Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

Barbier, Dominique; Billy, B. de; Gicquel, Philippe; Bourelle, S.; Journeau, Pierre

doi:10.1007/s11999-017-5438-y

Cited by 34 publications

(30 citation statements)

References 34 publications

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“…Most patients experienced one or more major complications such as caput humeri absorption or fracture; thus, the abductor mechanism was disrupted in almost all of these patients. Although excellent long-term outcomes were rare in our series, a flail shoulder is often the best alternative for the patient who does not need to use the hand in space; the same was reported by other authors [7][8][9][10][11][12][13][14][15][16][17]23]. We also find that functions of the elbow, wrist, and hand remained in a flail limb and can meet the requirements of daily life with the help of an orthotic or the contralateral hand.…”

Section: Discussionsupporting

confidence: 82%

“…Optimal methods for shoulder reconstruction after resection of the proximal humerus including caput humeri are controversial and challenging [2], especially in skeletally immature patients or massive bone resected, due to the narrow medullary canal, small length of the remaining bone, poor compliance in immobilization, and less soft tissue available for coverage [8,9]. Currently, commonly used reconstructive options following caput humeri resection include preservation of the mobile glenohumeral joint using a prosthesis, osteoarticular allograft or allograft prosthesis composite, fibular or autoclaved humeral autograft, and the clavicula pro humero procedure [10][11][12][13]. The reconstruction method is often determined by factors such as the patients' economic status, the tumor type and extension, the surgeon's skills, and the availability of instruments [5].…”

Section: Introductionmentioning

confidence: 99%

“…Theoretically, biological reconstruction has merits such as creating bone stock for possible future revision, and the attachment of remaining deltoid muscle and rotator cuff tendons to the soft tissue of the graft provides better stability and active range of motion of the shoulder, which should lead to a better overall function and higher patient satisfaction. Yet, numerous studies have reported high rates of major complications including fracture, nonunion, subchondral collapse, and infection, which often require removal or revision of the osteoarticular graft [9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

et al. 2020

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Background: The proximal humerus is one of the most common sites of primary or metastatic malignant tumors. Reconstruction of the shoulder after tumor resection is controversial and challenging. When intra-articular resection is performed, biological reconstruction (osteoarticular allograft and autologous bone implantation) may be the first choice rather than prosthetic reconstruction. Objective: To observe the mid-to long-term effects of oncologic, reconstructive, and functional outcomes of two different biological reconstruction methods for resection of humerus osteosarcoma involving caput humeri. Methods: This was a retrospective study of 13 consecutive patients who underwent humeral reconstruction of osteosarcoma including caput humeri using osteoarticular allograft (n = 7) and tumor bone inactivated and reimplantation (TBIR, n = 6) in our clinic between 2007 and 2017. Patients' general information, resection and reconstruction techniques, oncological and functional outcomes, and complications were collected and evaluated. Different complications of implantations were compared and analyzed for the different biological methods. Results: The study included ten males and three females with an average age of 19.15 years. The operation time was about 3.65 h with an average blood loss of 631 ml. The resection tumor bones were 13-45 cm (23.54 cm on average). The mean follow-up period was 5.27 years. The shoulder movement was 10-70°(average, 44.00°) in abduction, 0-30°(average, 14.17°) in flexion, and 0-20°(average, 11.90°) in extention at the last follow-up. The complications included fracture in four TBIR patients and two allograft patients with an average of 2.67 years postoperation. Fracture rate was higher and appeared time was earlier in TBIR patients than in allograft patients (p = 0.04); caput humeri absorption occurred in all seven allograft patients and three TBIR patients at an average of 3.10 years after surgery; severe graft bone resorption appeared in five TBIR patients and two allograft patients at an average of 2.57 years of follow-up. Conclusions: Humerus biological reconstruction involving caput humeri was associated with a high complication rate and acceptable limb function in the mid to long term. New combined biological methods should be explored and adopted in the future.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

et al. 2020

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“…There was a great diversity of options for reconstruction of regular bone defect after segmental resection of proximal humeral tumors, including endoprosthesis, [3,5,13,14] osteoarticular allograft, [7,8] allo/autograft prosthesis composite, [15–17] autograft (vascularized or nonvascularized fibula), [18,19] arthrodesis, [20] etc. Thereinto, endoprosthetic replacement is probably the most widely used because of its availability, relatively low complication rate, high IS, and comparable functional results by comparison with those of other approaches.…”

Section: Discussionmentioning

confidence: 99%

“…The median MSTS 93 score was 77% and complication rate reached up to 71.4%. [18] Puri and Gulia described a simple reconstructive method, using a custom-made plate fixed to residual humerus by screws and to glenoid by polypropylene mesh for reconstruction. The incidence of mechanical complications was 12.5%, but the function was restricted (MSTS 93 scores were not documented).…”

Section: Discussionmentioning

confidence: 99%

Plate-prosthesis composite reconstruction after large segmental resection of proximal humeral tumors

et al. 2019

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Since the standard reconstructive option after large segmental resection of proximal humeral tumors remained controversial, we designed and applied plate-prosthesis composite (PPC) for this circumstance. The purposes of the study were to: compare the functional outcome, implant survival (IS), surgical risk of PPC with those of conventional proximal humeral prosthesis (PHP); and describe the design and reconstructive procedure of PPC. Twenty patients (11 males, 9 females), who received intraarticular proximal humeral resection without preservation of abductor mechanism, were included in this study, with a mean resection length accounting for 72.5% (range, 61.9–81.8%) of whole humeral length. According to the reconstructive options, we categorized patients into PPC group (9 patients) and PHP group (11 patients). PPC was a semi-custom-made endoprosthesis, with modular proximal part same as PHP and custom-made distal part including dumpy stem and composite lateral anatomic plate for distal humerus. The mechanical prosthetic complication was defined as the imaging evidence regardless of reoperation. The IS was defined as the time from surgery to the occurrence of mechanical prosthetic complication. The mean follow-up time was 40.1 months (range, 14–129). The Musculoskeletal Tumor Society 93 scores of PPC and PHP group showed no significant difference (73.3% vs 70.0%, P = .46). Compared to PHP group, PPC group showed significantly lower mechanical prosthetic complication rates (0 vs 45.4%, P = .03) and better IS (86.0 vs 59.3 ± 21.7 months, P = .028). Moreover, the comparison of surgical time (3.2 vs 3.3 hours, P = .60), blood loss (288.9 vs 376.4 mL, P = .15) and perioperative complication rates (11.1% vs 18.2%, P = .58) between 2 groups showed no differences. For reconstruction after large segmental resection of proximal humeral tumors, PPC achieved better IS while maintained similar functional outcome compared to conventional PHP without influencing the complexity and safety of surgery.

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Artificial neural network‐based gene screening and immune cell infiltration analysis of osteosarcoma feature

Shi,

Guo,

Wang

et al. 2023

The Journal of Gene Medicine

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BackgroundThe present study aimed to construct an artificial neural network (ANN) model that leverages characteristic genes associated with osteosarcoma (OS) to enable accurate prognostication for OS patients.MethodsOur research revealed 467 differentially expressed genes (DEGs) via gene expression contrast analysis, consisting of 345 downregulated genes and 122 upregulated genes. Gene Ontology (GO) enrichment analysis illuminated functions primarily encompassing T‐cell activation, secretory granule lumen and antioxidant activity, among others. Through Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, we discovered significant correlations between the DEGs and certain pathways, including phagosome, Staphylococcus aureus infection and human T‐cell leukemia virus 1 infection. We then screened out 30 characteristic DEGs (CDEGs) based on random forest analysis and constructed the ANN model using the gene score matrix. To verify the credibility and accuracy of the ANN model, we performed internal and external validation processes, which affirmed our model's predictive capabilities.ResultsThe study further delved into the analysis of immune cell infiltration and its correlation with the target CDEGs, revealing disparities in the infiltration of 22 types of immune cells across different groups and their interrelationships. Moreover, we probed the expression of the two foremost CDEGs (YES1 and MFNG) in OS and normal tissues. We noted a positive relationship between the expression of YES1 and MFNG in OS tissues and the clinicopathological characteristics of OS patients.ConclusionsCollectively, the findings of the present study validate the effectiveness of the CDEGs‐based ANN model in predicting OS patients, which might facilitate early diagnosis and treatment of OS.

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Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

Abstract: Level IV, therapeutic study.

Cited by 34 publications

References 34 publications

Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

Plate-prosthesis composite reconstruction after large segmental resection of proximal humeral tumors

Artificial neural network‐based gene screening and immune cell infiltration analysis of osteosarcoma feature

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