THE OPERATIVE MANAGEMENT OF A MALIGNANT PROXIMAL HUMERUS TUMOR REPRESENTED BY SECONDARY PAGETS OSTEOSARCOMA

Purpose: Malignant tumors at the proximal humerus are an operative cha llenge. Radical removal is a principal of tumor surgery but as much fu nctionality as possible should be retained. These conditions often con flict so a compromise has to be reached. This paper proposes a solutio n to this dilemma, introducing an operative approach, with a new modul ar prosthesis, to a secondary Paget's osteosarcoma in the proximal hum erus, Methods and results: A recently developed humerus modular prosth esis is described, which has been implanted into a patient with Paget' s osteosarcoma. In these, mostly elderly, patients. successful operati ve therapy should combine radical removal with early mobilization. Pag et's osteosarcoma is a recognized complication of the disease, and its prognosis is poor. In our patient, the implanted humerus prosthesis a llowed a limb-saving procedure to be combined with radical removal of the tumor and postoperative early mobilization. A 3-month follow-up yi elded good results with no recurrence of the disease and the patient h ad satisfactory movement. She was able to resume normal daily life sho rtly after the operation. Conclusion: Implantation of a modular prosth esis of the humerus may allow radical removal of a malignant tumor in that area while achieving early motion. In the literature, amputation is often advocated, as radical treatment with chemotherapy is not a su ccessful option in this elderly patient group. We think the alternativ e use of a modular prosthesis of the humerus is possible in selected c ases. We have encountered no other case in the literature where a limb -saving procedure attempts to preserve as much functionality as possib le in Paget's osteosarcoma.