Clinical and functional outcomes of utilising nail cement spacer as a frugal method of reconstruction for tumours of the proximal humerus.

Background: The shoulder girdle and proximal humerus are common sites for neoplastic lesions be it benign or malignant. We aimed to evaluate the outcomes of a frugal method of reconstruction of the proximal humerus for neoplastic lesions at short to medium term follow-up.

Methods: Data for this retrospective case series was collected from an electronic data base held at the primary authors institution. All patients who had resection of the proximal humerus for any neoplastic lesion and reconstructed with a nail cement spacer were included in the study from January 2016 to January 2023. The functional outcomes were measured by Musculoskeletal tumour society score (MSTS) and the Toronto extremity salvage score (TESS). The survivorship and post-operative complications were also reported.

Results: Twenty-two patients were available at final follow up with a mean follow-up time of 37 ± 18 months (range 12-81 months) with Ewing's sarcoma, giant cell tumour, osteosarcoma and metastatic disease as the commonest indications for surgery with a mean age of 29 ± 17 years. The Kaplan-Meier estimates indicated that the survival rate for 22 patients with endpoint (event) taken as death was 63.6 % and for endpoint taken (event) as implant failure was 95.5 % with mean survival time of 58.1 and 77 months respectively. At final follow up, the mean MSTS score was 23.6 ± 2.9 (78.7 %). One patient had superficial infection which settled with a short course of oral antibiotics and one patient had breakage of nail, which was revised.

Conclusion: These results prove that this frugal method of reconstruction is comparable with endoprosthesis when considering clinical and functional outcomes but significantly cost effective and should be considered for the individual patient.