Reconstruction techniques after proximal humerus tumour resection

Reconstruction of the proximal humerus after tumour resection is a surgical challenge. The goal consists not only in reconstructing the resected bone segment, but also in restoring a stable and mobile shoulder. The choice of the technique depends on the status of the soft-tissues at the end of the r...

Full description

Saved in:
Bibliographic Details
Published in:Orthopaedics & traumatology, surgery & research surgery & research, 2019-02, Vol.105 (1), p.S153-S164
Main Author: Sirveaux, François
Format: Article
Language:English
Subjects:
Allograft
Allografts
Arthrodesis
Arthroplasty, Replacement, Shoulder
Biopsy
Bone Neoplasms - surgery
Bone Transplantation
Humans
Humerus
Humerus - surgery
Life Sciences
Postoperative Care
Postoperative Complications
Preoperative Care
Reverse shoulder prosthesis
Tendon Transfer
Tumour
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Reconstruction of the proximal humerus after tumour resection is a surgical challenge. The goal consists not only in reconstructing the resected bone segment, but also in restoring a stable and mobile shoulder. The choice of the technique depends on the status of the soft-tissues at the end of the resection. The preoperative work-up must determine the oncological goals of the resection and identify the structures that can be spared. When deltoid muscle function is preserved, a reverse prosthesis offers the best stability and mobility outcomes. The objective of this work is to describe the indications and techniques used in the various available reconstruction methods. Shoulder mobilities are restored using some of these methods and lost with others. Emphasis is put on the reverse shoulder prosthesis, with a description of its variants (standard prosthesis, cement sleeve, allograft-prosthesis composite, and massive prosthesis) and a discussion of the management of its early complications. When performing reverse shoulder arthroplasty, glenoid implant preparation and positioning are crucial to achieve stability, and humeral length restoration will govern soft-tissue tension. Latissimus dorsi tendon transfer is required to restore active external rotation if the posterior rotator cuff tendons have been removed. Allograft-anatomic prosthesis composites, osteo-cartilaginous allografts, arthrodesis, and spacer prostheses are proposed for patients in whom the local conditions preclude implantation of a reverse shoulder prosthesis.
ISSN:1877-0568
1877-0568
DOI:10.1016/j.otsr.2018.04.024