 12, 2023

Last Updated Month/Year

November 6, 2023

Document Type


Country of Publication


Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Treatment, Management

Diseases/Conditions (MeSH)

D009140 - Musculoskeletal Diseases, D027582 - Humulus


Humeral Disease, Metastatic Humeral Disease

Source Citation

Musculoskeletal Tumor Society Treatment of Mangement of Metastatic Humeral Disease Clinical Practice Guideline. (Endorsed by the American Academy of Orthopaedic Surgeons) https://  Published April 12, 2023