Shoulder Reconstruction with Massive Scapular-Proximal Humerus Osteoarticular Allograft after Total Scapulectomy for Proximal Humerus Osteosarcoma Recurrence

Alidou Traoré¹, Karim Tribak², Brahima Doukouré³, Daouda Kanaté Soumaro¹, Slim Alban Mbende⁴, Sidi Yaya Traoré¹, Rebecca Eva Boka¹, Christian Delloye²

¹Trauma and Orthopaedic Unit, Yopougon Teaching Hospital, Abidjan, Cote d’Ivoire.
²St-Luc University Clinics (UCL), Brussels, Belgium.
³Department of Pathology, Cocody Teaching Hospital, Abidjan, Cote d’Ivoire.
⁴Neurosurgery Unit, Yopougon Teaching Hospital, Abidjan, Cote d’Ivoire.

DOI: 10.4236/ojo.2015.512052                

Abstract

Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.

Keywords

Osteosarcoma, Scapula, Proximal Humerus, Allograft

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Dahlin, D.C. (1978) Bone Tumors: General Aspects and Data on 6221 Cases. 3rd Edition, Charles C. Thomas, Spring-field, 6-11.
[2]	Picci, P. (2014) Epidemiology. In: Picci, P., Manfrini, M., Fabbri, N., Gambarotti, M., Vanel, D., Eds., Atlas of Musculoskeletal Tumors and Tumorlike Lesions, Springer International Publishing, Switzerland, 3-8. http://dx.doi.org/10.1007/978-3-319-01748-8_1
[3]	Mnaymneh, W.A., Temple, H.T. and Malinin, T.I. (2002) Allograft Reconstruction after Resection of Malignant Tumors of the Scapula. Clinical Orthopaedic Related and Research, 405, 223-229. http://dx.doi.org/10.1097/00003086-200212000-00029
[4]	Nakamura, S., Kusuzaki, K., Murata, H., Takeshita, H., et al. (1999) Clinical Outcome of Total Scapulectomy in 10 Patients with Primary Malignant Bone and Soft-Tissue Tumors. Journal of Surgery Oncology, 72,130-135. http://dx.doi.org/10.1002/(SICI)1096-9098(199911)72:3<130::AID-JSO4>3.0.CO;2-O
[5]	Malawer, M.M., Meller, I., Dunham, W.K., et al. (1991) A New Surgical Classification System for Shoulder-Girdle Resections. Analysis of 38 Patients. Clinical Orthopaedic Related and Research, 267, 33-44
[6]	Burwell, H.N. (1965) Resection of the Shoulder with Humeral Suspension for Sarcoma Involving the Scapula. The Journal of Bone & Joint Surgery, 47-B, 300-303
[7]	Chandrasekar, C.R., Mohammed, R. and Grimer, R.J. (2009) Extracorporeally Irradiated Scapula as Autograft in Tumor Surgery. Journal of Shoulder and Elbow Surgery, 18, 28-32. http://dx.doi.org/10.1016/j.jse.2008.07.014
[8]	Ham, S.J., Hoekstra, H.J., Eisma, W.H., Koops, H.S. and Old-hoff, J. (1993) The Tikhoff-Linberg Procedure in the Treatment of Sarcomas of the Shoulder Girdle. Journal of Surgery Oncology, 53, 71-77. http://dx.doi.org/10.1002/jso.2930530204
[9]	Lee, F.Y., Hornicek, F.J., Hazan, E.J., Kloen, P., et al. (1998) Reconstruction of the Shoulder Joint Using an Acetabular Allograft. A Report of Two Cases. Clinical Orthopaedic Related and Research, 357, 116-121. http://dx.doi.org/10.1097/00003086-199812000-00015
[10]	Schwab, J.H., Athanasian, E.A., Morris, C.D., Boland, P.J., et al. (2006) Function Correlates with Deltoid Preservation in Patients Having Scapular Replacement. Clinical Orthopaedic Related and Research, 452, 225-230. http://dx.doi.org/10.1097/01.blo.0000229323.37793.6d
[11]	Richards, R.R., An, K.N., Bigliani, L.U., Friedman, R.J., et al. (1994) A Standardized Method for the Assessment of Shoulder Function. Journal of Shoulder and Elbow Surgery, 3, 347-352. http://dx.doi.org/10.1016/S1058-2746(09)80019-0
[12]	Tang, X., Guo, W., Yang, R., Ji, T. and Sun, X. (2011) Reconstruction with Constrained Prosthesis after Total Scapulectomy. Journal of Shoulder and El-bow Surgery, 20, 1163-1169. http://dx.doi.org/10.1016/j.jse.2010.12.014
[13]	Vrettos, B.C., Wallace, W.A., Neumann, L. and Frostick, S.P. (2004) Total Scapular Replacement: Medium-Term Follow-Up. Journal of Shoulder and Elbow Surgery, 13, 472-475. http://dx.doi.org/10.1016/j.jse.2004.01.025
[14]	Zhang, K., Duan, H., Xiang, Z. and Tu, C.(2009) Surgical Technique and Clinical Results for Scapular Allograft Reconstruction Following Resection of Scapular Tumors. Journal of Experimental & Clinical Cancer Research, 28, 45. http://dx.doi.org/10.1186/1756-9966-28-45
[15]	Wittig, J.C., Bickels, J., Wodajo, F., Kellar-Graney, K.L. and Malawer, M.M. (2002) Constrained Total Scapula Reconstruction after Resection of a High-Grade Sarcoma. Clinical Orthopaedic Related and Research, 397, 143-155. http://dx.doi.org/10.1097/00003086-200204000-00020
[16]	Pritsch, T., Bickels, J., Wu, C.C., Squires, M.H., et al. (2007) Is Scapular Endoprosthesis Functionally Superior to Humeral Suspension? Clinical Orthopaedic Related and Research, 456,188-195. http://dx.doi.org/10.1097/01.blo.0000238840.26423.b6
[17]	Delloye, C., Brichard, B., Docquier, P.L. and Cornu, C. (2007) Pelvic Reconstruction with a Structural Pelvic Allograft after Resection of a Malignant Bone Tumor. The Journal of Bone & Joint Surgery, 89-A, 346-354. http://dx.doi.org/10.2106/jbjs.e.00943
[18]	Peabody, T.D., Finn, H.A. and Simon, M.A. (1991) Allograft Arthrodesis of the Shoulder after Extra-Articular Resection of Malignant Tumors of the Proximal Humerus. In: Brown, K.L.B., Ed., Complications of Limb Salvage: Prevention Management and Outcome, International Symposium of Limb Salvage, Montréal, 589-592.