Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results

Abstract

It is a great challenge to spare the upper limb with a malignant or invasive benign bone tumour of the shoulder girdle. We retrospectively analysed 35 patients with bone tumours of the shoulder girdle treated with various limb salvage procedures. The tumours included 25 primary malignancies, three metastases and seven giant cell tumours which involved the proximal humerus in 21 patients, scapula in 12 and clavicle in two. The reconstruction procedures included eight prosthetic replacements, four devitalised tumorous bone grafts, three osteoarticular allografts, two autogenous fibular grafts, one intramedullary cemented nail, three Tikhoff-Linberg procedures, two replantation of shortened arms, and four humeral head suspensions. Six partial scapulectomies and two lateral clavicectomies needed no bone reconstruction. With an average follow-up of 71 months, local recurrences occurred in four cases and systemic metastases in six. Nine patients died and 23 remained disease free. The five year Kaplan-Meier survival rate of 28 patients with malignancies was 69.5%. The average Musculoskeletal Tumour Society (MSTS) functional score was 77% (range 40-100%) in all patients.

Fig. 1

Two reconstructive methods after proximal humerus resection (type I resection). a Cemented intramedullary nail acted as a spacer for osteosarcoma of proximal humerus. b Postoperative 15.5-year radiograph of the osteoarticular allograft reconstruction for bone giant cell tumor of proximal humerus shows good union, collapsed humeral head and subsided intramedullary nail

Fig. 2

One 14-year-old patient with osteosarcoma of the left scapula (a) was treated with total scapulectomy (type III resection) and inverted tumor prosthetic reconstruction. b Resected specimen. c The tumor prosthesis. d Postoperative plain radiograph

Fig. 3

A patient presented with giant cell tumor of the left humerus accompanied with pathologic fracture. The proximal humerus was resected widely and a tumor endoprosthesis was implanted. a Anteroposterior plain radiograph. b Magnetic resonance imaging (T1WI). c CT three-dimensional reconstruction imaging. d The tumor endoprosthesis was placed and suspended from the residual articular capsule (yellow arrow) with the tendon of the long head of biceps brachii (white arrow). e Postoperative radiograph 1 year later shows good position of endoprosthesis

Fig. 4

Kaplan–Meier curves showing the five-year survival rate of patients with malignant tumours of the shoulder girdle