Limb salvage for malignant tumors of the proximal humerus

Objective To investigate limb salvage methods in reconstructing post operative defects after malignant tumor resection of proximal humerus. Methods Thirty six patients had limb salvage procedures for treatment of malignant tumors of the proximal humerus from 1989 through 1999. There were 12 osteosarcomas, 6 chondrosarcomas, 2 primitive neuroectodermal tumors, 2 malignant fibrous histiocytomas, 5 metastatic carcinomas in bone, and 4 malignant giant cell tumors of bone. The patients with osteosarcoma or primitive neuroectodermal tumor or malignant fibrous histiocytoma received neo adjuvant chemotherapy. 33 cases of malignancies underwent intra articular resection and 3 cases extra articular resection, in which 21 underwent reconstruction with osteoarticular allograft, 4 cases underwent reconstruction with endoprosthesis, 6 cases with free periosteum vascularized clavicle; and 5 cases underwent claviculoplasty with peri osteolar vascular pedicle. Results The patients were followed up from 6 to 118 months postoperatively. 11 cases died and 3 cases recurred. According to Enneking Function Evaluation Standard, the mean post operative function score of the upper extremity was 23 points (total 30 points) in group of reconstructing proximal humerus with collateral clavicle, 24 points in patients underwent reconstruction with osteoarticular allograft, and 26 points in patients underwent reconstruction with endoprosthetic. Conclusion The reconstructive method with osteoarticular allograft or endoprosthesis is the first choice after malignant tumor resection of proximal humerus. Limb salvage with collateral clavicle in reconstructing proximal humerus is suitable for children. The function following reconstructive procedures is closely related with the reconstruction of the rotator cuff and the abductor mechanism.