PMC5591451_01
Local state of the tumor mass at the right elbow.
gr1.jpg
PMC5591451_01_gr1.jpg
fig0005
The elbow was fixed in slight flexion, but no neurovascular disturbances were found (Fig. 1).
Elbow radiographs: (A) a destructive lytic lesion on the lateral side of the humerus through the lateral condyle with osteoid matrix formation (before neoadjuvant chemotherapy); (B) After neoadjuvant chemotherapy, the tumor mass became bigger.
gr2.jpg
PMC5591451_01_gr2.jpg
fig0010
Elbow radiograph demonstrated a lytic lesion on the lateral side of the humerus that extended to the lateral condyle (Fig. 2).
Histopathological examination demosntrated pleomorphic cells with osteoid matrix (Hematoxylin and Eosin, 100x).
gr3.jpg
PMC5591451_01_gr3.jpg
fig0015
Histopathological result was consistent with conventional osteosarcoma (Fig. 3).
Surgical technique. (A) Muscle groups were conserved except for the part of muscles attached to the tumor mass; (B). Osteotomy of the olecranon and of the proximal humerus for the sitting of the fibular graft, doing so exposing the whole mass; (C) Wide excision of the tumor mass was performed; (D) After implanting the fibular graft, we re-attached the olecranon back, positioned it so that the olecranon could glide along the head of the fibula and fix it with tension band wires to the proximal portion of the ulna; (E) Reconstruction of bone and soft tissues had been done; (F) Gross specimen of tumor mass.
gr4.jpg
PMC5591451_01_gr4.jpg
fig0020
Most muscle groups were conserved except for the part of muscles attached to the tumor mass (Fig. 4-A). Distal resection margin were performed on the olecranon and the proximal one was on the proximal shaft of humerus (Fig. 4-B). Wide excision of the tumor mass was performed (Fig. 4C). The articulating surface of the "new" elbow joint was optimized by interposing the biceps tendon and lateral collateral ligament between the fibular head and the olecranon (Fig. 4D).
Postoperative X rays.
gr5.jpg
PMC5591451_01_gr5.jpg
fig0025
On the postoperative radiograph (Fig. 5) the graft was well-positioned and stable.
Clinical picture of 2 years follow up the DASH score went up to 22.5.
gr6.jpg
PMC5591451_01_gr6.jpg
fig0030
The DASH score was improved to 27 point and improved even further (22.5) at 2 years follow up (Figs. 6 & 7).
Postoperative X rays two years after surgery.
gr7.jpg
PMC5591451_01_gr7.jpg
fig0035
The DASH score was improved to 27 point and improved even further (22.5) at 2 years follow up (Figs. 6 & 7).