Abstract
Proximal humeral reconstructive options following radical resection of proximal humeral primary and metastatic bone malignancies have evolved over time. With the relatively recent advent of the reverse total shoulder (RTSA), this technique has been increasingly employed in this setting over hemiarthroplasty techniques. An array of options, including proximal humeral allograft-prosthetic composites (including both RTSA and hemiarthroplasty), megaprostheses, and osteoarticular allografts, is reviewed from the perspective of their indications, techniques, complications, and published results. An extensive case-based pictorial presentation illustrates these options.
Highlights
The proximal humerus is a common site for metastatic and primary bone tumors[1,2]
With the evolution of chemotherapeutics, radiotherapy, and advanced imaging techniques, limb salvage surgery has become the norm in this location except for very advanced cases
The purpose of our article is to provide a comprehensive review of current reconstruction options after proximal humeral resection for oncologic reasons
Summary
The proximal humerus is a common site for metastatic and primary bone tumors[1,2]. With the evolution of chemotherapeutics, radiotherapy, and advanced imaging techniques, limb salvage surgery has become the norm in this location except for very advanced cases. Tumors in this region impose significant challenges for local control, reconstruction, and function. Potential glenohumeral joint involvement and close proximity of neurovascular structures affects local control and function, while lack of intrinsic stability and dependence on dynamic and static stabilizers affects reconstruction and function. No restriction (Intermediate) Recreational restriction (Intermediate) Partial occupational restriction Total occupational restriction. Intra-articular proximal humeral resection Partial scapulectomy Intra-articular total scapulectomy Extra-articular scapular and humeral head resection Extra-articular humeral and glenoid resection Extra-articular humeral and total scapular resection Score Pain 2 (Intermediate) Function
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