Ulnohumeral reconstruction with autogenous, nonvascularized, fibular graft for metastatic clear cell renal carcinoma of the proximal ulna: a case report

Megas, Panagiotis; Kokkalis, Zinon T.; Iliopoulos, Ilias; Pantazis, Konstantinos; Tyllianakis, Minos; Panagopoulos, Andreas

doi:10.1016/j.jses.2017.06.002

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Giantosus et al (11) reported elbow ROM of 10-100 0 with 45-30 0 of prono-supination in a case of adamantinoma. Megas et al (12) reported 20-110 0 of elbow ROM with 40-30 0 of prono-supination at more than 2 years follow-up with non-vascularized fibula in a case of metastatic carcinoma. However, the outcomes were superior when part of the olecranon was saved, and fibular graft was used as intercalary grafts (14,15).…”

Section: Resultsmentioning

confidence: 99%

“…Levels of resection -Complete proximal ulna resection was performed in 25/31 cases while partial excision, preserving either a sliver of triceps attachment to 1-2 cm of the proximal ulna was done in 6 cases. Four reports (1 case each) described reconstruction with free fibula/ non-vascularized fibula (8,11,12,13). Cases with complete resection of the proximal ulna and reconstruction with fibular graft had functional outcomes similar to radius transfers.…”

Section: Resultsmentioning

confidence: 99%

“…Non-vascularized fibula with trans-osseous sutures has also been used with good functional outcomes. This technique provides stable elbow but with a mild loss of elbow ROM as well as forearm rotatory movements (8,11,12,13).…”

Section: Discussionmentioning

confidence: 99%

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Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions

Gulia

Pruthi

Gupta

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions

Gulia

Pruthi

Gupta

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Reconstruction after proximal ulnar resection

Prajapati,

Thakur,

Gulia

et al. 2024

Bone Joint J

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AimsReconstruction after osteoarticular resection of the proximal ulna for tumours is technically difficult and little has been written about the options that are available. We report a series of four patients who underwent radial neck to humeral trochlea transposition arthroplasty following proximal ulnar osteoarticular resection.MethodsBetween July 2020 and July 2022, four patients with primary bone tumours of the ulna underwent radial neck to humeral trochlea transposition arthroplasty. Their mean age was 28 years (12 to 41). The functional outcome was assessed using the range of motion (ROM) of the elbow, rotation of the forearm and stability of the elbow, the Musculoskeletal Tumor Society score (MSTS), and the nine-item abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH-9) score.ResultsAll patients were available for follow-up at a mean of 33 months (25 to 43) and were disease-free. The mean flexion arc was 0° to 105°. Three patients had complications. One had neuropraxia of the ulnar nerve. The symptoms resolved after three months. In one patient, the screw used for fixation of the triceps tendon became exposed and was removed, six months postoperatively. One patient with wound dehiscence required a local flap for soft-tissue cover, four months postoperatively. At a mean follow-up of 33 months (25 to 43), the mean flexion arc was 0° to 105°. All patients had full supination (85°) but none had any pronation. The mean MSTS score was 23.5 (23 to 24) and mean QuickDASH-9 score was 26.13 (16.5 to 35.75). Three patients had varus-valgus instability on examination, although only one had a sense of instability while working.ConclusionRadial neck to humeral trochlea transposition offers a satisfactory and cost-effective biological reconstructive option after osteoarticular resection of the proximal ulna, in the short term. It provides good elbow function and, being a biological reconstruction option using native bone, is likely to provide long-term stability and durability.Cite this article: Bone Joint J 2024;106-B(11):1301–1305.

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Outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumour

Hajialiloo Sami,

Kargar Shooroki,

Ammar

et al. 2024

Bone Jt Open

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AimsThe ulna is an extremely rare location for primary bone tumours of the elbow in paediatrics. Although several reconstruction options are available, the optimal reconstruction method is still unknown due to the rarity of proximal ulna tumours. In this study, we report the outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumours.MethodsMedical profiles of 13 patients, who between March 2004 and November 2021 underwent osteoarticular ulna allograft reconstruction after the resection of the proximal ulna tumour, were retrospectively reviewed. The outcomes were measured clinically by the assessment of elbow range of motion (ROM), stability, and function, and radiologically by the assessment of allograft-host junction union, recurrence, and joint degeneration. The elbow function was assessed objectively by the Musculoskeletal Tumor Society (MSTS) score and subjectively by the Toronto Extremity Salvage Score (TESS) and Mayo Elbow Performance Score (MEPS) questionnaire.ResultsThe mean follow-up of patients was 60.3 months (SD 28.5). The mean elbow flexion-extension ROM was 95.8° (SD 21). The mean MSTS of the patients was 84.4 (SD 8.2), the mean TESS was 83.8 (SD 6.7), and the mean MEPS was 79.2 (SD 11.5). All the patients had radiological union at the osteotomy site. Symptomatic osteoarthritic change was observed in three patients (23%), one of whom ended up with elbow joint fusion. Two patients (15.4%) had recurrence during the follow-up period. Surgical complications included two allograft fractures, two plate fractures, three medial instabilities, and two infections.ConclusionOsteoarticular ulna allograft reconstruction provides acceptable functional outcomes. Despite a high rate of complications, it is still a valuable reconstruction method, particularly in skeletally immature patients who need their distal humerus physis for the rest of hand growth.Cite this article: Bone Jt Open 2024;5(9):749–757.

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Ulnohumeral reconstruction with autogenous, nonvascularized, fibular graft for metastatic clear cell renal carcinoma of the proximal ulna: a case report

Cited by 3 publications

References 18 publications

Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions

Elbow reconstruction after excision of proximal ulna tumors: Challenges and solutions

Reconstruction after proximal ulnar resection

Outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumour

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