Functional Outcome of Arthrodesis with a Vascularized Fibular Graft and a Rotational Latissimus Dorsi Flap After Proximal Humerus Sarcoma Resection
- 314 Downloads
The prognosis of humeral sarcomas has improved greatly in the past 20 years. As a result, the challenges for orthopedic oncologists include long-term handicap and local morbidity.
Shoulder reconstruction after the resection of sarcomas with the proximal humerus was evaluated for 55 patients from 1990 to 2007 at two universities. After S34(5)B resections (intra-articular resection of the proximal humerus and the abductor mechanism), the shoulders were reconstructed with arthrodesis, prosthesis, or allograft–prosthesis composites (APC).
At the time of the latest follow-up examination, the average duration of follow-up was 86.73 months for the 39 patients who were still alive and whose limbs were salvaged. The local recurrence rate was 7.27% (4 of 55). Functional evaluation was conducted on the 39 patients who had the postreconstructions: 12 arthrodeses, 17 prostheses, and 10 APC. Statistical analysis showed that the functional score of shoulder reconstruction significantly varied among the three groups by the test of homogeneity of variances with P = 0.222, by analysis of variance with P < 0.01, and by post hoc test (Student–Newman–Keuls) with α = 0.05. Primary arthrodesis resulted in better function and increased strength than the prostheses and the APC. Insertion of an allograft, a vascularized fibular graft, a rotational latissimus dorsi flap, and cancellous autograft bone were the preferred arthrodesis techniques used to achieve fusion and reduce complications.
After resection of the sarcoma with the proximal humerus with the abductor apparatus, shoulder arthrodesis is recommended above other reconstructions for better functional outcome as well as increased strength and capacity to position the hand.
KeywordsRotator Cuff Proximal Humerus Distal Humerus Latissimus Dorsi Muscle Fibular Graft
This study was supported by the National Natural Science Foundation of China (no. 30872967).
Conflict of interest
The authors declare no conflict of interest.
- 8.Damron TA, Rock MG, O’Connor MI, et al. Functional laboratory assessment after oncologic shoulder joint resections. Clin Orthop Relat Res. 1998;348:124–34.Google Scholar
- 14.Bos G, Sim F, Pritchard D, et al. Prosthetic replacement of the proximal humerus. Clin Orthop Relat Res. 1987;224:178–91.Google Scholar
- 17.Potter BK, Adams SC, Pitcher JD Jr, Malinin TI, Temple HT. Proximal humerus reconstructions for tumors. Clin Orthop Relat Res. 2009;467:1035–41.Google Scholar
- 20.Enneking WF. Musculoskeletal tumor surgery, vol 1. New York: Churchill-Livingstone, 1983:360–1, 389.Google Scholar
- 28.Dorai AA, Halim AS, Zulmi W. Versatility of the latissimus dorsi flap in upper limb salvage tumor surgery. Med J Malaysia. 2004;59(Suppl F):42–6.Google Scholar