proximal humerus megaprosthesis in case of proximal humerus chondrosarcoma

1. Functional Restoration of a Malignant
Tumor of Proximal Humerus in a
Young Lady
By
Dr. SASWATA DATTA
MS Orthopedics PGT
IPGME&R

2. The Patient
• 37 year female
• House wife
• Poor economic resources
• Left shoulder Pain for 18 months
• Swelling for 6 months
• Restriction of shoulder
movement.

3. Radiography •Bone destruction
•Cortical erosions
•Periosteal reaction
Irregular
matrix
calcification
Lytic lesion

4. Clinico-radiological Diagnosis
• Osteoblastoma
• Giant cell tumour (GCT)
• Metastasis
• Aneurysmal bone cyst (ABC)
• Chondroblastoma
• Chondrosarcoma
•Enchondroma
•Simple bone cyst

5. Lab tests
• CBC .
• Alk. Phosphates.
• Ur/Cr.
• LFT .
• Serum albumin.
• Etc.

6. Investigation workout
CT SCAN
expansile lytic
lesion
involving the
whole
proxymal
humerus with
cortical
breach
without
involving
shoulder
joint.

7. Investigation workout
MRI
subdeltoid extension
and posterior
enhancement
And suggested–
? Chondrosarcoma

8. Histopathology
• Core needle biopsy
Conventional
Chondrosarcoma

9. PET CT Scan
No metabolic active disease
elsewhere in the body.

10. Diagnosis by invasive & non invasive
modalities of investigations
Primary Chondrosarcoma
with no active metastasis.

11. Management option

12. Management we chose
• Limb salvage
surgery

13. Management
Pre OP radiotherapy.
Wide resection of tumor & Reconstructive
Endoprosthesis Surgery.
Post OP rehab & regular follow up

14. Pre op photograph

15. Intra operative photograph
Deltopectoral
approach
Rotator cuff
tagging

16. Intra operative photograph
Wide resection
of the tumor
mass

17. Intra operative photograph
Endoprosthesis
implantation

18. Photograph of implant

19. Post OP Tissue Biopsy Report
Grade II
Chondrosarcoma
Cortical erosion
•Mitotic
figure
•Binucliete
cell
•High
cellularity

20. Follow Up
• Regular follow up at ortho dept. with
CXR
Imaging of Operative site
• Regular follow up at RT dept. And PMR Dept.

21. 7 Days Post OP

22. One month follow up

23. What we achieved ??
• Painless active mobile
joint.
• Patient satisfaction.
• Make the patient able to
do household activities.

24. Take home massage
• Never ignore mild swelling with pain in
shoulder.
• Limb salvaging with endoprosthesis with
proper followup – excellent result.