CHONDORSARCOMA. SHOULDER PROSTHESIS

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A case of chondrosarcoma of the humeral head treated by resection of the upper humerus and replacement with a Mathys prosthesis. Operation performed in Mogadiscio, Somalia in 1973.
(English text).

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CHONDORSARCOMA. SHOULDER PROSTHESIS

  1. 1. Alberto Bencivenga MD, DCh, PhD, FCS (ECSA) Facharzt für Chirurgie (M. Chir.) (Tübingen) Specialista in Chirurgia (M. Chir.) (Florence) Specialista in Chirurgia addominale (M. Abdominal Surg.) (Florence) Specialista in Urologia (M. Urol.) (Florence) Professor Emeritus of General Surgery, Somali National University Professor Emeritus of Orthopaedic Surgery, University of Nairobi CONSULTANT GENERAL AND TRAUMA SURGEON TECHNIQUE OF UPPER HUMERUS REPLACEMENT. THE FIRST CASE OF CHONDROSARCOMA EVER TREATED WITH THIS TECHNIQUE (26.12.1973)
  2. 2. Asha A. age 17 . History of fast growth in the left shoulder during the previous few months. Irregular and unex-plained fever episodes most recently. Clinical aspect of her lesion
  3. 3. Radiological aspect of the lesion (totally extra-articular). Lungs free.
  4. 4. THE CUSTOM MADE PROSTHESIS
  5. 6. THE OPERATION 26.12.1973
  6. 7. DIVISION OF THE DELTOID
  7. 8. THE CAPUT LONGUM OF THE BICEPS
  8. 9. IDENTIFYING THE LEVEL OF THE BONE RESECTION (BELOW THE SO CALLED WAX DROP)
  9. 10. CUTTING THE SHAFT WITH THE OSCILLATING SAW
  10. 11. REMOVAL OF THE SPECIMEN
  11. 12. REAMING OF THE MEDULLARY CANAL TO 9 mm, THE ACTUAL SIZE OF THE PROSTHESIS STEM
  12. 13. DO NOT REAM MORE THAN THE NECESSARY DIAMETER AND THE NECESSARY LENGTH!
  13. 14. SPECIAL REAMER TO SHAPE THE ENTRANCE INTO THE MEDULLARY CANAL TO EXACTLY ACCEPT THE TAPERED BASE OF THE PROSTHESIS STEM
  14. 15. VERY CAREFUL FINAL REAMING BY HAND, AND UNDER PROTECTION OF THE BONE WITH ONE OR TWO AO CLAMPS
  15. 16. SECOND SPECIAL REAMER TO FINALISE THE SHAPE OF THE ENTRANCE POINT OF THE PROSTHESIS STEM
  16. 17. FINISHING THE TAPERING TO THE EXACT SHAPE OF THE PROSTHESIS STEM. AGAIN BY HAND
  17. 18. INSERTING THE PROSTHESIS INTO THE PREPARED CHANNEL WHERE IT SHOULD NOW FIT PERFECTLY
  18. 19. ARTE , NON VI ! TAP GENTLY WITH YOUR HAND
  19. 20. SECURING THE ROTATIONAL STABILITY WITH AN AO SMALL-FRAGMENT-SET SCREW THROUGH THE STEM DRILLING A 2 mm HOLE
  20. 21. MEASURING THE LENGTH OF THE NECESSARY SCREW
  21. 22. TAPPING THE THREAD
  22. 23. INSERTING THE SCREW
  23. 24. THE CAPUT LONGUM OF THE BICEPS WAS PRESERVED AS LONG AS POSSIBLE, NOT ONLY FOR ITS RE-INSERTION, BUT ALSO TO OBTAIN A STUCTURE WHERE THE GLENO-HUMERAL LIGAMENTS CAN BE SUTURED
  24. 25. <ul><li>The split tendon is threaded through the lower middle hole, inside-out; then, each of the two halves are threaded through the side holes, inside-out, and, after pulling them out, they are sutured according to Bunnel to the main tendon. This will provide reliable soft tissue at both sides of the central holes, where one can suture the capsulo-ligamentous structures for the benefit of an increased joint stability. </li></ul>
  25. 26. SPLITTING THE TENDON END INTO TWO HALVES
  26. 27. THREADING THE TENDON INTO THE CENTRAL HOLE OF THE PROSTHESIS HEAD AND PULLING OUT THE TWO HALVES THROUGH THE TWO SIDE HOLES
  27. 28. SUTURING THE TWO TENDON HALVES INTO THE MAIN TENDON WITH BUNNEL’S TECHNIQUE
  28. 29. SUTURING THE ARM MUSCLES TO THE PROSTHESIS USING THE AD HOC HOLES IN THE PROSTHESIS SHAFT
  29. 31. SUTURING THE DELTOID MUSCLE
  30. 32. THE INCISION AFTER REMOVING THE INCISION DRAPE
  31. 33. PRIMARY WOUND CLOSURE, LEAVING ONE REDON DRAIN IN EVERY LAYER
  32. 34. SKIN DRESSING
  33. 35. A BACK SLAB WAS USED FOR PATIENT’S CONFORT UNTIL THE WOUND HEALED
  34. 36. THE SPECIMEN WITH AN IRREGULAR JOINT SURFACE, BUT ONE NOT INVADED BY THE NEOPLASM
  35. 37. SECTION TH SECTION THROUGH THE NEOPLASM
  36. 38. POST-OPERATIVE CHECK X-RAY. NOTE THE EXTREMELY THIN HUMERAL SHAFT, WHICH INITIALLY WOR-RIED US AND ROBERT MATHYS Sen., THE MANU-FACTURER OF THE PRO-STHESIS. NOTE ALSO THE PERFECT JOINT CONGRUENCE.
  37. 39. CHECK X-RAY PICTURE AFTER 8 MONTHS. OBSERVE THE BONE GROWTH FIXING THE STEM BIOLOGICALLY.
  38. 40. 11 MONTHS AFTER THE SURGERY. THE NEW FORMED BONE SHELF IS BEGINNING TO PRODUCE A “MEDULLARY” CANAL!
  39. 41. AFTER 7 YEARS, A SORT OF A MEDULLARY CANAL DEVELOPED AROUND THE PROSTHESIS STEM, WITHIN THE NEOFORMED BONE SHELF ( * ) * * POST-OPERA_ TIVE PICTURE CHECK X-RAY AFTER 7 YEARS AND 4 MONTHS
  40. 42. A STUDY OF THE SCAPULO-HUMERAL JOINT CONGRUENCE UNDER AXIAL PRESSURE. ( PATIENT SUSPENDED ON PARALLEL BARS ).
  41. 43. <ul><li>THANK YOU FOR YOUR KIND ATTENTION! </li></ul>

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