Limb sparing surgery for bone tumors of the shoulder girdle

Objective To investigate the clinical and functional outcome of limb sparing surgery for bone tumors of the shoulder girdle.Methods 35 patients with bone tumors of the shoulder girdle,24 males and 11 females,34 years in average (range:12-74 years),were treated with limb sparing surgery.The tumors,including 10 osteosarcomas,7 chondrosarcomas,3 malignant fibrous histiocytomas,3 Ewing's sarcomas,1 fibrosarcoma,1 myeloma,7 bone giant cell tumors and 3 metastases tumors,involved proximal humerus in 21 patients,scapula in 12,clavicle in 2.There were 5 patients accompanied with pathological fracture.The tumors were staged according to Enneking surgical staging system.Resections were classified according to the classification system of Malawer et al.as 19 type-Ⅰ,6 type-Ⅱ,4 type-Ⅲ,1 type-Ⅵ,1 type-Ⅴand 1 type-Ⅳ.There were lateral clavicle resections in 2 patients and glenoid resection in 1.Two patients underwent marginal resections.The reconstruction procedures included 8 prosthetic replacements,and 4 tumorous bone devitalization and replantation,3 osteoarticular allografts,2 autogenous fibular grafts,1 centromedullar cemented nailing,3 Tikhoff-Linberg procedures,2 replantation of shortening arms,and 4 humeral head suspension.6 partial scapulectomy and 2 lateral clavicectomy needed no bone reconstruction.16 cases received neo-adjuvant chemotherapy.Results The patients were followed up for mean 71 months(range:6-186 months),including 4 local recurrences,6 systemic metastases,9 death and 22 patients with event free survival.According to functional rating system of the Musculoskeletal Tumor Society for the upper extremity,the mean functional score was 77% (40%-100%) in all patients,88%(77%-100%)in 8 cases without gleiohumeral joint involvement,78%(57%-90%)in 18 cases with resection and reconstruction of proximal humerus,63%(40%-77%)in 9 patients with shortening humeruses and humeral head suspension.The complications included wound infection or dehiscence in 4 patients,allograft bone fracture in 2,temporary radial nerve palsy in 2 and subluxation in 3.Conclusions Bone tumors of the shoulder girdle are treated mainly with limb sparing surgeries including prosthetic replacement,osteoarticular auto-or allo-graft,tumorous bone devitalization and replantation and Tikhoff-Linberg procedure et al.which are applied after tumor resection according to the patient's conditions and tumorous type and extension.Local tumor control,stable and painless shoulder reconstruction and good function of elbow and hand can be achieved in the majority of patients.