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Humeral Reconstruction for Osteosarcoma using a Cemented Intercalary Endoprosthesis.
Humeral Reconstruction for Osteosarcoma using a Cemented Intercalary Endoprosthesis. Presented by Dr. Fiifi Brakatu at the 2025 Annual General Scientific Conference (AGSC) of the Orthopaedic Association of Ghana.
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Humeral Reconstruction for Osteosarcoma using a Cemented Intercalary Endoprosthesis.
- 1. Humeral Reconstruction for Osteosarcomausing Intercalary Endoprosthesis Senior Resident 37 Military Hospital
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- 3. Outline • Clinical Assessment •Workup • Surgical Planning • management
- 4. Clinical Assessment • 38M, RHD • Referred o/a pathological fracture of the humerus • Pain and inability to move arm • Managed conservatively in periphery • DOI – 6months ptp • MOI – low energy fracture sustained while arranging books on table • No red flags • Good baseline • Closed injury • Wrist drop+
- 5. Plain Radiograp h Initial x-ray –Jan 2024 Aug 2024 – Seen at 37MH
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- 7. Tumor Workup • Hypochromicmicrocytic anaemia • Normal kidney and liver function • CT – chest – No Mets • MRI – suggestive of tumor; soft tissue infiltration
- 8. Tumor Workup- Biopsy ChondroblasticOsteosarcoma Low grade No perineural or lymphovascular invasion
- 9. Summary Enneking IB Locally Advanced NeoadjuvantChemo + Surgery + Adjuvant RT
- 10. Neo-adjuvant Chemotherapy • Doxorubicin+ Ifosphamide - 6 cycles BSA 2 • 3 days for each cycle • Adriamycin 20mg/m2 • Total dose/cycle =40mg • Ifosphamide 2000mg/m2 • Total dose/cycle = 4000mg • Mesna 2000mg/m2 • Total dose/cycle = 4000mg • Zoledronic acid – 4mg
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- 12. PRE-OP PLANNING (PIP) PatientOptimization Implant Selection Procedure
- 13. Patient Optimization Transfused Labs WNL CXR– still no mets Echo – normal (after Doxorubicin) ASA1 Cleared by Anaesthesia
- 14. Planning – Osteotomyand Custom-made implant
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- 16. Procedure- Decisions •Biological vsMegaprosthesis •Cemented vs Cementless •Assistant Plate vs Standalone •Improved stability and integration •Lower risk of implant failure and loosening •Faster healing and recovery
- 17. Synopsis Diagnosis: Osteosarcoma ofthe left humerus Findings: • Extracompartmental humeral shaft tumor • Radial nerve infiltrated by tumor Procedure: • Radical Tumor Excision + Left Humerus Reconstruction Implants: Intercalary Humerus Endoprosthesis OR Time: 230min EBL – 400mls Complications: None
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- 20. Post-op Protocol • Antibiotics •Analgesia • Antcoagulation – • stopped after reactionary bleeding on POD2 • Codman’s • Pendulum -2wks • Passive ROM – 2wks • Strengthening – 2wks
- 21. Post-op Course Day 142months 4 months 3months
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- 23. Outlook • Satisfied patient •Back to work • Wants a tendon transfer for the wristdrop
- 24. Plan for tendon Transfer •PT to ECRB – Wrist Extension • PL to EPL - Thumb extension) • FCU to EDC – digital extension • LD to Triceps – Elbow extension
- 25. Take Home Message •Faster return to work with megaprosthesis than biological fixation • Cemented prosthesis for tumor patients • Assistant plate if stem is <5cm • Meticulous planning is key!
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