Modified total humeral replacement on unusual osteosarcoma of the humerus: A case report

Introduction: Osteosarcoma of the humerus is an unusual case. In order to salvage the limb, resection followed with total humeral replacement is preferred. In situations where those prostheses are not available, a technique of modified total humeral replacement could be used. Case presentation: A 20-year-old female patient came with osteosarcoma of the right humerus accompanied by pathological humeral shaft fracture, with the onset of six months. The lesion extended along the proximal to distal part of humerus. The patient underwent a neoadjuvant chemotherapy before surgery and a limb salvage surgery by wide excision of the humerus and reconstruction using modified total humeral replacement was performed. Modifications to the shoulder hemiarthoplasty and total elbow prostheses were made, so both prostheses could join as one unit. Discussion: After the surgery, no disturbances of hand function were seen, and functional outcome was evaluated by using Musculoskeletal Tumour Society Score (MSTS)score with score of 83% (excellent). After 3 years of follow up, patient could work and resume daily activity with improved MSTS score. There were neither sign of tumor recurrence nor distant metastasis on follow up. Conclusion: Total Humeral Replacement for the treatment of humerus malignancy was feasible by using this modification. This procedure yielded good functional outcome.