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DOI: DOI: http://dx.doi.org/10.21088/ijcer.2321.9815.6118.3

Abstract

 

Introduction: Humerus is a common site for malignant tumors. Advances in adjuvant therapies  and reconstructive methods provide salvage of the upper limb with improved outcomes.

Materials and Methods: In our surgical oncology department five patients with tumors of the proximal humerus were operated over the course of two years from 2010 ­to 2012.

Results: All patients had different tumor pathology emphasising the wide heterogeneity of sarcomas of bone and soft tissue. Ages ranged from 12yrs to 52yrs, again a broad range. Five patients described above all presented with arm swelling and pain. One patient diagnosed outside as a Giant Cell Tumor by CT scan and FNAC had curettage performed. Both children had high grade sarcomas of the proximal humerus. The 12 year old had a STS of bone and had an intraarticular resection albeit with abductors resected. The 14 year old had an osteosarcoma for which 5 cycles of cisplatin based neoadjuvant chemotherapy had been given. In her
case a modified Tickhoff ­ Linberg resection had to be performed for adequate margin and the prosthesis was suspended statically and dynamically for a stable shoulder. As her abductors had been resected along with the glenoid she had severe restriction of shoulder motion. The 45 year old female underwent a modified Tickhoff ­ Linberg resection with deltoid sacrifice for a low grade STS due to extensive soft tissue involvement and therefore had severe restriction of shoulder function. We obtained our best results in the two male patients with benign tumors as we were able to spare both the abductors and glenoid and replace the resected humerus with a prosthesis. Both recovered rapidly and had excellent abduction at the shoulder. All had near complete relief of pain and complete function at elbow and wrist.

Conclusions: Routine endoprosthetic reconstruction for proximal humeral reconstruction is recommended in view of its simplicity of fixation, durability and excellent long term outcome and we reserve autologous fibula only in situations where a prosthesis cannot be used.

Keywords: Humerus; Tickhoff ­ Linberg Resection; Osteosarcoma.

 

Corresponding Author : M. Muralidhar, Assistant Professor, Department of Surgical Oncology, MNJ Institute of Oncology and Regional Cancer Center, Osmania Medical College, Hyderabad, Telangana 500095, India.