Abstract
Limb salvage after tumor resection of the proximal humerus in the pediatric and adult patient poses significant surgical challenges, as it often implies (functional) loss of surrounding soft tissues that function as stabilizers of the glenohumeral joint (10–30%). Reconstruction options after tumor resection include modular endoprosthesis, osteoarticular allografts, free vascularized fibula autograft, allograft-prosthetic composites (APC), or arthrodesis; all options are associated with relatively poor postoperative function. Improved functional results can be achieved when the deltoid muscle including axillary nerve are left unharmed using a deltoid-preserving surgical approach.
In this chapter, we present two cases with proximal humerus malignancy. The first is an adult patient with osseous leiomyosarcoma with a large soft tissue component involving all rotator cuff muscles and caudal border of the glenoid, treated with en bloc resection, and reconstruction with a reversed shoulder megaprosthesis and a custom-made 3D printed glenoid component. The second is a pediatric patient with Ewing’s sarcoma treated with chemotherapy, en bloc resection, temporary reconstruction with a functional spacer, and planned definitive reconstruction with a free vascularized fibula autograft.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Potter BK, Adams SC, Pitcher JD Jr, Malinin TI, Temple HT. Proximal humerus reconstructions for tumors. Clin Orthop Relat Res. 2009;467(4):1035–41.
Abdeen A, Hoang BH, Athanasian EA, Morris CD, Boland PJ, Healey JH. Allograft-prosthesis composite reconstruction of the proximal part of the humerus: functional outcome and survivorship. J Bone Joint Surg Am. 2009;91(10):2406–15.
Trovarelli G, Cappellari A, Angelini A, Pala E, Ruggieri P. What is the survival and function of modular reverse total shoulder prostheses in patients undergoing tumor resections in whom an innervated deltoid muscle can be preserved? Clin Orthop Relat Res. 2019;477(11):2495–507.
van de Sande MA, Dijkstra PD, Taminiau AH. Proximal humerus reconstruction after tumour resection: biological versus endoprosthetic reconstruction. Int Orthop. 2011;35(9):1375–80.
Glanzmann MC, Goldhahn J, Flury M, Schwyzer HK, Simmen BR. Deltoid flap reconstruction for massive rotator cuff tears: mid- and long-term functional and structural results. J Shoulder Elb Surg. 2010;19(3):439–45.
Martini M. The sub-deltoid approach to the metaphyseal region of the humerus. J Bone Joint Surg Am. 1976;58(3):377–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
1 Electronic Supplementary Material
The reattachment of the large shoulder musculature to the trevira tube is demonstrated: teres major and latissimus dorsi dorsocranially as exorotators; pectoralis major as anterior stabilizer; triceps dorsodistally; deltoid over the entire construct and reattachment on its own fascia. The prosthesis and trevira tube are then fully covered by vital muscles, providing a stable shoulder with preservation of the axillary nerve. The video demonstrates the range of motion and stability of this reconstruction (MP4 36465 kb).
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
van der Heijden, L., van de Sande, M.A.J. (2022). Implant Reconstruction of the Proximal Humerus. In: Özger, H., Sim, F.H., Puri, A., Eralp, L. (eds) Orthopedic Surgical Oncology For Bone Tumors . Springer, Cham. https://doi.org/10.1007/978-3-030-73327-8_41
Download citation
DOI: https://doi.org/10.1007/978-3-030-73327-8_41
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-73326-1
Online ISBN: 978-3-030-73327-8
eBook Packages: MedicineMedicine (R0)