Principles of surgical treatment of primary malignant bone tumors of the humerus

The proximal humerus represents the first location of primary tumors of the upper limb and the fourth for all primary malignant tumors [1]. The functional result of conservative treatment of shoulder tumors depends on the preservation of the glenoid, deltoid muscle and rotator cuff tendons as well as the vasculo-nervous elements. “Open” surgical biopsy is preferable for primary bone tumors, especially when a cartilaginous tumor is suspected. It is carried out by a short approach, located on the route of the approach, which will be used for the surgical resection of the tumor so that the biopsy scar is excised in one piece with the tumor. The surgical treatment of primary malignant bone tumors is based on a wide resection, with excision of the bone segment affected by the tumor and any adjacent soft parts invaded, in a single piece without entering the tumor while maintaining a margin of healthy tissue in the periphery. Most malignant bone tumors currently benefit from chemotherapy treatment following surgery, this is particularly the case for osteosarcomas and Ewing sarcomas. Surgical treatment represents only part of this treatment. It has three essential objectives: - Diagnosis, with biopsy, - Excision of the tumor, - Reconstruction. As in other locations, several techniques can be used: A scapulohumeral arthrodesis using a vascularized autograft and/or an intercalary allograft or using a locked screwed plate and cement. Stabilization of the shoulder by the MARCOVE device: suspension of the humerus to the clavicle or to the second rib via a nail. Reconstruction using a cement or metal spacer. Massive prosthesis, reversed or not. Reconstruction with the clavicle turned over and fixed to the humerus