"Whoops" fixation of proximal humerus pathological fracture ended with forequarter amputation – Case report. (2020)

• Record Type: Journal Article
• Authors: Abdel Al, Samer; Abou Chaar, Mohamad K.; Zmaily, Mais; Asha, Wafa; Haddad, Hussam; Al-Najjar, Hani
• Is Part Of: International journal of surgery case reports. Volume 75(2020)
• Page Start: 53
• Page End: 60
• Publication Date: 2020
• Subjects: FQA forequarter amputation -- KHCC King Hussein Cancer Center -- MRI magnetic resonance imaging -- PET/CT positron emission tomography/computed tomography -- MDC multiple disciplinary clinic -- PCA patient controlled analgesia -- OS osteosarcoma -- MTP-PE muramyl tripeptide phosphatidylethanolamine; Forequarter amputation -- Osteosarcoma -- Upper limb -- Whoops surgery; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.08.052
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Forequarter amputation is still used in orthopedic oncology as a treatment of last resort. "Whoops" fixation refers to fracture fixation without investigating possible underlying conditions. Oncological scenario must be ruled out in fractures preceded by trivial trauma. Publishing such cases can participate in increasing the awareness of such cases and how to properly manage them. Abstract: Introduction: Even with the advancement of limb salvage surgery techniques, forequarter amputation (FQA) is still used in orthopedic oncology. Even though it might pose catastrophic sequelae on the patient's lifestyle, debilitating one's ability to perform regular tasks, FQA is still considered as a treatment of last resort for huge fungating tumors of the upper extremity. Case presentation: We present a case of an 18-year-old male patient, who was diagnosed in Libya with left proximal humerus fracture after a trivial trauma and underwent open reduction and internal fixation using k-wires as it was thought to be a simple fracture. Soon after, pain and swelling progressed severely and an open biopsy confirmed a diagnosis of osteosarcoma and imaging suggested metastatic disease to the lungs for which he was started on chemoradiotherapy. He was referred to our cancer center to continue his management and due to the aggressive nature of the tumor, the patient underwent palliative forequarter amputation followed by multiple lines of chemotherapy and radiotherapy, all of which failed to halt the progression of the disease. The patient was lost to follow up due to his decision to go back to Libya. Conclusion: "Whoops" surgeries are fixated upon repairing fractures without looking for the alarming signs on radiographs to exclude pathological entity. As in our case, the procedure done escalated the osteosarcoma into such a massive fungating tumor due to the violation of the osteosarcoma pseudo capsule, in which the only available option is to do a palliative forequarter amputation.