Limb Sparing Resection for Tumors Involving the Distal Humerus and Reconstruction with a Modular Endoprosthesis.

Tumors involving the distal humerus are extremely rare. Those tumors can be safely resected and then the extremity reconstructed. In this article, we present a series of patients treated with hinged semiconstrained modular distal humeral replacement for reconstruction following wide resection of tumors of the distal humerus. We retrospectively reviewed the charts of nine patients treated for tumors of the distal humerus between 2002 and 2013. The diagnoses consisted of three primaries, five metastatic, and one benign aggressive tumor. There were four male and five female patients ranging in age from 36 to 78 years old. Patients were followed for an average of 34 months (3 to 75 months). The functional status was rated using the Musculoskeletal Tumor Score System (MSTS). Five of the nine cases presented as a pathologic fracture. Six of the nine patients died of their diseases at a mean of 17 months after main surgery. Three patients were alive and disease-free at a mean follow-up of 69 months (63 to 75 months). Seven patients demonstrated significant improvement in their elbow pain after the endoprosthetic surgery. The MSTS score for the nine cases was 81% (63% to 97%). Tumors of the distal humerus can be safely resected through an anterior approach. Once the tumor is resected, the resultant defect is reconstructed with a modular semiconstrained prosthesis. This technique allows safe tumor resection with a low complication rate and good functional results.

Osteosarcoma of the proximal tibia: limb-sparing resection and reconstruction with a modular segmental proximal tibia tumor prosthesis.

A limb-sparing resection was performed for osteosarcoma of the proximal tibia in a young patient. A special modular segmental proximal tibial endoprosthesis that includes a hinged total knee component was used for reconstruction. A medial gastrocnemius rotational flap was utilized to reconstruct the extensor mechanism of the knee. The muscle flap aids in covering the prosthesis and helps to protect against infection. Limb-sparing resection for tumors arising from the proximal tibia, and reconstruction with a modular segmental proximal tibia tumor prosthesis and gastrocnemius muscle flap, is a safe and reliable method for treating tumors involving this area.

Osteoblastoma of the sternum--case report and review of the literature.

Osteoblastoma is an extremely rare entity that represents less than 1% of all bone tumors, and affects twice as many males as females with peak incidence between 15 and 20 years. Osteoblastomas commonly affect axial bones, long bones, bones of the foot and hand, and less commonly the pelvis, scapula, ribs, and clavicle. Osteoblastoma does not have a classic presentation, but can vary with the location and size of the tumor. The main complaint is often progressive pain localized at the tumor site. Osteoblastoma is a benign tumor with an aggressive behavior. The treatment is wide surgical resection, otherwise it continues to enlarge and destroy the bone and surrounding structures. We report a 32-year-old male with an osteoblastoma of this sternum who was treated with an en-bloc resection and reconstruction with Marlex((R)) and a methylmethacrylate plate.

Limb-sparing resection of the scapula and reconstruction with a constrained total scapula prosthesis: a case of multicentric epithelioid hemangioendothelioma involving the scapula and surrounding soft tissues.

INTRODUCTION: The scapula is a relatively uncommon site for primary bone sarcomas. Tumors arising from the scapula are often initially contained by the rotator cuff muscles that protect pertinent adjacent muscles as well as the brachial plexus and axillary blood vessels. Limb-sparing resection of a scapula sarcoma is technically complex and requires meticulous dissection and mobilization of the brachial plexus and axillary blood vessels. Several muscles must be capable of being preserved in order to reconstruct the scapula and shoulder girdle with a special customized total scapula replacement. The goal of reconstruction is to restore a stable shoulder girdle to preserve elbow and hand function. METHODS AND RESULTS: In the procedure demonstrated in this video, limb-sparing scapula resection and reconstruction was performed for a patient with a multicentric epithelioid hemangioendothelioma. The steps of the procedure are detailed along with accommodations made for the multicentric nature of the tumor. To allow for optimal postoperative function and maximum soft tissue coverage, a small constrained scapular prosthesis was utilized. The glenohumeral ligaments were reconstructed with a Gore-Tex aortic graft. Multiple muscle rotation flaps were performed to cover and protect the prosthesis as well as restore shoulder girdle stability. CONCLUSION: Limb-sparing surgery for scapula sarcomas and anatomic reconstruction with a constrained total scapula prosthesis is a reliable and safe technique for resecting selected sarcomas and reconstructing the shoulder girdle. A stable shoulder girdle can be restored for optimal hand and elbow function. A total scapula prosthetic reconstruction is the authors' procedure of choice when the deltoid, trapezius, rhomboid, latissimus, and serratus anterior muscles are capable of being preserved. The functional outcome is superior to a forequarter amputation and a flail (nonreconstructed) shoulder in which the extremity is left hanging by soft tissues (nonanatomic method).