Expandable Total Humeral Replacement in a Child with Osteosarcoma

Custom-made 3D-printed prosthesis and free vascularised fibula for humeral reconstruction after osteosarcoma resection in a 13-year-old patient

Surgical reconstruction after humeral resection represents a challenging issue in orthopaedic oncology. Particularly in paediatric patients, the main concerns are maintaining limb function and reconstruction longevity. We describe a novel strategy of humeral reconstruction based on the use of a three-dimensional-printed custom-made prosthesis in a 13-year-old patient diagnosed with osteosarcoma. The implant was specifically designed to sustain the native head, which was spared, as it was not involved by the neoplastic tissue. The mechanical support the prosthesis provided was associated with the biological stimulus of a free vascularised fibular graft to obtain an anatomic, functional and stable construct. This solution has had good longevity, and after 3 years of follow-up, the patient still shows excellent limb function and personal satisfaction.

Hydatidosis of the complete humerus. Treated with radical resection and endoprosthesis. Case report

•

Hydatid bone disease is caused by the Echinococcus granulosus worm. Osseous involvement accounts for 0.5% to 4% of cases in humans.

•

No reports of hydatid disease in the entire humerus have been found in the bibliography.

•

There is no consensus as regards the medical treatment of hydatidosis in the humerus.

•

The affections of the entire humerus and the recurrences present a challenge of treatment for the reconstruction and rescue of the limb.

•

We report a case of salvatage limb with a total humerus endophrostesis with 2 years of follow up.

Introduction

Hydatid bone disease is caused by the Echinococcus granulosus worm. The location of the disease in the humerus is infrequent.

No reports of hydatid disease in the entire humerus have been found in the bibliography. We present one case of primary hydatid bone disease affecting the entire humerus, which was treated with radical resection and total endoprosthesis of the humerus.

Case

A 24-year-old patient presented with a diaphyseal humerus fracture. The x-rays and MRI showed an oblique fracture and heterogeneous osteolytic and multiloculated images along the entire humerus. The biopsy resulted in hydatid cysts. Oncological resection of the humerus and total replacement of the same with a non-conventional prosthesis designed for the patient was performed.

Conclusion

Total humerus hydatidosis is infrequent, and there is scarce information about its treatment. The local resection plus graft and osteosynthesis conserving the bone has shown complications and recurrences. For healing, a radical procedure is necessary. Although functional results may be limited.

Modified total humeral replacement on unusual osteosarcoma of the humerus: A case report

•

The patient underwent a neoadjuvant chemotherapy before surgery, but the mass became more expanded.

•

Limb salvage surgery by wide excision of the humerus and reconstruction using modified total humeral replacement was done.

•

Total Humeral Replacement for the treatment of humerus malignancy was feasible by using this modification.

•

This procedure yielded good functional outcome.

Introduction

Osteosarcoma of the humerus is an unusual case. In order to salvage the limb, resection followed with total humeral replacement is preferred. In situations where those prostheses are not available, a technique of modified total humeral replacement could be used.

Case presentation

A 20-year-old female patient came with osteosarcoma of the right humerus accompanied by pathological humeral shaft fracture, with the onset of six months. The lesion extended along the proximal to distal part of humerus. The patient underwent a neoadjuvant chemotherapy before surgery and a limb salvage surgery by wide excision of the humerus and reconstruction using modified total humeral replacement was performed. Modifications to the shoulder hemiarthoplasty and total elbow prostheses were made, so both prostheses could join as one unit.

Discussion

After the surgery, no disturbances of hand function were seen, and functional outcome was evaluated by using Musculoskeletal Tumour Society Score (MSTS) score with score of 83% (excellent). After 3 years of follow up, patient could work and resume daily activity with improved MSTS score. There were neither sign of tumor recurrence nor distant metastasis on follow up.

Conclusion

Total Humeral Replacement for the treatment of humerus malignancy was feasible by using this modification. This procedure yielded good functional outcome.