Short-term Functional Outcomes of Shoulder Girdle Limb Salvage in Primary Bone Tumors: A 2-year Follow-up Study

The shoulder girdle, encompassing the proximal humerus, scapula, lateral third of the clavicle, and surrounding soft tissues, is the third most frequent site for bone tumors. The proximal humerus is the most commonly affected area, followed by the scapula and clavicle. Managing malignant or aggressive benign bone tumors in this region is particularly challenging due to the proximity to vital neurovascular structures and the need to maintain both stability and dexterity in the shoulder. While traditional treatment often involved extensive resections, contemporary limb salvage techniques focus on preserving function while ensuring effective tumor control.

This prospective study included 18 patients who underwent various limb salvage procedures at the Department of Orthopaedics, Vydehi Institute of Medical Sciences and Research Centre in Bengaluru between 2012 and 2019, with a minimum follow-up of 2 years. Diagnosis and staging were performed using imaging modalities and core needle biopsies, with musculoskeletal tumors staged according to the Enneking System. Functional outcomes were assessed using the Musculoskeletal Tumor Society Rating Scale (MSTS). Surgical techniques varied and included endoprosthetic reconstruction, arthrodesis with fibular grafting and plating, and plate fixation with primary shortening. Among the 18 patients, the majority (61%) had giant cell tumors, followed by aneurysmal bone cysts (17%), chondrosarcoma (11%), and osteosarcoma (11%). Functional outcomes, as measured by the MSTS, showed a 75% satisfactory rate. The study population was composed of 55.56% males and 44.44% females. Key parameters evaluated included pain, functional activity, hand positioning, dexterity, lifting ability, and emotional acceptance.

Limb salvage surgery for primary bone tumors of the shoulder girdle offers favorable functional outcomes and represents a viable alternative to amputation. Modern reconstruction techniques, such as endoprosthetic reconstruction and fibular grafting with plating, achieve satisfactory results in both function and appearance. The MSTS scoring system is an effective tool for assessing postoperative functional status, and there is a growing preference for less aggressive surgical techniques that preserve limb function while ensuring tumor control.