Reconstruction of the proximal humerus with the clavicle after tumor resection: a case report

Reconstruction of the proximal humerus after resection for tumor and modification of the clavicular transposition procedure is described in which the blood supply of the clavicle is preserved and the clavicle is used to bridge the defect. An 11-year-old boy presented with shoulder pain, and the diagnosis was osteosarcoma of the right proximal humerus. After resection of the sarcomatous proximal humerus, the clavicle was released with its periosteum remaining intact, and the clavicle was rotated downward around the acromioclavicular joint. A vascularized fibula supplemented the reconstruction in trying to gain length of the arm. The acromioclavicular joint and the vascular supply of the clavicle were preserved. Internal fixation from the clavicle and the fibula to the distal humerus was made with an AO plate and screws. Muscles around the proximal humerus were reattached to the clavicle. Range of motion of the shoulder was 80 degrees flexion, 85 degrees abduction, 30 degrees external rotation, and 90 degrees internal rotation. Although the postoperative followup is relatively short, only 2 years, the functional advantages of this operation over other forms of reconstruction can be observed.