The operative management of a malignant proximal humerus tumor represented by secondary Paget's osteosarcoma.

Abstract

Malignant tumors at the proximal humerus are an operative challenge. Radical removal is a principal of tumor surgery but as much functionality as possible should be retained. These conditions often conflict so a compromise has to be reached. This paper proposes a solution to this dilemma, introducing an operative approach, with a new modular prosthesis, to a secondary Paget's osteosarcoma in the proximal humerus. A recently developed humerus modular prosthesis is described, which has been implanted into a patient with Paget's osteosarcoma. In these, mostly elderly, patients, successful operative therapy should combine radical removal with early mobilization. Paget's osteosarcoma is a recognized complication of the disease, and its prognosis is poor. In our patient, the implanted humerus prosthesis allowed a limb-saving procedure to be combined with radical removal of the tumor and postoperative early mobilization. A 3-month follow-up yielded good results with no recurrence of the disease and the patient had satisfactory movement. She was able to resume normal daily life shortly after the operation. Implantation of a modular prosthesis of the humerus may allow radical removal of a malignant tumor in that area while achieving early motion. In the literature, amputation is often advocated, as radical treatment with chemotherapy is not a successful option in this elderly patient group. We think the alternative use of a modular prosthesis of the humerus is possible in selected cases. We have encountered no other case in the literature where a limb-saving procedure attempts to preserve as much functionality as possible in Paget's osteosarcoma.