Abstract
ObjectiveDifferent classification systems for surgical tumor resections in the proximal humerus and scapula have been described, but none are specific or have been recently revised. The purpose of this article is to report modified surgical techniques and a new classification system for resections in the humerus and scapula.MethodsThirty-two patients with shoulder girdle bone tumors were operated upon. Two separate new classifications were assigned to resections in the humerus (types I–IV) and scapula (types I–III). An annotation is added to signify deltoid preservation (A) or sacrifice (B). Modified surgical techniques were devised.ResultsFor extra-articular resections of the proximal humerus, we show that sacrificing the acromion and coracoid process is not required. Preservation of these structures can improve cosmetic shoulder outcome. For tumors with no large medial component, we show that there is no need to detach the muscle attachment from the coracoid process allowing earlier elbow extension postoperatively. After a mean follow-up period of 46 months, only two patients developed local recurrence. Postoperative infection was seen in two and stem loosening in one patient. The average MSTS functional score for all patients was 83%.ConclusionOur modified surgical techniques saved structures which were unnecessarily resected with no advantage in surgical series. We reserved the integrity of more muscular tissues and attachments leading to less restriction during the rehabilitation process. This new classification system is realistic, easy to implement, and applicable to all patients.
Highlights
Shoulder girdle resection and reconstruction are some of the most demanding surgeries in the field of orthopedic oncology
More than 95% of patients with shoulder sarcomas can be safely treated by limb-sparing surgical techniques [1]
According to our new classification, 16 cases were of humerus IA, four were of humerus IIB, six were of scapula III, three were of humerus IIA, one was of humerus IIIA, one was of humerus IVA, and one was of humerus IB (Table 1)
Summary
Shoulder girdle resection and reconstruction are some of the most demanding surgeries in the field of orthopedic oncology. More than 95% of patients with shoulder sarcomas can be safely treated by limb-sparing surgical techniques [1]. A few published reports have reviewed and proposed surgical techniques and classifications for shoulder girdle tumor resection [2, 3]. In a study involving 38 patients with shoulder girdle tumors (92% were malignant, average follow-up was 4.6 years), the Malawer et al classified surgical techniques into six categories based on the structures removed, relation to the glenohumeral joint, and the status of the abductor mechanism. In another article from Mayo Clinic, 57 patients with shoulder girdle tumors underwent limb-sparing surgeries and were assessed after an average of 5.3 years for intermediate functional results. Results and complications were related to the type of resection, reconstruction (spacers, osseous arthrodesis, and proximal humeral prosthesis), and the patients’ needs [3]
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