In what they are terming a medical first, surgeons at Stanford University's Lucille Packard Children's Hospital have implanted a telescoping artificial prosthesis in the arm of a 3-year-old to replace a humerus that was removed because of cancer. Nearly a year later, now-4-year-old Mark Blinder is thriving and cancer-free.
Mark began developing pain in his arm in April of last year and, by July, oncologists had diagnosed Ewing's sarcoma, a rare bone tumor. Chemotherapy reduced the pain, but did not completely destroy the tumor. Radiation could have been used, but that would have destroyed the growth plates in the bone, producing a physical impairment as he grew. The other common alternative was amputation.
Orthopedic surgeon Dr. Lawrence Rinsky of Stanford convinced parents Alla Ostrovskaya and Gene Blinder to consider a third option, an artificial bone produced by Biomet Inc. of Warsaw, Ind. Biomet produces artificial joints, which are quite common, and artificial bones, which are less so. The titanium/cobalt chrome expandable bone designed specifically for Mark was much rarer, spokesman Bill Kolter said.
The prosthetic bone had to be small enough to fit in a 3-year-old's arm, durable enough to last a lifetime and expandable to allow for Mark's growth. Most artificial bones, furthermore, are used to replace only part of a bone, so they are glued securely to remaining bones. In Mark's case, the entire humerus was removed, so the prosthetic had to be attached to soft tissue.
On Dec. 4, Mark was wheeled into the operating room to be greeted by Rinsky's team, all dressed in space-suit-like outfits to reduce the risk of infection. Because of fears that touching the bone to be removed might dislodge cancer cells that would spread to the rest of the body, the team carved out a little bit of flesh all around it. "It was like carving out a peach pit without ever touching the pit, staying in the pulp," Rinsky said.
Once the old bone was removed, Rinsky implanted the artificial bone, sewing a piece of Dacron fabric attached to the top to soft tissue in Mark's shoulder. At the elbow, Rinsky saved the ligaments and placed them around the prosthetic as best he could.
Subsequent studies showed that the tumor was entirely removed. Mark spent a month recuperating from the surgery, then received more chemotherapy as a safety measure. He will have three to four minor surgeries over the next few years in which Rinsky will make a minor incision in the shoulder and use a few turns of a screwdriver to lengthen the implant.
Mark is gradually relearning how to use his arm. He's moving the right wrist and fingers, can pick up small objects, and is receiving physiotherapy to rebuild strength and flexibility in the elbow and shoulder. He won't ever regain full function in those joints, but he is using the arm more each day, his mother said. Mark often tells his family, "I have a special arm."
-- Thomas H. Maugh II
Above, 4-year-old Mark Blinder received an artificial, expandable bone to replace a humerus removed during cancer surgery.
at bottom, an X-ray of the prosthetic.
Photo credit: Lucille Packard Children's Hospital