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Ke S, Zhang B, He Y, Zhou Y, Hu X, Fan Y, Wang M, Zhang Y, Wang C. Reconstruction Strategy for Upper Extremity Defects After Bone Tumor Resection Based on 3D Customized Bone Cement Mold. Surg Innov 2024:15533506241244493. [PMID: 38606504 DOI: 10.1177/15533506241244493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Reconstructing bone defects in the upper extremities and restoring their functions poses a significant challenge. In this study, we describe a novel workflow for designing and manufacturing customized bone cement molds using 3D printing technology to reconstruct upper extremity defects after bone tumor resection. METHODS Computer tomography data was acquired from the unaffected upper extremities to create a detachable mold, which can be customized to fit the joint precisely by shaping the bone cement accordingly. Fourteen patients who underwent reconstructive surgery following bone tumor resection in the proximal humerus (13 cases) or distal radius (1 case) between January 2014 and December 2022 were retrospectively evaluated. The medical records of this case series were reviewed for the demographic, radiological, and operative data. Metastasis, local recurrence, and complication were also reviewed. Additionally, Musculoskeletal Tumor Society Score (MSTS) and Visual Analogue Scale (VAS) were used to assess clinical outcomes. RESULTS The mean follow-up period was 49.36 ± 15.18 months (range, 27-82 months). At the end of follow-up, there were no cases of metastasis or recurrence, and patients did not experience complications such as infection, dislocation, or implant loosening. Two cases complicated with subluxation (14.3%), and 1 case underwent revision surgery for prosthetic fracture (7.1%). The average MSTS score was 23.2 ± 1.76 (77.4%, range, 66.7%-86.7%), and the postoperative VAS score was 1.86 ± 1.03 (range, 1-4), which was significantly lower than that before surgery (average preoperative VAS score was 5.21 ± 2.00 (range, 2-8)) (P < .001). CONCLUSION Customized 3D molds can be utilized to shape bone cement prostheses, which may serve as a potential alternative for reconstructing the proximal humerus and distal radius following en bloc resection of bone tumors. This reconstruction strategy offers apparent advantages, including precise matching of articular surfaces and comparatively reduced costs.
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Affiliation(s)
- Song Ke
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Bokai Zhang
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yongqin He
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yuanyuan Zhou
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xu Hu
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Min Wang
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yuan Zhang
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chao Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
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Takenoshita S, Asano N, Kasahara T, Hirozane T, Yamaguchi S, Mori T, Ohkita H, Nakayama R, Nakamura M, Matsumoto M. Secondary peripheral chondrosarcoma arising from solitary osteochondroma of the clavicle: A case report. J Orthop Sci 2023; 28:1592-1596. [PMID: 34924250 DOI: 10.1016/j.jos.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shinichi Takenoshita
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Naofumi Asano
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan.
| | - Tomoki Kasahara
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toru Hirozane
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Sayaka Yamaguchi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Tomoaki Mori
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Hajime Ohkita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
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Prabowo Y, Fajrin Armin M, Alhuraiby SS, Canintika AF. Surgical techniques for medial clavicular tumors: A report of 3 cases. Int J Surg Case Rep 2023; 106:108115. [PMID: 37060765 PMCID: PMC10139884 DOI: 10.1016/j.ijscr.2023.108115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Clavicular tumors are rare, consisting of <1 % of all skeletal tumors. In this series, we described our experience of treating medial clavicular tumors. CASE PRESENTATION We treated three patients with medial clavicle tumors at a national tertiary referral hospital in Jakarta, Indonesia. The patients were treated with wide excision following bony reconstruction from fibular bone and one patient was treated by marginal excision. Each patient was treated by surgery and one patient underwent reconstruction using non-vascularized fibular graft and composite using bone cement. CLINICAL DISCUSSION All patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. Based on these cases above and the extension of tumor, we recommend medial clavicle tumor resection classification divided into three type to decide which type of surgical procedure that should be performed. In our report, all patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. CONCLUSION Clavicle resection in management of medial third clavicle tumor is technically demanding. We proposed three types of clavicular resection based on tumor extension. The surgical technique of medial end clavicle in this patient resulted in tumor free margin of medial clavicular, medial scapula, and lateral scapular incision. Reconstruction surgery following clavicle resection can be done in order to restore symmetry of the lower neck and upper chest, protect nearby neurovascular bundle, and rarely associated with significant shoulder function loss.
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Affiliation(s)
- Yogi Prabowo
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - M Fajrin Armin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sammy Saleh Alhuraiby
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Arunwatthanangkul P, Piyabenjarad P, Wisitthipakdeekul S, Chobpenthai T. Innovative method with two-stage surgery for Ewing sarcoma with personalized distal clavicle reconstruction: A case report and diagnosis review. Front Oncol 2023; 13:1134324. [PMID: 37064107 PMCID: PMC10090420 DOI: 10.3389/fonc.2023.1134324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
A 13-year-old boy presented with a growing lump on his left clavicle for 5 months. The plain radiograph revealed an osteolytic mass with aggressive periosteal reaction, suggesting a malignant lesion. The results of advanced imaging and histopathological examinations revealed that the patient had Ewing sarcoma without metastasis. The two-stage surgery was as follows: resection–observation–reconstruction. The underlying rationale was that Ewing sarcoma has a high recurrence. After 2 years of resection, the patient had remission, and he currently has a personal 3D-printed titanium implant with intact shoulder function.
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Li Z, Zou C, Lu M, Zhang Y, Gong T, Wang J, Luo Y, Zhou Y, Min L, Tu C. Case report: Intraosseous hemangioma of the lateral clavicle treated by surgical resection and reconstructed by three-dimensional-printed personalized prosthesis. Front Bioeng Biotechnol 2023; 10:1085674. [PMID: 36698635 PMCID: PMC9868392 DOI: 10.3389/fbioe.2022.1085674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Background: Intraosseous hemangiomas occurring the clavicle is uncommon. Reconstruction of the clavicle is suggested to maintain the normal shoulder joint function and prevent adverse outcomes. Complex anatomy shape of the clavicle remains a great challenge for prosthetic reconstruction of the clavicle. Case presentation: A 37-year-old female with no conclusive history of trauma presented with progressive mass at the right lateral clavicle for 5 years. The patient was treated by surgical resection and reconstructed by three-dimensional-printed personalized prosthesis. Postoperatively radiographic examinations revealed a good position of the prosthesis, neither breakage nor loosening was detected. The right shoulder mobility returned to approximate level of preoperative shoulder 2 months after surgical reconstruction, with the range of motion of flexion 80°, extension 40°, abduction 80°, adduction 30°, external rotation 55°, and internal rotation 60°. The patient maintained the normal shoulder function during the 48 months follow-up period. There was no pain during shoulder motion. The Musculoskeletal Tumor Society Score (MSTS) score was 29 and the Functional Evaluation Form recommended by the American Shoulder and Elbow Surgeons (ASES) score was 95. Conclusion: 3D-printed personalized prosthesis is a good option to reconstruct the lateral clavicle bone defect and restore the shoulder support structure. It maintains the normal shoulder joint function and avoids adverse effects on daily activities after claviculectomy.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Chang Zou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Taojun Gong
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yi Luo
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China,*Correspondence: Li Min, ; Chongqi Tu,
| | - Chongqi Tu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China,*Correspondence: Li Min, ; Chongqi Tu,
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Nistor CE, Ciuche A, Cucu AP, Serban B, Cursaru A, Cretu B, Cirstoiu C. Clavicular Malignancies: A Borderline Surgical Management. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070910. [PMID: 35888630 PMCID: PMC9315479 DOI: 10.3390/medicina58070910] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/04/2022]
Abstract
Nearly 1% of all bone cancers are primary clavicular tumors and because of their rarity, treating clinicians are unfamiliar with their diagnosis, classification, treatment options, and prognosis. In terms of preserving function and avoiding complications, clavicle reconstruction seems logical; however, further studies are needed to support this measure. Reconstruction techniques are difficult taking into account the anatomical structures surrounding the clavicle. When chest wall defects are present, a multidisciplinary team, including an orthopedist and thoracic and plastic surgeons, is of paramount importance for optimal surgical management. Malignant clavicle tumors may include primary and secondary malignancies and neighboring tumors with clavicular invasion. Surgical resection of complex thoracic tumors invading the clavicles can result in larger defects, requiring chest wall reconstruction, which is a substantial challenge for surgeons. Correct diagnosis with proper preoperative planning is essential for limiting complications. Post-resection reconstruction of the partial or total claviculectomy is important for several reasons, including maintaining the biomechanics of the scapular girdle, protecting the vessels and nerves, reducing pain, and maintaining the anatomical appearance of the shoulder. The chest wall resection and reconstruction techniques can involve either partial or full chest wall thickness, influencing the choice of reconstructive technique and materials. In the present paper, we aimed to synthesize the anatomical and physiopathological aspects and the small number of therapeutic surgical options that are currently available for these patients.
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Affiliation(s)
- Claudiu-Eduard Nistor
- Department of Thoracic Surgery, Central Military Emergency University Hospital Bucharest, University of Medicine and Pharmacy “Carol Davila”, 010825 Bucharest, Romania; (C.-E.N.); (A.C.); (A.-P.C.)
| | - Adrian Ciuche
- Department of Thoracic Surgery, Central Military Emergency University Hospital Bucharest, University of Medicine and Pharmacy “Carol Davila”, 010825 Bucharest, Romania; (C.-E.N.); (A.C.); (A.-P.C.)
| | - Anca-Pati Cucu
- Department of Thoracic Surgery, Central Military Emergency University Hospital Bucharest, University of Medicine and Pharmacy “Carol Davila”, 010825 Bucharest, Romania; (C.-E.N.); (A.C.); (A.-P.C.)
| | - Bogdan Serban
- Department Orthopedics and Traumatology, University of Medicine and Pharmacy “Carol Davila”, University Emergency Hospital, 050098 Bucharest, Romania; (B.S.); (A.C.); (C.C.)
| | - Adrian Cursaru
- Department Orthopedics and Traumatology, University of Medicine and Pharmacy “Carol Davila”, University Emergency Hospital, 050098 Bucharest, Romania; (B.S.); (A.C.); (C.C.)
| | - Bogdan Cretu
- Department Orthopedics and Traumatology, University of Medicine and Pharmacy “Carol Davila”, University Emergency Hospital, 050098 Bucharest, Romania; (B.S.); (A.C.); (C.C.)
- Correspondence:
| | - Catalin Cirstoiu
- Department Orthopedics and Traumatology, University of Medicine and Pharmacy “Carol Davila”, University Emergency Hospital, 050098 Bucharest, Romania; (B.S.); (A.C.); (C.C.)
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Abdalbary SA, Amr SM, Abdelghany K, Nssef AA, El-Shaarawy EAA. A Case Report of the Reconstruction of a Bone Defect Following Resection of a Comminuted Fracture of the Lateral Clavicle Using a Titanium Prosthesis. Front Surg 2021; 8:646989. [PMID: 34540884 PMCID: PMC8447902 DOI: 10.3389/fsurg.2021.646989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: This case report describes the reconstruction of a severe comminuted fracture and bone defect in the lateral half of the clavicle using a novel titanium prosthesis. This unique prosthesis has been specifically designed and three dimensionally printed for the clavicle, as opposed to the Oklahoma cemented composite prosthesis used in common practice. The aims of this study were to: (1) describe the prosthesis, its stress analysis, and its surgical fixation and (2) to demonstrate the results of the 2-year follow-up of the patient with the lateral clavicle prosthesis. Patient's Main Concerns: A 20-year-old, right-handed woman complaining of severe pain in the right shoulder was admitted to our hospital following a traffic accident. Physical examination revealed pain, swelling, tenderness, limb weakness, asymmetric posturing, and loss of function in the right shoulder. Diagnosis, Intervention, and Outcomes: Radiographic evaluation in the emergency room showed complete destruction with a comminuted fracture of the lateral half of the right clavicle and a comminuted fracture of the coracoid. We designed a new prosthesis for the lateral half of the clavicle, which was then tested by finite element analysis and implanted. Use of the new prosthesis was effective in the reconstruction of the comminuted fracture in the lateral half of the clavicle. After 2 years of follow-up, the patient had an aesthetically acceptable curve and was able to perform her activities of daily living. Her pain was relieved, and the disabilities of the arm, shoulder, and hand score improved. Active range of motion of the shoulder joint and muscle strength were also improved. Conclusion: This novel prosthesis is recommended for reconstruction of the lateral half of the clavicle following development of bony defects due to fracture. Our patient achieved functional and aesthetic satisfaction with this prosthesis.
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Affiliation(s)
- Sahar Ahmed Abdalbary
- Department of Orthopaedic Physical Therapy, Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
| | - Sherif M Amr
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Khaled Abdelghany
- Advanced Manufacturing Division, The Central Metallurgical Research and Development Institute, Helwan, Egypt
| | - Amr A Nssef
- Department of Intervention Radiology, Radiology and Vascular Imaging, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ehab A A El-Shaarawy
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Giza, Egypt
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Chen C, Yin Y, Xu H, Li Z, Wang F, Chen G. Personalized three-dimensional printed polyether-ether-ketone prosthesis for reconstruction after subtotal removal of chronic clavicle osteomyelitis: A case report. Medicine (Baltimore) 2021; 100:e25703. [PMID: 33907152 PMCID: PMC8083998 DOI: 10.1097/md.0000000000025703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Three-dimensional (3D) printing has attracted wide attention for its potential and abilities in the assistance of surgical planning and the development of personalized prostheses. We herewith report a unique case of chronic clavicle osteomyelitis treated with a two-stage subtotal clavicle reconstruction using a 3D printed polyether-ether-ketone (PEEK) prosthesis. PATIENT CONCERNS A 23-year-old Chinese female presented to our clinic complaining about a progressive pain of her right clavicle for about 1 year. DIAGNOSES Chronic clavicle osteomyelitis confirmed by percutaneous biopsy and lesion biopsy. INTERVENTIONS This patient accepted a long-term conservative treatment, which did not gain satisfactory outcomes. Thus, a subtotal removal and two-stage reconstruction of the right clavicle with a 3D-printed polyether-ether-ketone prosthesis stabilized by screw fixation system was performed. OUTCOMES At 2-year follow-up, complete pain relief and satisfactory functional recovery of her right shoulder were observed. LESSONS Personalized 3D printed prosthesis is an effective and feasible method for reconstruction of complex bone defects.
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Affiliation(s)
- Chang Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou City, Sichuan Province
| | - Yiran Yin
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou City, Sichuan Province
| | - Huan Xu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou City, Sichuan Province
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou City, Sichuan Province
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ge Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou City, Sichuan Province
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Liu Y, Huang XY, Feng WY, Luo XT, Wei CW, Liu JH, Lai YJ, Xiao ZM, Zhang X, Zhan XL. Analysis of the clinical efficacy of tumor resection methods used in 20 patients with clavicular tumor. World J Surg Oncol 2019; 17:106. [PMID: 31208415 PMCID: PMC6580492 DOI: 10.1186/s12957-019-1642-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background To retrospectively analyze the tumor resection method used in 20 patients with clavicular tumors and evaluate its clinical efficacy. Methods A total of 9 patients with clavicular benign tumors underwent intracapsular resection, and 11 patients with clavicular malignant tumors underwent tumor resection from May 2012 to May 2017. Of the 11 patients, 5 underwent clavicular reconstruction using the plate-cement complex. Surgical efficacy was assessed using the Musculoskeletal Tumor Society, Constant-Murley, and American Shoulder and Elbow Surgeons shoulder outcome scores preoperatively until 12 months postoperatively. Results The average duration of follow-up care was 33.7 (12–71) months. Of the 20 patients, 3 patients died, 3 survived with tumor recurrence or metastasis, and 14 survived with no tumor recurrence. Among the 5 patients who underwent resection of malignant clavicular tumors and reconstruction, 2 underwent a re-operation because of a loose screw and plate displacement. In the functional assessment of the shoulder joint, patients with benign and malignant clavicular tumors showed significantly higher scores postoperatively compared with preoperative scores. For malignant clavicular tumors, no significant improvement was observed when comparing the non-reconstruction and reconstruction groups. Conclusions Surgery is an optimal treatment for clavicular tumors. In patients with benign clavicular tumors, simple intracapsular resection can achieve a satisfactory prognosis. Reconstruction of a clavicular defect after resection of a clavicular malignant tumor is not recommended.
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Affiliation(s)
- Yun Liu
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xian-Ying Huang
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wen-Yu Feng
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Ting Luo
- Department of Pharmacy, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chang-Wu Wei
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | | | - Yin-Juan Lai
- Guangxi Medical University, Nanning, Guangxi, China
| | - Zeng-Ming Xiao
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Zhang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| | - Xin-Li Zhan
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Goetti P, Pham C, Gallusser N, Becce F, di Summa PG, Vauclair F, Cherix S. Total clavicle reconstruction with free peroneal graft for the surgical management of chronic nonbacterial osteomyelitis of the clavicle: a case report. BMC Musculoskelet Disord 2019; 20:211. [PMID: 31084601 PMCID: PMC6515610 DOI: 10.1186/s12891-019-2588-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic nonbacterial osteomyelitis (CNO) is a rare chronic autoinflammatory syndrome affecting mainly children and young adults. The natural history of the disease is marked by recurrent pain as the mainstay of inflammatory outbreaks. Typical radiographic findings are osteosclerosis and hyperostosis of the medial clavicle, sternum and first rib. Compression of the brachial plexus is exceedingly rare and one of the few surgical indications. Literature on total clavicle reconstruction is scarce. While claviclectomy alone has been associated with fair functional and cosmetic outcomes, several reconstruction techniques with autograft, allograft or even cement ("Oklahoma prosthesis") have been reported with the aim of achieving better pain control, cosmetic outcome and protecting the brachial plexus and subclavian vessels. We herewith report a unique case of complicated CNO of the clavicle treated with total clavicle reconstruction using a free peroneal graft. CASE PRESENTATION A 21-year-old female patient presented with CNO of her left clavicle, associated with recurrent, progressive and debilitating pain as well as limited range of motion. In recent years, she started complaining of paresthesia, weakness and pain radiating to her left arm during arm abduction. The clavicle diameter reached 6 cm on computed tomography, with direct compression of the brachial plexus and subclavian vessels. Following surgical biopsy for diagnosis confirmation, she further developed a chronic cutaneous fistula. Therefore, a two-stage total clavicle reconstruction using a vascularized peroneal graft stabilized by ligamentous reconstruction was performed. At two-year follow-up, complete pain relief and improvement of her left shoulder Constant-Murley score were observed, along with satisfactory cosmetic outcome. CONCLUSIONS This case illustrates a rarely described complication of CNO with direct compression of the brachial plexus and subclavian vessels, and chronic cutaneous fistula. To our knowledge, there is no consensus regarding the optimal management of this rare condition in this context. Advantages and complications of clavicle reconstruction should be carefully discussed with patients due to limited evidence of superior clinical outcome and potential local and donor-site complications. While in our case the outcomes met the patient's satisfaction, it remains an isolated case and further reports are awaited to help surgeons and patients in their decision process.
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Affiliation(s)
- Patrick Goetti
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Chau Pham
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Gallusser
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pietro G di Summa
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frédéric Vauclair
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Stéphane Cherix
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Chen Y, Yu X, Huang W, Wang B. Is clavicular reconstruction imperative for total and subtotal claviculectomy? A systematic review. J Shoulder Elbow Surg 2018; 27:e141-e148. [PMID: 29305098 DOI: 10.1016/j.jse.2017.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effects of clavicular reconstruction on total and subtotal claviculectomy are controversial. The aim of this study is to disclose the impact of clavicular reconstruction on the efficacy of this rare surgical procedure. METHODS This is a systematic review of multiple medical databases for level I through IV evidence. RESULTS Eleven studies (level IV) with a mean follow-up duration of 53 months (range, 12-156 months) met the inclusion criteria. There were 70 subjects (70 shoulders) including 36 male patients (51%), and the average age at operation was 30 years (range, 2-77 years). The etiology included tumors in 34 subjects (49%) and other disorders in 36 (51%). Of the patients, 41 (59%) underwent total claviculectomy whereas 29 (41%) underwent subtotal clavicular excision. Clavicular reconstruction was performed in 14 subjects (20%), with bone allograft in 8, autograft in 1, and a bone cement prosthesis in 5. Objective measurement disclosed compromised strength and mobility in aclaviculate limbs; however, no studies investigating clavicular reconstruction used similar means of measurement. Functional assessment scales implied global limb function following the 2 procedures was similar (American Shoulder and Elbow Surgeons score, P = .13; Constant score, P = .38). Claviculectomy with and without reconstruction resulted in a similar incidence of complications (P = .45); however, isolated claviculectomy was related to fewer further surgical procedures (P <.001) and faster recovery (P <.001). The 2 procedures were associated with similar satisfaction rates (P > .99). CONCLUSIONS No evidence suggested clavicular reconstruction led to clinical outcomes superior to those of isolated claviculectomy. It is noteworthy that isolated excision of the clavicle was associated with a lower risk of further surgery and faster rehabilitation.
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Affiliation(s)
- Yu Chen
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China
| | - Xiuchun Yu
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China.
| | - Weimin Huang
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China
| | - Bing Wang
- Orthopedic Department, General Hospital of Jinan Military Command, Jinan City, China
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