Can a cancer patient whose limb gets damaged and not make a mobility after serious infections and a chemo type treatment be operated and cured through Orthopaedic surgery ? It was a rare and remarkable medical milestone when a Jaipur Ortho surgeon made it possible for the patient to have a normal activity in the hand.
Dr. Rohil Singh Kakkar, Consultant Orthopaedic and Joint Replacement Surgeon at Eternal Hospital here successfully performed the institution’s first Onco-Orthopaedic upper limb reconstruction surgery on a 60-year-old cancer patient, setting a new benchmark in advanced orthopaedic oncology care.
The patient, Mrs. Kulwinder Kaur, a resident of Jaipur, had been undergoing treatment for multiple myeloma, a type of blood cancer, for the past four months under the care of a medical oncologist. She was suffering with persistent pain and complete immobility of her right shoulder, arm, and elbow joint for over three months.
Prior conservative management with full-length plaster immobilisation at another facility had worsened her condition, resulting in significant joint stiffness and muscular atrophy-further complicating the clinical scenario, according to Dr Kakkar.
Comprehensive clinical evaluation and advanced imaging, including radiographs, magnetic resonance imaging (MRI), and computed tomography (CT), revealed multiple critical findings:
- A pathological fracture of the distal third of the humeral shaft,
- A chronic full-thickness tear of the supraspinatus tendon of the rotator cuff,
- A displaced lateral condylar fracture, and
- Extensive lytic lesions in the humeral head and shaft, characteristic of myelomatous bone disease.
After obtaining requisite preoperative clearances from the oncology, cardiology, and anaesthesia teams, Dr. Kakkar led a meticulously planned and executed multi-component surgical reconstruction. This included intramedullary fixation of the humeral shaft using a cement-augmented humeral nail to address the compromised bone quality, rotator cuff repair employing the parachute technique with high-strength titanium anchor sutures, and fixation of the lateral humeral condyle using a cannulated compression (CC) screw for articular stability.
“The surgery posed considerable challenges due to the presence of multiple lytic lesions, poor bone stock, and complex segmental fractures compounded by chronic rotator cuff injury,” stated Dr. Kakkar. “A comprehensive, biomechanically robust approach was essential to achieve stability, mobility, and long-term functional recovery.”
Postoperative rehabilitation was initiated on the tenth day, with a gradual progression to active-assisted and active range-of-motion exercises. The patient has since demonstrated encouraging early functional outcomes, with restored mobility and reduction in pain, Dr Kakkar, who has been serving as a faculty member in the orthopaedic subspecialties of joint replacement, limb reconstruction and trauma surgery at the esteemed Royal College of Surgeons of Edinburgh, United Kingdom, since 2023, said.
This complex surgical procedure was successfully executed with the vital support of a dedicated multidisciplinary team, notably Dr. Ananya Pareek (Medical Oncologist), and Dr. Somyata Sharma (Cardiologist) whose collective expertise and coordination were instrumental in ensuring a smooth intraoperative course and optimal patient outcomes.