Abstract
Introduction: The proximal humerus is one of the common site for neoplasms requiring excision and reconstruction. Out of more than 600 cases of bone tumours operated in the last 12 years, we have managed 33 cases of proximal humerus tumours with custom made megaprosthesis.
Methods: 33 cases of neoplastic involvement of upper end humerus, aged between 18–65 years (mean age 37 years) were operated over a period of 12 years (1995–2007). 23 were males and rest females. The primary lesions were: 19 giant cell tumours; 7 osteosarcoma; 4 chondrosarcoma; 1 metastatic; 2 Round cell sarcoma. The Enneking staging was: 1b(19), IIb(13), III(1). All patients with giant cell tumour had a break of cortex and a soft tissue component necessitating wide surgical excision. Surgery was the primary mode of treatment in all patients and was always undertaken with curative intent. Surgery was supplemented with appropriate chemo- radiotherapy in patients with osteosarcoma/ewing’s sarcoma. Surgical and functional results were evaluated according to MSTS scoring system.
Outcomes: The scoring ranged from 22–27.5%. The hand and elbow function was good in all while the shoulder abduction was always lost. The minimum follow up was 24 months.
Complications included: Superficial infection (1), deep infection (1); Recurrence 2; Improper cementing (2); Neuropraxia [radial nerve] (8); Subluxation of prosthesis head (8); Post radiotherapy skin necrosis and contracture (1); 4 patients died.
Conclusion: Adequate resection of malignant tumours/benign aggressive tumours in the shoulder region gives good oncological & surgical results. For post tumour excision humeral gaps, megaprosthesis is a near ideal choice.
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
