Abstract
Wide en bloc excision of proximal ulna sections is used to treat traumatic and pathological fractures of the ulna, though poor standardization of clinical treatment often results in long-term failure of such reconstructed biomechanical structures. In order to provide insight into effective ulnar reconstructive treatments, the case of an 80-year-old Chinese Han male presenting with pathological fracture caused by a proximal ulnar metastatic tumor concurrent with metastatic renal cancer complicated by occurrence in the brain and lungs is reported and contrasted with alternative treatment techniques. Wide resectioning of the proximal ulna and reconstruction with local radius neck-to-humerus trochlea transposition resulted in preservation of functionality, sensitivity, and biomechanical integrity after postsurgical immobilization, 6 weeks of passive- and active-assisted flexion, and extension with a hinged brace. The resultant Musculoskeletal Tumor Society rating score was 25 of 30 (83 %). Full sensitivity and mobility of the left hand and elbow (10° to 90° with minimally impaired supination and pronation) was restored with minimal discomfort. No evidence of local recurrence or other pathological complications were observed within a 1-year follow-up period. Efficient reconstruction of osseous and capsuloligamentous structures in the elbow is often accomplished by allografts, prosthesis, and soft tissue reconstruction, though wide variations in risk and prognosis associated with these techniques has resulted in disagreements regarding the most effective standards for clinical treatment. Current findings suggest that radius neck-to-humerus trochlea transposition offers a superior range of elbow movement and fewer complications than similar allograft and prosthetic techniques for patients with multiple metastatic cancers.
Highlights
Reconstruction processes addressing the defects produced by wide excision of portions of the proximal ulna are difficult to treat because of the complex biomechanical interactions surrounding the hinge joint of the elbow
In order to successfully reconstruct the biomechanical interactions between osseous and capsuloligamentous structures required for normal elbow function, structural vascularized bone grafts with internal fixation, elbow arthrodesis, and custom or modular prosthetic elbow arthroplasty are often conducted in clinical settings [2,3]
Both the previous case findings and the outcomes of the current case suggest that successful implementation of radius neck-to-humerus trochlea transposition for the reconstruction of the proximal ulna may improve prognosis compared with alternative techniques
Summary
Reconstruction processes addressing the defects produced by wide excision of portions of the proximal ulna are difficult to treat because of the complex biomechanical interactions surrounding the hinge joint of the elbow. The appropriate treatment choice varies highly among different cases, often related to the patient’s condition, pathology, previous mobility, pain level, and unique mobility requirements Each of these techniques represents a unique set of risks for the development of complications, such as infection, prosthetic loosening, or fracture. The patient expressed an explicit preference for a limb-sparing option, resulting in a treatment designed to provide localized disease control without amputation, offering maximum preservation of the forearm and elbow functionality This treatment, is not generally recommended for limiting the risk of metastasis in recurrent patients with or without a history of metastatic growths. Due to the presence of stable renal cancer and concurrent lung and brain metastases, the patient remains at elevated risk for future metastatic occurrences
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