Clavicula pro humero reconstruction after tumor resection of the proximal humerus

WANG Wei; YU Xiu-chun; LI Xiao; WANG Zhen-xing; ZHAO Ren-tao; XU Ming; ZHENG Kai

doi:10.3969/j.issn.2095-252X.2017.11.015

Abstract：Objective To investigate the clinical outcomes and feasibility of Clavicula Pro Humero ( CPH ) reconstruction after tumor resection of the proximal humerus. Methods Ten patients were treated with CPH reconstruction after wide tumor resection of the proximal humerus from September 1998 to December 2015. There were 5 males and 5 females with the average age of 29.6 years ( range: 10 - 50 years ), including 3 giant cell tumors, 3 osteosarcomas, 1 Ewing's sarcoma, 1 chondrosarcoma, 1 bone fibrosarcoma and 1 bone metastatic cancer. Results CPH procedures were accomplished in all patients including simple CPH in 6 patients, CPH combined with allogenous graft in 2 patients and CPH combined with autogenous fibular graft in 2 patients. Osseous unions were ultimately obtained in all patients. All patients were followed up for 12 - 223 months. Three patients died with no evidence of disease. Simple CPH group: 3 clavicle fractures, 3 rotated clavicles got well reunion, 2 death. Four patients of rotated clavicles combined with allogeneic or autologous bone graft got good bone healing, while 1 patient died of tumor metastasis. Musculoskeletal Tumor Society ( MSTS ) was recorded except for 2 dead patients and 1 lost patient. MSTS functional scores were excellent with a range of 20 - 26 ( 67% - 87% ), with an average of 23.7 ( 79% ). Limited shoulder motion was the only functional deficit noted with external rotation and elevation. Good internal rotation, abduction ( 40° - 80° ), antexion ( 45° - 70° ), rear protraction ( 30° - 45° ) were observed. Functions of the elbow and the hand were well preserved. Conclusions CPH reconstruction after tumor resection of the proximal humerus is feasible. The fracture of the rotated clavicle is the most common complication. With the use of the long plate and autogenous / allogenous bone graft, the strength of the rotated clavicle is enhanced to minimize the possibility of fracture and to promote the healing of the bone.