No studies met inclusion criteria to compare en bloc resection and internal fixation in terms of disease control or clinical outcomes. Based on the lack of definitive evidence, no recommendations can be made for or against specific surgical treatments for metastatic disease of the humerus. While supporting literature is lacking, it is appropriate for the surgeon to consider en bloc resection based on the clinical circumstances and/or the reconstructive needs of the patient. The histologic subtype of metastatic bone disease, oligometastatic disease state, condition of the adjacent joint, available bone stock, and other patient-centric factors may indicate resection as an appropriate treatment.
Future studies should compare internal fixation versus intramedullary nailing versus en bloc resection for functional outcomes, failure and/or reoperation rates, pain relief, and oncologic outcomes. Comparisons between histologic primaries and number of bony metastases should be considered in these studies.