Limb-Salvage Surgery with Modular Endoprosthetic Reconstruction for Distal Humeral Ewing Sarcoma: A Case Report and Literature Review

Abstract

Background:
Ewing sarcoma is an aggressive malignant bone tumor predominantly affecting children and young adults. Multimodal treatment combining systemic chemotherapy with definitive local control has improved survival, while limb-salvage surgery has become an important treatment option for resectable tumors. However, wide resection of tumors involving the distal humerus may result in substantial skeletal defects and compromise elbow function. Modular tumor endoprostheses provide an option for immediate reconstruction and restoration of limb function following oncological resection.

Case presentation:

We present the case of a 19-year-old male diagnosed with Ewing sarcoma of the distal humerus after approximately one year of pain during active and passive movements of the affected upper limb. Following multidisciplinary evaluation, the patient underwent neoadjuvant chemotherapy followed by wide surgical resection of the tumor and reconstruction using a MUTARS modular tumor endoprosthesis. Postoperatively, the patient received additional chemotherapy. During follow-up, no major postoperative complications, local recurrence, or prosthetic failure were observed. Functional recovery was favorable, with only a slight limitation of forearm pronation reported at the latest follow-up.

Conclusion:
Limb-salvage surgery with modular endoprosthetic reconstruction can provide satisfactory functional restoration following wide resection of distal humeral Ewing sarcoma. In appropriately selected young patients, the use of a MUTARS prosthesis may allow preservation of the affected limb and facilitate early functional rehabilitation. Further long-term follow-up is required to assess prosthetic durability and oncological outcomes.