# Limb-Sparing Reconstruction for Pediatric Osteosarcoma: A Case Report of Shoulder Preservation With Proximal Humerus Anatomical Mega Prosthesis and Review of the Literature

## TL;DR

A child with shoulder osteosarcoma successfully underwent limb-sparing surgery and prosthesis reconstruction, achieving good function and no cancer recurrence after 1.5 years.

## Contribution

Demonstrates successful limb-sparing surgery with prosthetic reconstruction as a preferable alternative to fibula grafting in pediatric proximal humeral osteosarcoma.

## Key findings

- Limb-sparing surgery with mega prosthesis provided good shoulder and elbow function in a pediatric patient.
- No local recurrence or metastasis was observed at 1.5 years post-surgery.
- Prosthetic reconstruction was stable and avoided the need for radiotherapy.

## Abstract

Osteosarcoma of the proximal humerus presents significant challenges due to the proximity of critical neurovascular structures. This case report describes the management of an eight-year-old male diagnosed with high-grade intramedullary osteosarcoma of the proximal humerus with axillary lymph node involvement. Following neoadjuvant chemotherapy, the patient underwent wide resection, axillary lymph node dissection, and reconstruction using a proximal humerus anatomical mega prosthesis, followed by adjuvant chemotherapy. Radiotherapy was not required. Early postoperative range of motion was considerably good, with satisfactory shoulder and elbow function achieved. At the 1.5-year follow-up, there was no evidence of local recurrence or metastasis, and the prosthesis remained stable. This report demonstrates that limb-sparing surgery with prosthetic reconstruction offers favorable oncological and functional outcomes and may represent a preferable alternative to vascularized fibula grafting in pediatric patients with proximal humeral osteosarcoma.