Abstract
Introduction and Objectives: This study analyses the results of our experience in reconstruction of high-grade sarcomas of the proximal humerus.
Materials and Methods: A total of 37 patients were treated from March 1983 to December 2001. Average age was 24 years (19–38), with 21 males and 16 females, all presenting with high-grade sarcomas of the proximal humerus. The primary tumour was osteosarcoma in 49% (n=18) of cases, chondrosarcoma in 22% (n=8), Ewing’s sarcoma in 13% (n=5), parosteal sarcoma in 8% (n=3), malignant fibrous histiocytoma in 5% (n=2), and adamantinoma in 3% (n=1). All cases were classified as Type 1 Malawer resections (intraarticular resections of the proximal humerus).
Results: During this period, scapulohumeral or scapulothoracic disarticulation was performed in 32% of cases (12 patients). In the remaining 68% (25 cases), limb salvage surgery was performed (relative limb salvage rate: 67.5%). In terms of reconstruction type, 6 cases received megaprotheses, and the remaining 19 cases received osteoarticular allografts of the humerus. Four of the 25 patients had reconstructions with sufficient follow-up time to be considered survivors without recurrence. Results were “acceptable” based on the Enneking-MTS functional scale (overall movement arcs in all directions between 60–120° with tolerable subluxations.) From a subjective point of view, all the patients obtained good results in terms of physical health and mobility of distal joints. No analysis was done of survival due to the varied nature of the neoplasias and adjuvant therapies. The main complication was fracture of the osteoarticular allograft, which occurred in 4 of 19 cases (21%). Subluxation was practically constant throughout our series but was of relatively minor clinical significance.
Discussion and Conclusions: The results obtained in this study in terms of local and functional control are similar to those reported in the literature. In spite of the poor functional results for the shoulder joint, the functional results for distal joints and the cosmetic appearance of the extremity are satisfactory. However, the high rate of allograft fractures forces us to reconsider our reconstruction technique, placing priority on a mixed reconstruction using both allograft and mega-prosthesis.
The abstracts were prepared by Dr. E. Carlos Rodríguez-Merchán, Editor-in-Chief of the Spanish Journal of Orthopaedics and Traumatology (Revista de Ortopedia y Traumatología). Correspondence should be sent to him at Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT), Calle Fernández de los Ríos, 108, 28015-Madrid, Spain
