A 45-year-old woman has a chondrosarcoma of the proximal humerus (grade 2, extracompartmental, no metastases — MSTS stage IIB). The most important factor distinguishing whether limb salvage is feasible versus amputation is:

• A Tumor grade alone — grade 2 always mandates amputation
• B Neurovascular involvement by the tumor mass — encasement of the brachial artery and brachial plexus precluding wide margin resection ✓
• C Patient age — amputation is always preferred over 40
• D Alkaline phosphatase level

Explanation

The primary determinant of limb salvage feasibility for sarcomas is whether wide oncologic margins can be achieved while preserving functional neurovascular structures. Encasement or intimate involvement of the brachial artery and major nerve trunks of the brachial plexus (which cannot be sacrificed without profound functional loss) is the most common reason limb salvage is converted to amputation. Tumor grade influences chemosensitivity (chondrosarcomas are typically chemo-resistant) but does not alone dictate the surgical approach. Patient age is not a contra-indication to limb salvage.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.