Dataset Information

Complications and Survivorship of Distal Humeral Allograft Reconstruction After Tumor Resection: Literature Review and Case Series.

ABSTRACT:

Background

Primary bone sarcomas of the proximal humerus represent most bone sarcomas in the upper extremity. However, limited literature exists on the survival and complications of distal humeral allograft reconstruction because of the relative rarity of disease at the distal end.

Methods

We performed a literature review in PubMed and EMBASE using the terms"Humerus,""Distal," "Allograft," and "Reconstruction" to include all the patients with distal humeral reconstructions. In addition, a retrospective review of all patients who underwent distal humerus tumor resection and allograft reconstruction at our tertiary care center over a 23-year period was performed.

Results

Fourteen patients in four different case series have been reported previously with an allograft survival rate of 86%. Thirty-six percent of patients experienced complications, most commonly nonunion (3) and allograft subluxation (2). In a retrospective review at our institution, six met the inclusion criteria and were found to have similar complications.

Conclusion

Based on our experience and the review of the literature, nonunions are the most frequent complication and junctional fractures are the most common cause of revision of allografts in this location. Larger sample studies are required to identify potential correctable predictors of these complications. In addition, complications should be correlated with functional outcome data.

SUBMITTER: Kamalapathy P

PROVIDER: S-EPMC7886443 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Complications and Survivorship of Distal Humeral Allograft Reconstruction After Tumor Resection: Literature Review and Case Series.

Kamalapathy Pramod P Shah Akash A Raskin Kevin K Schwab Joseph H JH Lozano-Calderón Santiago A SA

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 20210211 2

<h4>Background</h4>Primary bone sarcomas of the proximal humerus represent most bone sarcomas in the upper extremity. However, limited literature exists on the survival and complications of distal humeral allograft reconstruction because of the relative rarity of disease at the distal end.<h4>Methods</h4>We performed a literature review in PubMed and EMBASE using the terms"Humerus,""Distal," "Allograft," and "Reconstruction" to include all the patients with distal humeral reconstructions. In add ...[more]

PMID: 33591127

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Project description:BackgroundLocked posterior glenohumeral dislocations with a reverse Hill-Sachs impaction fracture involving less than 30% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 50% undergo humeral head arthroplasty. Reconstruction of the defect with segmental femoral osteochondral allografts has been proposed to treat patients between these two ranges, but the medium-/long-term outcomes of this joint-preserving procedure are controversial.MethodsBetween 2001 and 2018, 12 consecutive patients with a unilateral locked posterior shoulder dislocation and an impaction fracture from 30 to 50% (mean 31% ± 1.32) of the humeral head were treated with segmental reconstruction of the defect with fresh-frozen humeral head osteochondral allografts. Patients were assessed clinically, radiographically and with computed tomography (CT) at a medium follow-up of 66 ± 50.25 months (range, 24-225).ResultsAll twelve shoulders presented a slight limitation in anterior elevation (average, 166.6° ± 22.76). The mean active external rotation with the shoulder at 90° of abduction was 82.5° ± 6.61, and that with the arm held in stable adduction was 79.16 ± 18.80. The mean abduction was 156.25° ± 25.09. The mean Constant-Murley score (CS) was 82 ± 15.09 points (range, 40-97 points), and the mean ASES was 94 ± 8.49 points. The mean pre- and postoperatively Western Ontario Shoulder Instability index (WOSI) was 236.5 ± 227.9 and 11.20 ± 10.85, respectively. Development of osteoarthrosis (OA) was minimal. The average allograft resorption rate was 4% ± 2.4. There were no cases of failure (reoperation for any reason) in this series.ConclusionSegmental humeral head reconstruction with humeral head fresh-frozen osteochondral allografts provides good to excellent clinical results with low-grade OA and low allograft resorption in patients with locked posterior shoulder dislocation.Trial registrationClinicalTrials.gov PRS, ClinicalTrials.gov ID: NCT04823455 . Registered 29 March 2021 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AU8P&selectaction=Edit&uid=U0004J36&ts=12&cx=6cykp8 LEVEL OF EVIDENCE: Level IV, Case Series, Treatment Study.

Dataset Information

Complications and Survivorship of Distal Humeral Allograft Reconstruction After Tumor Resection: Literature Review and Case Series.

Background

Methods

Results

Conclusion

Publications

Complications and Survivorship of Distal Humeral Allograft Reconstruction After Tumor Resection: Literature Review and Case Series.

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