Application and improvement of ipsilateral clavicle turnover during proximal humeral tumorous bone defect repair. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Han, Jia; Wang, Wei; Yu, Xiuchun; Li, Xiao; Wang, Zhenxing; Zhao, Rentao; Xu, Ming; Zheng, Kai
• Is Part Of: Injury. Volume 52:Issue 10(2021)
• Page Start: 2941
• Page End: 2946
• Publication Date: 2021-10
• Subjects: Ipsilateral clavicle turnover -- Proximal humeral -- Bone defect -- Free fibula -- Fracture; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.04.063
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Each follow-up patient had a complete MSTS score of shoulder joint function. This paper describes in detail the whole operation process of CPH, including tumor resection and bone reconstruction, so that readers can have a general understanding of the whole operation process. Through this study and literature review, it is confirmed that the most common complication of CPH is fracture, and the causes are complex. In order to avoid the occurrence of postoperative fracture, on the basis of ensuring the function of shoulder joint, this study confirmed that the application of total clavicle fixation and free fibular transplantation can strengthen the bone strength of turnover clavicle and effectively reduce the risk of fracture. Abstract : Purpose: To investigate the clinical effects and complications that may arise as a result of ipsilateral clavicle turnover during tumorous bone defect repair of the proximal humerus, and to explore the feasibility of performing combined free fibula transplantation and internal fixation in reducing complications Methods: We treated 13 patients with clavicle turnover or free fibular transplantation from September 1998 to February 2020. There were 7 males and 6 females with the average age of 26.2 years (7–50 years). The histological diagnoses were osteosarcoma in 6 patients (Enneking IIB), giant cell tumors in 3 patients (Campanacci III) and one patient each with Ewing's sarcoma (Enneking IIB), chondrosarcoma (Canceration of multiple osteochondromatosis), fibrosarcoma and metastatic cancer of bone (Bone metastasis of lung cancer). Pathological fractures were found in 7 of the 13 patients. Results: The operation was successfully performed for all 13 patients. We followed 12 patients for 18 to 274 months (average 92.7 months). For 6 patients treated with simple clavicle turnover using a short plate, the average healing time was 7 months (4–12 months). Among them, there were 3 cases of clavicle fracture and 3 cases of overturned bone healed well. For the 7 patients treated with clavicle turnover and free fibula using a long plate, the healing time was 6.7 months. However, one patient died of tumor metastasis 19 months after operation, without reversal of clavicle fracture and other complications. Conclusion: Clavicle turnover is a feasible method for the treatment of tumorous bone defect of the proximal humerus. Flipping clavicle fracture is the most common complication. The application of total clavicle fixation and free fibular transplantation strengthens the flipping clavicle and reduces the risk of clavicle fracture.