Malignant humeral bone tumors in children: excision and reconstruction with the use of rotated clavicle.

Abstract

The application of intensive multimodality therapy has made possible salvage surgery in bone tumors. Reconstruction of the removed part of bone is the great problem, especially in fast-growing children. In three patients (two osteosarcomas and one Ewing's sarcoma), the tumor was confined to the proximal half part of humerus, without invasion of shoulder joint. After induction chemotherapy, reduction of tumor size was observed both clinically and radiologically. During the operation, wide resection of the tumor together with a 12- to 14-cm-long fragment of humerus, was performed. Afterward, the clavicle was rotated in the place of the removed bone, with preservation of the coracoacromial ligament. The humeral stump and clavicle were fixed with the use of metal plate. Adjuvant chemotherapy was used a few days following surgery. After 3 months, the osteosynthesis had healed. The movements in shoulder joint are limited, but functions of elbow joint remained normal. All children are alive and disease free. Reconstruction of humerus with clavicle rotation is possible when the proximal bone loss is not longer than 10-14 cm. This method seems to be an alternative to allogeneic grafts and endoprostheses.