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Updated: Nov 16, 2025
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Published on: June 6, 2025
Humeral Shaft Fracture With Placement of an Intramedullary Nail Through an Unrecognized Sarcoma
Mark M Cullen1, Ebubechi Okwumabua, Etienne M Flamant
1From the Duke University School of Medicine, Durham, NC (Mr. Cullen, Mr. Flamant, and Mr. Ferlauto); The University of Houston Health Science Center, Houston, TX (Dr. Okwumabua); the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC (Dr. Brigman and Dr. Eward); and Duke Cancer Institute, Durham, NC (Dr. Brigman and Dr. Eward).
Case:
A 72-year-old man underwent intramedullary nailing of a humeral diaphysis fracture with passage through an unrecognized pathologic fracture. Four months later, a biopsy of a soft-tissue mass in the arm revealed pleomorphic undifferentiated sarcoma. Only after local recurrence and forequarter amputation was the story of a pathologic fracture through undifferentiated pleomorphic sarcomas of bone clear. The patient developed metastatic disease and died after 2 years postoperatively.
Discussion:
Orthopaedic surgeons should consider sarcoma when assessing patients with fractures of unknown etiology and an inappropriate mechanism because the placement of an intramedullary device through a sarcoma of bone has consequences.
