Surgical resection is the universal standard of care for the treatment of bone GCT. The key ensuring an adequate surgical treatment with complete removal of tumor is by obtaining adequate exposure of the lesion. Presentation of case We reported a case of 24-years-old male with Giant cell tumor (GCT) of the right proximal humerus.
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How do you treat a fractured humerus without surgery?
· This section is focused on the treatment of patients with metastatic bone disease (MBD) of the humerus, which is the second most common long bone where this occurs. The goals of surgical treatment in patients with MBD are to (a) provide pain relief and (b) restore function. The surgical treatment is palliative rather than curative, and every effort should be made to …
How is the osteotomy of the humerus performed?
At 11.5 years after surgery, the survival rate for the whole cohort without complications was 72%, without revision of the implant 70%. Conclusions: Replacement of the proximal humerus with MUTARS endoprosthesis is a viable treatment option for bone tumors with satisfying results.
What are the surgical concepts for traumatic humerus fractures?
Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last …
Do you need surgery for a dislocated humerus?
1. Introduction. Proximal humerus is the fourth most common localization for primary bone tumors, the first between the bones of the upper limb, representing the site of 10%–15% among all osteosarcomas and 10% among Ewing sarcomas [1, 2].In addition, humerus is the second bone for metastatic involvement [].Shoulder as a whole is also the third anatomical site for …
How to do a proximal humerus biopsy?
The incision is oriented in a longitudinal way. The biopsy tract should traverse the anterior part of the deltoid muscle, parallel to the deltopectoral groove, avoiding the groove itself and the pectoral muscle [ 17 ]. The direction of the incision of the resection should be borne in mind as during the final surgery, the biopsy tract has to be excised. A portion of the anterior part of the deltoid is thus resected which does not impair the function of the reverse polarity [ 18 ]. A bone window is created using a high-speed drill at a predetermined level. A sufficient amount of representative material is curetted and sent for pathological examination. A hemostatic sponge is placed in the bone window, and the skin is closed after careful hemostasis (Fig. 25.4 ).
What is the characteristic of a tumor in the proximal humerus?
One characteristic feature of patients with a tumor in the proximal humerus is the loss of bone, sometimes leaving only a very short segment distally. The greater the resection is, the longer the lever arm effect on the relatively shorter prosthesis is in the distal humerus, causing an increased load and the risk of loosening [ 15 ].
What is a radiograph showing a pathological fracture of the proximal humerus due to
a Radiograph showing a pathological fracture of the proximal humerus due to metastatic renal cell tumor. b A resection type B is planned: intra-articular proximal humeral resection. c The tumor extends the insertion of the pectoral muscle, zone 2. The deltoid insertion is not affected. d Approach: the clavicle is transected, leaving the anterior part of the deltoid attached to the distal part. e The prosthesis is in place, note the axillary nerve traversing deep to the prosthetic stem ( arrow ). f Postoperative radiograph
How is a humeral diaphysis prepared?
The humeral diaphysis is prepared by reaming. We ream to the largest possible diameter in order to ensure a stable distal fixation. If an allograft of the proximal humerus is preferred by the surgeon, we advise to use the technique as described by Cuff et al. to overcome the ‘hornblower’s sign’ [ 20 ]. This surgical act is only indicated if the tendons of the latissimus dorsi and teres major are not resected by more than 1.5 cm and can be reinserted firmly to the allograft.
What is the bypass index for proximal humeral fracture?
defined a bypass index (distance from fracture level to stem tip divided by outer cortical diameter at fracture level) [ 16 ]. He described that a bypass index of 1.7 is sufficient for primary stability tested by torque to failure in their biomechanical setting. This can also be assumed applicable in reversed shoulder arthroplasty after tumor resection.
What is the best way to restore shoulder function after tumor resection?
Meticulous patient selection is imperative for a successful restoration of shoulder function through an inverse shoulder prosthesis after tumor resection. A thorough work-up regarding tumoral spread should be performed, including radiography and dynamic contrast MRI.
What is the surgical procedure for a shoulder biopsy?
The operative field and ample surrounding area of the skin are disinfected and draped. The arm is draped free and rested upon an independent mobile arm board. A large transparent plastic adhesive drape is wrapped around the shoulder. During the skin incision, the biopsy scar is excised and remains attached to the biopsy tract.
What is used to immobilize a humerus fracture?
If the humerus fracture is stable or not displaced, a splint may be used to immobilize it while it heals. This type of nonsurgical approach will be monitored throughout the healing process to ensure that there are no complications and that the bone is in fact healing as it should.
What happens after humeral replacement surgery?
Because of this, after surgery the patient will likely have to remain in a splint to reduce any strain on the incision. Elbow replacement —This is a unique treatment, but when the lower part of the humerus has been damaged, the elbow may have received equal force of the impact and may need to be replaced.
What is the purpose of a humerus fracture?
The aim of most humerus fracture surgeries is to realign the bones and guide them as they heal . Most humerus fractures are treated using one of the following techniques:
What is a humeral fracture?
A humerus fracture, which is a complete or partial breakage of the upper arm bone, is most commonly caused by trauma, particularly a fall, and accounts for 3 percent of all fractures. The treatment that is most suited for your humerus fracture depends on a number of factors including age, current health, the severity of the fracture, and history with various medications and treatments.
What type of surgeon treats fractures?
Our trauma surgeons treat all types of fractures—including those in the upper and lower extremities, spine and hip—in patients of all ages.
What is the procedure to replace an elbow?
This is most common in elderly patients. A metal or plastic implant will be used to replace the elbow. The procedure is similar to that of a hip or knee replacement. Our trauma surgeons treat all types of fractures—including those in the upper and lower extremities, spine and hip—in patients of all ages.
Can a humerus fracture be a problem?
A humerus fracture can reduce your ability to easily perform daily tasks. If you have any reason to think that you may have a fracture in your humerus, it is important to seek medical attention. To best diagnose your injury, your doctor will ask a series of questions about your health history and how the injury occurred. One or more of these tests will help locate the exact location of the fracture:
What is the diagnosis of proximal humeral tumor?
Recent Findings: Diagnosis of proximal humeral tumors should include a complete history, physical examination, appropriate imaging studies, and biopsy techniques. Advances in imaging capabilities with the improvement of MRI imaging and PET scanning make these modalities more useful for staging and treatment planning. These imaging improvements have contributed to the ability of physicians to use percutaneous treatment modalities for such relatively common tumors such as simple bone cysts and osteoid osteomas of bone. Advances in prosthetic implants have provided treating surgeons with wider selections of limb salvage and reconstruction options for the upper extremity. Bisphosphonate therapy has decreased morbidity for patients with metastatic bone disease.
Is proximal humerus benign?
Purpose of Review: Tumors of the proximal humerus are common . While most these neoplasms are benign, an appreciation of the importance of appropriate evaluation and management is necessary. This article reviews the appropriate clinical evaluation of bone tumor and advances in the treatment of common neoplastic processes of the proximal humerus.
What is the mechanism of a broken humerus?
One of the bones in the arm that could be broken is the humerus. Some of the common mechanisms of humerus fractures include: Arm injuries suffered in an auto accident. Falling from a motorcycle or bicycle.
What are the complications of humeral fracture?
Like any other injuries, there are some serious complications of a humerus fracture. Some of these could lead to lifelong issues. These include: 1 Damage to the brachial plexus that runs through the upper arm and shoulder. 2 The development of compartment syndrome following surgery or the application of a cast. 3 Infections that could take place at the surgical site. 4 Malunion which is used to describe bones that do not heal properly. 5 Premature growth plate closure in children which could lead to a limb-length discrepancy.
Is a humerus fracture serious?
Like any other injuries, there are some serious complications of a humerus fracture. Some of these could lead to lifelong issues. These include:
Can a fractured humerus be repaired?
If individuals suffer a fracture of the humerus, it could require surgery to repair. Even though bone fractures are relatively common, they can still be severe. Those who suffer a serious broken bone could end up with lifelong complications as a result of their injuries.
How to cure a tumor?
This is best achieved by making a large cortical window to access the tumor so as to avoid having to curette under overhanging shelves or ridges of bone. Use of a headlamp and dental mirror combined with multiple angled curettes help to identify and access small pockets or residual disease, which may otherwise result in recurrence. A high-power burr to break the bony ridges helps extend the curettage. A pulsatile jet-lavage system used at the end of the curettage helps to bare raw cancellous none and physically washout tumor cells [14]. Historically, the rate of local recurrence after curettage alone and bone grafting has been reported to range between 25% and 50% [15]. This has led surgeons to enhance their surgical procedure with use of chemical or physical adjuvants such as liquid nitrogen, acrylic cement, phenol, hydrogen peroxide, locally delivered chemotherapy, or radiation therapy [16,17]. The latter has been linked with malignant transformation in the past but the risk of this complication has been recently challenged and may be different with modern radiotherapy modalities [18]. Local adjuvant therapy has been shown to be useful in controlling recurrence rates (Fig. 6). The literature has shown 6%–25% recurrence rates in GCT treated with curettage and local adjuvant therapy [19]. Having described that, recent studies have questioned the role of adjuvants and filling agents in reducing the recurrence rate of GCT, they infer that adequate removal of the tumor seems to be a more important predictive factor for the outcome of surgery than the use of adjuvants.
What is the best way to treat a GCT?
Surgical resection is the universal standard of care for treatment of GCT of bone. As most giant cell tumors are benign and are located near a joint in young adults, several authors favor an intralesional approach that preserves anatomy of bone in lieu of resection [9,10]. Various studies suggested that wide resection is associated with decreased risk of local recurrence compared to intralesional curettage and may increase the recurrence free survival rate from 84% to 100% [11]. However, wide resection is associated with higher rates of surgical complications and leads to functional impairment, generally necessitating reconstruction [11,12]. Local control without sacrificing joint function has traditionally been achieved by intralesional curettage with autograft reconstruction by packing the cavity of the excised tumor with morsellised iliac cortico cancellous bone. Regardless of how thoroughly performed, intralesional excision leaves microscopic disease and hence has a reported recurrence rate as high as 60% (Fig. 5).
What is a giant cell tumor?
Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. GCT represents approximately 5% of all primary bone tumors [1,2]. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations [2]. Although considered to be benign tumors of bone, GCT has a relatively high recurrence rate. Metastases occur in 1%–9% of patients with GCT and some earlier studies have correlated the incidence of metastases with aggressive growth and local recurrence [3]. The prevalence of GCT peaks during the 3rd decade, with 80% of cases occurring between 20 and 50 years of age. Less than 3% of cases occur before the age of 14 years, and only 13% of cases occur in patients over the age of 50 years [4] (Fig. 1).
Can GCT be treated with phenol?
Trieb demonstrated that local recurrence rate of GCT located in long bones treated with or without phenol is similar [15]. Prosser recommended primary curettage for intra-osseous GCT without adjuvant treatment or filling agents [20]. Reconstructing the defect after curettage can be quite a challenge. If the gap left behind after the curettage is small and does not jeopardize the structural integrity of bone it can be left alone and the cavities fill up with blood clot, which then gets ossified to form bone. For larger defects the traditional methods of reconstruction have been cementation or use of bone graft.
Is a giant cell tumor a tumor?
Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. Although considered to be benign tumors of bone, GCT has a relatively high recurrence rate. Tumor often extends to the articular subchondral bone or even abuts the cartilage. The joint and/or its capsule are rarely invaded. Surgical resection is the universal standard of care for the treatment of bone GCT. The key ensuring an adequate surgical treatment with complete removal of tumor is by obtaining adequate exposure of the lesion.
Is a pedicle and rod system for shoulder reconstruction a viable option?
Wide resection and total elbow arthroplasty enables good functional outcome and lower risk for recurrence. Pedicle and rod system for shoulder reconstruction is a viable option, as it provides good pain relief and functional improvement with lower complication rates.