CHONDORSARCOMA. SHOULDER PROSTHESIS

Alberto Bencivenga

MD, DCh, PhD,FCS (ECSA)

Facharzt für Chirurgie (M. Chir.) (Tübingen)Specialista in Chirurgia (M. Chir.) (Florence)

Specialista in Chirurgia addominale (M. Abdominal Surg.) (Florence)Specialista in Urologia (M. Urol.) (Florence)

Professor Emeritus of General Surgery, Somali National UniversityProfessor Emeritus of Orthopaedic Surgery, University of Nairobi

CONSULTANT GENERAL AND TRAUMA SURGEON

TECHNIQUE OF UPPER HUMERUS REPLACEMENT. THE FIRST CASE OF

CHONDROSARCOMA EVER TREATED WITH THIS TECHNIQUE (26.12.1973)

Asha A. age 17.

History of fast growth in the left shoulder during

the previous few months. Irregular and unex-

plained fever episodes most recently.

Clinical aspect

of her lesion

Radiological aspect of the lesion (totally extra-articular).Lungs free.

THE CUSTOM MADE PROSTHESIS

THE OPERATION26.12.1973

DIVISION OF THE DELTOID

THE CAPUT LONGUM OF THE BICEPS

IDENTIFYING THE LEVEL OF THE BONE RESECTION (BELOW THE SO CALLED WAX DROP)

CUTTING THE SHAFT WITH THE OSCILLATING SAW

REMOVAL OF THE SPECIMEN

REAMING OF THE MEDULLARY CANAL TO 9 mm, THE ACTUAL SIZE OF THE PROSTHESIS STEM

DO NOT REAM MORE THAN THE NECESSARY DIAMETER AND THE NECESSARY LENGTH!

SPECIAL REAMER TO SHAPE THE ENTRANCE INTO THE MEDULLARY CANAL TO EXACTLY ACCEPT THE TAPERED

BASE OF THE PROSTHESIS STEM

VERY CAREFUL FINAL REAMING BY HAND, AND UNDER PROTECTION OF THE BONE WITH ONE OR TWO AO

CLAMPS

SECOND SPECIAL REAMER TO FINALISE THE SHAPE OF THE ENTRANCE POINT OF THE

PROSTHESIS STEM

FINISHING THE TAPERING TO THE EXACT SHAPE OF THE PROSTHESIS STEM. AGAIN BY HAND

INSERTING THE PROSTHESIS INTO THE PREPARED CHANNEL WHERE IT SHOULD NOW FIT PERFECTLY

ARTE, NON VI! TAP GENTLY WITH YOUR HAND

SECURING THE ROTATIONAL STABILITY WITH AN AO SMALL-FRAGMENT-SET SCREW THROUGH THE STEM

DRILLING A 2 mm HOLE

MEASURING THE LENGTH OF THE NECESSARY SCREW

TAPPING THE THREAD

INSERTING THE SCREW

THE CAPUT LONGUM OF THE BICEPS WAS PRESERVED AS LONG AS POSSIBLE, NOT ONLY FOR ITS RE-INSERTION, BUT ALSO TO OBTAIN A

STUCTURE WHERE THE GLENO-HUMERAL LIGAMENTS CAN BE SUTURED

The split tendon is threaded through the lower middle hole, inside-out; then, each of the two halves are threaded through the side holes, inside-out, and, after pulling them out, they are sutured according to Bunnel to the main tendon. This will provide reliable soft tissue at both sides of the central holes, where one can suture the capsulo-ligamentous structures for the benefit of an increased joint stability.

SPLITTING THE TENDON END INTO TWO HALVES

THREADING THE TENDON INTO THE CENTRAL HOLE OF THE PROSTHESIS HEAD AND PULLING OUT THE TWO

HALVES THROUGH THE TWO SIDE HOLES

SUTURING THE TWO TENDON HALVES INTO THE MAIN TENDON WITH BUNNEL’S TECHNIQUE

SUTURING THE ARM MUSCLES TO THE PROSTHESIS USING THE AD HOC HOLES IN THE PROSTHESIS SHAFT

SUTURING THE DELTOID MUSCLE

THE INCISION AFTER REMOVING THE INCISION DRAPE

PRIMARY WOUND CLOSURE, LEAVING ONE REDON DRAIN IN EVERY LAYER

SKIN DRESSING

A BACK SLAB WAS USED FOR PATIENT’S CONFORT UNTIL THE WOUND HEALED

THE SPECIMEN WITH AN IRREGULAR JOINT SURFACE, BUT ONE NOT INVADED BY THE NEOPLASM

SECTION TH

SECTION THROUGH THE NEOPLASM

POST-OPERATIVE CHECK X-RAY. NOTE THE EXTREMELY THIN HUMERAL SHAFT, WHICH INITIALLY WOR-RIED US AND ROBERT MATHYS Sen., THE MANU-FACTURER OF THE PRO-STHESIS.NOTE ALSO THE PERFECT JOINT CONGRUENCE.

CHECK X-RAY PICTURE AFTER 8 MONTHS. OBSERVE THE BONE GROWTH FIXING THE STEM BIOLOGICALLY.

11 MONTHS AFTER THE SURGERY. THE NEW FORMED BONE SHELF IS BEGINNING TO PRODUCE A “MEDULLARY”

CANAL!

AFTER 7 YEARS, A SORT OF A MEDULLARY CANAL DEVELOPED AROUND THE PROSTHESIS STEM, WITHIN

THE NEOFORMED BONE SHELF (*)

**

POST-OPERA_TIVE PICTURE

CHECK X-RAY AFTER 7 YEARS AND 4 MONTHS

A STUDY OF THE SCAPULO-HUMERAL JOINT CONGRUENCE

UNDER AXIAL PRESSURE.(PATIENT SUSPENDED ON

PARALLEL BARS).

THANK YOU FOR

YOUR KIND ATTENTION!