Arthroscopic Management of Juxta-articular Proximal Humeral Chondroblastoma: The Bazooka Technique

ABSTRACT: Chondroblastoma is a rare benign cartilaginous lesion located mostly in the epiphyses of the long bones. The most common locations are the proximal tibia or femur, distal femur, and proximal humerus. Open curettage and bone grafting constitute the mainstay treatment for this condition. Few reports have documented the use of arthroscopy in tumor surgery owing to the problem of inadequate removal and the difficulty of bone graft delivery to the tumor cavity. The bazooka technique should solve these 2 main problems. In this article, arthroscopic curettage and grafting are described for the treatment of juxta-articular proximal humeral chondroblastoma to lessen postoperative pain and thus enable early mobilization and a quicker rehabilitation in skeletally immature patients. Technique Video Video 1 The bazooka procedure is performed with the patient in the modified beach-chair position. In this case, the patient had proximal humeral chondroblastoma in the right shoulder. The procedure starts with the use of a posterior portal as the viewing portal. A spinal needle is then used to locate the lesion from anterior. An anterior rotator interval portal is established, with care taken to avoid damage to the biceps tendon and subscapularis. A small periosteal elevator is used to raise a cartilage flap from the roof of the lesion, with care taken to avoid damage to uninvolved cartilage. A small curette is used to penetrate the roof and make the orifice to the lesion. A 4.5-mm shaver is used through the anterior portal to debride tumor tissue. A high-speed burr is used under fluoroscopic guidance to penetrate the walls of the lesion until healthy subchondral bone is reached for later graft incorporation. The scope is shifted to the anterior portal to visualize the lesion from anterior and ensure complete tumor excision. The bazooka is then prepared. A wide-diameter transparent cannula is obtained and dislodged. The trocar is blunted for later graft impaction. A bone graft is taken from the patient's iliac bone and fashioned into small chips. The bazooka is loaded with bone graft to two-thirds of its length. The cannula is inserted from the anterior portal and centered over the orifice of the defect. The bone graft is loaded into the bazooka. Bone graft impaction is performed using the blunted cannula trocar. This step is repeated until complete sealing of the defect is achieved.

SUBMITTER: Morsy M 

PROVIDER: S-EPMC10466432 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature