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Aneurysmal Bone Cyst of the Proximal Humerus Managed with En Bloc Resection, Fibular Strut Grafting, and PHILOS
Chinmay S Torne1, Sandeep V Gavhale1, Vijaysing Chandele1
1Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.
Introduction:
Aneurysmal bone cyst (ABC) is a benign, locally aggressive osteolytic lesion characterized by expansile blood-filled cavities separated by fibrous septa affecting the metaphyseal region of long bones in young individuals and accounting for approximately 1-2% of primary bone tumors. Proximal humerus involvement presents with reconstructive challenges due to the need to preserve shoulder biomechanics and rotator cuff function.
Case Report:
A 28-year-old female presented with progressive pain and swelling of the left shoulder for 5 months, with restricted overhead activity. Imaging showed an expansile metaphyseal lytic lesion (Capanna Type II). A prior biopsy was suggestive of ABC. Two trials of selective arterial embolization failed to improve clinically and radiologically. Management included repeat pre-operative angio-embolization followed by en bloc resection. The defect was reconstructed using a 15-cm non-vascularized ipsilateral fibular strut graft stabilized with a PHILOS plate. Histopathology confirmed the diagnosis of ABC. Serial follow-up demonstrated graft incorporation and union with restoration of painless full shoulder motion.
Conclusion:
Large proximal humerus ABCs require meticulous oncologic clearance combined with stable structural reconstruction. Pre-operative embolization followed by en bloc excision, fibular strut grafting, and PHILOS fixation provides satisfactory functional and radiological outcomes.
