Table 2.
Comparison of outcomes of various reconstruction options reported in the literature, following proximal ulna resection for bone tumors.
| Study, year | Cases | Reconstruction technique | Results | Complications and remarks |
|---|---|---|---|---|
| Current study | 3 | Osteoarticular extracorporeal irradiation and reimplantation of proximal ulna resected segment | ROM: 0° to 130° Pronosupination: full Power: 5/5 MSTS: 100% (30/30) DASH: zero MEPS: 100 |
Implant prominence over the elbow in 1 case |
| Rydholm, 1987 [3] | 1 | Radius neck to humerus trochlea articulation | ROM: 35° to 135° Pronosupination: 40° |
Muscle weakness nearly 50 percent of normal |
| Gianoutsos et al., 1994 [6] | 1 | Osteocutaneous fibular free flap | ROM: 10° to 100° Pronation: 45° Supination: 35° Power: 4/5 |
Instability of the joint Donor site: leg edema |
| Kimura et al., 2002 [7] | 1 | Vascularized fibular graft | MSTS 100% (30/30) | Annular ligament reconstructed for joint stability |
| Weber et al., 2003 [8] | 11 elbows (1 proximal ulna tumor) | Total elbow replacement | Mean MSTS: 83% (25/30) | Periprosthetic lysis |
| Duncan et al., 2008 [2] | 2 | Radial neck to humerus trochlea transposition | MSTS (Mean): 88.3% (26.5/30) | Joint instability and muscle weakness |
| Guo et al., 2008 [9] | 19 elbows (5 proximal ulna tumors) | Total elbow arthroplasty | MEPS: Good in 14/19: 77.8% Poor in 4/19: 22.2% |
Stem loosening Periprosthetic lysis Revision surgeries |
| Ogose et al., 2010 [13] | 1 | Combined vascularized fibula + osteochondral extracorporeal irradiated graft. | ROM: 20° to 120° Pronation: 80° Supination: 10° |
Proximal osteotomy site nonunion: bone grafting at 16 months after surgery |
| Chen et al., 2012 [4] | 1 | Radius neck to humerus trochlea transposition | MSTS: 83% (25/30) ROM: 10° to 90° |
Joint instability Muscle strength weakness |
| Sewell et al., 2012 [10] | 4 | Custom proximal ulna endoprosthetic replacement | Mean MSTS: 90% (27/30) Mean TESS: 81 (73 to 88) |
Triceps weakness |
| Sulko, 2013 [5] | 1 | Radial head transposition with inverted V-plasty of triceps | MSTS: 96.67% (29/30) DASH: zero Power: 5/5 |
Restricted Pronation. Limb length discrepancy: 2 cm |
| Puri et al., 2016 [1] | 1 | Medialization of radius to a preserved proximal articular segment of ulna | ROM: 10° to 130° MSTS: 90% (27/30) |
Restricted pronosupination Limb length discrepancy. Implant prominence over elbow |
ROM: range of movement. MSTS: musculoskeletal tumor society score. MEPS: Mayo elbow performance score. TESS: Toronto extremity salvage score. DASH: disability of arm, shoulder, and hand score. Muscle power as measured on the Lovett scale.