Reconstruction After the Tikhoff-Linberg Procedure

High incidence of complications associated with shoulder girdle reconstruction utilizing a Stryker proximal humerus cap endoprosthesis following Tikhoff-Linberg resections

“…Tikhoff-Linberg procedures are known to be associated with poor function of the shoulder; however, it is important to note the purpose of this procedure, and reconstruction is not aimed to provide shoulder motion and function but to provide normal hand, elbow, and wrist function. The purpose of the functional spacer is to maintain humeral length, allowing for tensioning of the elbow flexors, provide cosmetic shape, and allow for a stable platform for the elbow, hand, and wrist [1,5,8,12,13,22,23]. Although patients who retained their proximal humerus had improved motion of the shoulder, there was no difference in the mean MSTS93 score between groups, with a mean score of 67%, which is similar to previous series of these resections [12].…”

“…Subluxation and skin erosion are reported complications of early implants used to stabilize the arm on the remaining clavicle or scapula and chest wall [22,23]. In order to reduce the incidence of subluxation, various mesh and graft combinations have been used to enhance soft tissue reconstruction around the endoprosthesis [12,[24][25][26][27][28].…”

The tikhoff‐linberg procedure in the treatment of sarcomas of the shoulder girdle

“…In 1928 Linberg reported 3 cases of this type of resection and referred to Professor Tikhoff for the initiation of the procedure [ 181. To our knowledge, until now only 37 cases are reported in the literature [18][19][20][21][22][23][24][25][26]. Local recurrence occurred in only two cases [ 15,201. The indications for this procedure are malignant neoplasms of the shoulder girdle (distal clavicula, acromioclavicula joint, scapula, upper third of humerus and associated muscles), without involvement of the neurovascular bundle or chest wall.…”

“…Pack and Baldwin (1955) and Francis and Worchester (1962) sutured the soft tissues around the humeral stump to the second or the third rib [24,25]. Whitehall et al [23] described a case report of a patient who underwent a Tikhoff-Linberg resection for a proximal humeral osteosarcoma. The interposition they used consisted of a Kuntscher nail, which fixed the humerus to the second rib, thus increasing stability and function.…”