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A, Photograph of the back of the patient showing the scar and the maximal shoulder abduction at most recent review. B, Photograph of the side of the patient showing the scar and the amount of shoulder flexion at most recent review.
Source publication
We report the case of a patient with Gorham’s disease of the scapula and proximal humerus who was treated with a total scapular replacement combined with a Nottingham Humeral hemiarthroplasty. This is the first report of a scapular replacement for Gorham’s disease or for any other indication when carried out in 1997.
Context in source publication
Context 1
... 6-year follow-up, the patient is pain-free with 80° of active abduction, 40° of external rotation, and internal rotation to T12 ( Figure 5). He reports that his strength continues to improve, and he has been able to continue working as a car spray painter. His Constant score mea- sures 44 (pain, 15; activities of daily living, 13; range of motion, 16; and strength, 0) as compared with 98 on the opposite side. Although the patient feels that he has good functional strength, he obtained no points for strength in the Constant score, because he could not abduct to 90°. Ra- diographs ( Figure 4) showed no signs of loosening of the humeral component or change of position of the scapular ...
Citations
... Recent reports of scapular prostheses show an acceptable range of motion and function [3,4,5,6], but there is no strong evidence of a long term positive outcome using scapular prostheses. Furthermore, a scapular prosthesis is not widely available, and the design is not well established yet. ...
Total scapulectomy and reconstruction has been performed for scapular tumor, however, most of the reconstruction methods have resulted in poor functional outcomes and there is still room for improvement. Most of the reports of reconstruction after scapulectomy are from a single institution. In the present study, we investigated functional outcomes after total scapulectomy in a multicenter study in The Eastern Asian Musculoskeletal Oncology Group (EAMOG). Thirty-three patients who underwent total scapulectomy were registered at EAMOG affiliated hospitals. The patients were separated into no reconstruction group (n=8), humeral suspension group (n=15) and prosthesis group (n=10). Functional outcome was assessed by the Enneking score. One-way ANOVA was used to compare parameters between the patient groups. Complications included five local recurrences, one superficial infection, one dislocation and one clavicle protrusion. The average follow-up period was 43.5 months. The average active flexion range was 45.8° (0 – 120°), and 37.1° in abduction (0 – 120°). The mean total functional score was 22.9 out of 30 (15 − 29), which is a satisfactory score following resection of the shoulder girdle. There were significant differences in reconstruction methods for active range of motion. Bony reconstruction provided better range of motion in this study. There was a variety of reconstruction methods after scapulectomy in the eastern Asian countries. Although better functional score was obtained using scapular prosthesis or recycled bone and prosthesis composite grafting, postoperative function is still lower than preoperative function. Modified designed prosthesis with or without combination of recycle bone or allograft would restore the lost shoulder function in the future.
... Preliminary results of scapular prostheses showed an acceptable stability of the shoulder joint and a moderate active function. 14,[16][17][18][19] Long-term results have not been published yet. Osteoarticular acetabular allograft 6 and scapular allograft reconstructions have been described and seemed to ensure moderate to good stability and function. ...
... 11,12 There are several reconstruction techniques to maintain some of the arm function after a total scapulectomy, including humeral suspension, 1 scapular autograft 2 or allograft, 6 and prosthetic devices. 18 An overview of the current literature concerning scapular allograft and scapular prosthesis is given in Tables VI and VII, respectively. After humeral suspension, in which the proximal humerus is simply stabilized with heavy nonabsorbable sutures or wires to the clavicle, the shoulder's active range of motion and cosmetic results are always unsatisfactory. ...
... Scapular prostheses are linked to a higher rate of inadvertent events. 14,[16][17][18][19] Shoulder joint dislocations and infections, which seem especially to be a major problem with this kind of reconstruction, were completely avoided in our patients. ...
Hypothesis:
Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate.
Methods:
The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws. The periscapular muscles and the residual joint capsule were sutured to the corresponding insertions of the allograft.
Results:
The mean follow-up was 5.5 years (range, 24-175 months). In all patients, a wide surgical margin was achieved. The average functional scores were 20 points for the International Society of Limb Salvage score and 60 points for the American Shoulder and Elbow Surgeons score. Mean active shoulder flexion of 60° (range, 30°-90°) and mean active abduction of 62° (range, 30°-90°) were achieved. During the follow-up, 1 patient (16.6%) had a local recurrence and lung metastasis, whereas the remaining 5 patients (83.3%) were disease free. Two breakages of the osteosynthesis and 2 allograft fractures were observed, necessitating a revision surgery in 2 cases (33.3%). In this series, no infection, allograft resorption, or shoulder instability occurred.
Conclusion:
Allograft substitution of a completely removed scapula is an oncologically safe procedure, with good functional results, avoiding common complications in prosthetic replacements such as infection and dislocation of the shoulder joint.
... There are few reconstruction techniques available in surgical practice. There are few or not all megaprosthesis to reconstruct both the proximal humerus and the scapula [12] [13]. 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. ...
... Les résultats fonctionnels sont médiocres, avec une épaule ayant peu ou pas de mobilité active et qui manque de stabilité (absence contrôle musculaire de l'épaule) pour permettre des mouvements en force du coude et de la main. Certains proposent de reconstruire la scapula, cependant les prothèses de scapula [5,6] n'ont pas fait la preuve de leur intérêt sur le plan fonctionnel et entraînent des risques de complications spécifiques aux prothèses (infection, devenir à moyen et long terme). Chandrasekar et al. [7] ont rapporté deux cas de résultats fonctionnels très satisfaisant, mais avec un recul modéré après irradiation extracorporelle et réimplantation de scapula ou après allogreffe de scapula [5,17]. ...
... Certains proposent de reconstruire la scapula, cependant les prothèses de scapula [5,6] n'ont pas fait la preuve de leur intérêt sur le plan fonctionnel et entraînent des risques de complications spécifiques aux prothèses (infection, devenir à moyen et long terme). Chandrasekar et al. [7] ont rapporté deux cas de résultats fonctionnels très satisfaisant, mais avec un recul modéré après irradiation extracorporelle et réimplantation de scapula ou après allogreffe de scapula [5,17]. ...
Résumé
Les tumeurs du membre supérieur sont le plus fréquemment localisées autour de l’épaule. Elles intéressent l’humérus proximal ou la scapula. La reconstruction a pour objectif de retrouver une épaule stable indolore et capable de se mobiliser activement au prix d’une chirurgie limitant le risque de complications. Les éléments clés d’une reconstruction fonctionnelle sont le caractère extra- ou intra-articulaire de la résection, les possibilités de reconstruction de la coiffe des rotateurs et la fonction du deltoïde (résection musculaire ou de son nerf). Lorsque le deltoïde peut être conservé et la résection intra-articulaire (conservant la glène), les prothèses inversées, manchonnées ou pas dans une allogreffe osseuse, permettent de retrouver une fonction de qualité sur le plan des mobilités actives. Dans les autres cas, une reconstruction par prothèse conventionnelle ou «tumeur» peut être proposée, mais avec des résultats toujours médiocres sur le plan de la fonction; l’arthrodèse de l’épaule est une alternative intéressante dans ces situations. Dans tous les cas, les complications chirurgicales et les séquelles fonctionnelles sont fréquentes, la longévité des reconstructions incertaines et le préjudice esthétique important.
... Different surgical reconstructions described to maintain arm function include humeral suspension, scapular autograft/allograft, scapular endoprosthesis, 21 and glenothoracic fusion. 3 Whatever the method used, the functional outcome from these conservative operations must at least equal that of radical procedures. ...
Resumen
Los tumores óseos del miembro superior son menos frecuentes que los del miembro inferior. Esta localización no presenta ninguna especificidad epidemiológica, ya que todas las entidades patológicas pueden desarrollarse en el miembro superior. El condrosarcoma, el sarcoma de Ewing y el osteosarcoma son los tumores malignos más frecuentes. El objetivo de la resección es la exéresis del tumor en bloque, sin invadirlo, para las patologías malignas. Este procedimiento quirúrgico forma parte de un programa terapéutico multidisciplinario y sólo puede considerarse tras la práctica de una biopsia y la discusión en un comité multidisciplinario (CM) de los tumores del aparato locomotor. La resección se planifica y se lleva a cabo sobre la base de una reciente evaluación preoperatoria por pruebas de imagen (al menos por resonancia magnética), en un centro especializado en ortopedia oncológica, para conciliar los objetivos contradictorios de una resección oncológica completa y adaptada y la mejor preservación posible de la función. En más del 90% de los casos, el tratamiento puede ser conservador. La reconstrucción debe cumplir los requisitos de estabilidad y resistencia: la calidad del tejido blando musculotendinoso es fundamental para los resultados funcionales. En función de la localización anatómica, la extensión de la resección en los tejidos blandos, el estado del paciente y la enfermedad, la reconstrucción se basa en técnicas protésicas, biológicas de injertos óseos o compuestas. En todos los casos, existen numerosas complicaciones, tanto precoces como tardías, y justifican una estrecha coordinación con el equipo de oncología médica en el período perioperatorio para no dificultar el tratamiento de la enfermedad y el seguimiento a largo plazo en un centro ortopédico especializado.
Case:
We describe a 22-year-old woman who underwent total scapulectomy and shoulder joint reconstruction with use of a custom-made ceramic implant composed of hydroxyapatite and beta-tricalcium phosphate (β-TCP) for a recurrent atypical perineurioma that had arisen from the scapula.
Conclusion:
To our knowledge, there have been no previous reports of shoulder joint reconstruction with use of a custom-made ceramic implant after a total scapulectomy. The patient showed excellent function of the new shoulder joint and good range of motion without pain or dislocation at 18 months postsurgery. This new method of reconstructing the shoulder joint after a total scapulectomy appears useful and promising.
Vanishing bone disease is a rare idiopathic disease, leading to extensive loss of bony matrix, replaced by proliferating thin-walled vascular channels and fibrous tissue. There are >191 cases reported in the English literature. Gorham and Stout made the first overview of the disease in 1955 and they first presented 24 cases known at that time. The etiology remains speculative, the prognosis unpredictable, and effective therapy still unknown. The disease can be monostotic or polyostotic although multicentric involvement is exceptional. We report 2 cases of a histologically studied vanishing bone disease involving the humerus and the femoral head. The patients' past history was noncontributory. The radiographic study revealed a destructive lesion of the left humerus in the first case, and complete disappearance of the femoral head in the second case. Laboratory findings including hormonological tests revealed no evidence of metabolic, immunologic, neoplastic, or infection etiology. Histopathological findings of the 2 cases revealed thickened bone of lamellar structure without marrow cavities next to fibrous tissue, with few fibroblasts and a small number of newly formed vascular channels. The prognosis varies from slight disability to death by involvement of vital skeletal structures. The treatment of vanishing bone disease is controversial. Several treatment modalities have been proposed. Surgical intervention has been suggested as a method of choice by many authors and concerns local resection of the affected bone, with or without replacement prosthesis or bone grafts.
