Case of the Month 5/2003
This 67 year old male presentat with pain and a mass in the right dominant elbow. He had a history of smoking for many years. Work-up revealed a lytic lesion in the distal humerus.
What would you do next?
A CT scan of the chest, abdomen, and pelvis showed a mass in the right upper lung field and hilar lymphadenopathy. Biopsy of the mass in the right elbow showed adenocarcinoma, presumably metastatic from the lung. MRI of the brain showed metastasis to the brain.
What would you recommend be done about the lesion in the right elbow?
The patient had resection of the right distal humerus and distal humeral replacement incorporating a total elbow arthroplasty.
This case illustrates the agressive approach to treating metastatic lesions. There are other acceptable methods, but the author recommends that initial orthopedic treatment of serious, painful and disabling metastatic lesions be as complete as possible, occur as soon as possible. The method selected should have minimum delay in resumption of full activities and weight bearing. Cemented arthroplasty reconstructions are more durable than osteosynthetic techniques and allow immediate weight bearing.
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