Dataset Information

[Treatment of chondroblastoma of the humeral head : A tumour- and shoulder-orthopaedic challenge].

ABSTRACT: We present the case of a 22-year-old female patient with chondroblastoma in the right humeral head. To allow a gentle and anatomic resurfacing of the humeral joint surface and to avoid total joint arthroplasty in our young patient with high functional requirements, we implanted a HemiCAP® after intralesional curettage of the chondroblastoma. Our patient's excellent short-term functional outcome shows that our approach can be considered a very good therapeutic option.

SUBMITTER: Oenning S

PROVIDER: S-EPMC7683489 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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[Treatment of chondroblastoma of the humeral head : A tumour- and shoulder-orthopaedic challenge].

Oenning Sebastian S Schneider Kristian Nikolaus KN Gosheger Georg G Theil Christoph C Müller Friederike F Deventer Niklas N Lübben Timo T

Der Orthopade 20201201 12

We present the case of a 22-year-old female patient with chondroblastoma in the right humeral head. To allow a gentle and anatomic resurfacing of the humeral joint surface and to avoid total joint arthroplasty in our young patient with high functional requirements, we implanted a HemiCAP® after intralesional curettage of the chondroblastoma. Our patient's excellent short-term functional outcome shows that our approach can be considered a very good therapeutic option. ...[more]

PMID: 32748105

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Project description:Chondroblastoma is a rare benign cartilaginous lesion located mostly in the epiphyses of the long bones. The most common locations are the proximal tibia or femur, distal femur, and proximal humerus. Open curettage and bone grafting constitute the mainstay treatment for this condition. Few reports have documented the use of arthroscopy in tumor surgery owing to the problem of inadequate removal and the difficulty of bone graft delivery to the tumor cavity. The bazooka technique should solve these 2 main problems. In this article, arthroscopic curettage and grafting are described for the treatment of juxta-articular proximal humeral chondroblastoma to lessen postoperative pain and thus enable early mobilization and a quicker rehabilitation in skeletally immature patients. Technique Video Video 1 The bazooka procedure is performed with the patient in the modified beach-chair position. In this case, the patient had proximal humeral chondroblastoma in the right shoulder. The procedure starts with the use of a posterior portal as the viewing portal. A spinal needle is then used to locate the lesion from anterior. An anterior rotator interval portal is established, with care taken to avoid damage to the biceps tendon and subscapularis. A small periosteal elevator is used to raise a cartilage flap from the roof of the lesion, with care taken to avoid damage to uninvolved cartilage. A small curette is used to penetrate the roof and make the orifice to the lesion. A 4.5-mm shaver is used through the anterior portal to debride tumor tissue. A high-speed burr is used under fluoroscopic guidance to penetrate the walls of the lesion until healthy subchondral bone is reached for later graft incorporation. The scope is shifted to the anterior portal to visualize the lesion from anterior and ensure complete tumor excision. The bazooka is then prepared. A wide-diameter transparent cannula is obtained and dislodged. The trocar is blunted for later graft impaction. A bone graft is taken from the patient's iliac bone and fashioned into small chips. The bazooka is loaded with bone graft to two-thirds of its length. The cannula is inserted from the anterior portal and centered over the orifice of the defect. The bone graft is loaded into the bazooka. Bone graft impaction is performed using the blunted cannula trocar. This step is repeated until complete sealing of the defect is achieved.

Project description:Background:Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA). Questions/Purposes:The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN. Methods:Patients who underwent TSA were identified in the PearlDiver database using ICD-9 codes. Patients who underwent shoulder arthroplasty for humeral head AVN were identified using ICD-9 codes and were subclassified according to AVN etiology (posttraumatic, alcohol use, chronic steroid use, and idiopathic). Complications evaluated included postoperative infection within 6 months, dislocation within 1 year, revision shoulder arthroplasty up to 8 years postoperatively, shoulder stiffness within 1 year, and periprosthetic fracture within 1 year and systemic complications within 3 months. Postoperative complication rates were compared to controls. Results:The study cohorts included 4129 TSA patients with AVN with 141,778 control TSA patients. Patients with posttraumatic AVN were significantly more likely to have a postoperative infection (OR 2.47, P < 0.001), dislocation (OR 1.45, P = 0.029), revision surgery (OR 1.53, P = 0.001), stiffness (OR 1.24, P = 0.042), and systemic complication (OR 1.49, P < 0.001). Steroid-associated AVN was associated with a significantly increased risk for a postoperative infection (OR 1.72, P = 0.004), revision surgery (OR 1.33, P = 0.040), fracture (OR 2.76, P = 0.002), and systemic complication (OR 1.59, P < 0.001). Idiopathic and alcohol-associated AVN were not significantly associated with any of the postoperative evaluated complications. Conclusions:TSA in patients with humeral head AVN is associated with significantly increased rates of numerous postoperative complications compared to patients without a diagnosis of AVN, including infection, dislocation, revision arthroplasty, stiffness, periprosthetic fracture, and medical complications. Specifically, AVN due to steroid use or from a posttraumatic cause appears to be associated with the statistically highest rates of postoperative TSA complications. Given these findings, orthopedic surgeons should be increasingly aware of this association, which should influence the shared decision-making process of undergoing TSA in patients with humeral head AVN.

Dataset Information

[Treatment of chondroblastoma of the humeral head : A tumour- and shoulder-orthopaedic challenge].

Publications

[Treatment of chondroblastoma of the humeral head : A tumour- and shoulder-orthopaedic challenge].

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