Abstract
Massive bone replacing endoprostheses have become a well-recognised option in reconstruction of massive bone defects following tumor resections of the humerus, femur and proximal tibia. While the design of such bone replacements is somewhat standardised, massive endo-prosthetic replacements of the proximal radius have not been described. Previous work with radial head replacements for arthritis and fracture indications has been performed, but a massive replacement of the proximal radius has not been reported. The design for such a prosthesis has not been described. Herein, we present our initial case with a massive custom proximal radius replacement, and the incorporated design features.
A 43 year old gentleman presented with progressive destruction of the proximal right radius from meta-static renal cell carcinoma despite radiation treatment. His systemic disease was under satisfactory control. He had undergone a nephrectomy (37 months previously), hip replacement for metastatic disease (28 months previously) and internal fixation of a humerus fracture (10 months previously). Prior treatment of his radius included cast immobilisation and radiation treatment of a pathologic fracture 13 months preoperatively. He refractured his partially healed pathologic fracture two weeks prior to presentation. Following staging with CT and MRI scan, a custom proximal radius endoprosthe-sis was designed that replaced 13 cm of the proximal radius. It was designed with 6 degrees of radial bow. The design specifics will be presented during the presentation. Surgical technique will be demonstrated. By one month postoperatively, his elbow range of motion was from 10 degrees to 140 degrees of flexion, with 90 degrees each of supination and pronation. He continued to have excellent use of his arm until he developed brain metastasis 10 months postoperatively.
Massive custom proximal radius endoprostheses of this design may be useful in the reconstruction of meta-static and primary tumors of the forearm. They are compatible with preservation of motion, and may provide additional stability to the elbow in patients whom soft tissue may be compromised due to tissue destruction or tissue loss secondary to neoplasia.
The abstracts were prepared by Nico Verdoschot. Correspondence should be addressed to him at Orthopaedic Research Laboratory, Universitair Medisch Centrum, Orthopaedie / CSS1, Huispost 800, Postbus 9101, 6500 HB Nijmegen, Th. Craanenlaan 7, 6525 GH Nijmegen, The Netherlands.
