Sternoclavicular reconstruction with a 3D prosthesis in a patient with chondrosarcoma: case report

Abstract

Background: Atypical cartilaginous tumor/chondrosarcoma grade 1 (ACT/CS1) is a locally aggressive cartilage-producing neoplasm that primarily affects the axial and appendicular skeleton. Complete surgical resection is the treatment of choice due to the limited effectiveness of chemotherapy and radiotherapy. When these tumors involve the sternoclavicular joint, resection may result in complex defects affecting chest wall stability and shoulder girdle biomechanics. Patient-specific three-dimensional (3D) printed prostheses have emerged as a promising reconstructive option for these challenging defects. Case Presentation: We report the case of a 61-year-old female with a medical history of diabetes, hypertension, hearing impairment, and psychiatric disorders who presented with a lesion involving the left sternoclavicular joint. Imaging studies, including computed tomography and magnetic resonance imaging, revealed a heterogeneous mass involving the joint and surrounding soft tissues. Biopsy suggested an atypical cartilaginous tumor. The patient underwent wide tumor resection with manubrial osteotomy followed by reconstruction using a custom-made 3D-printed trabecular titanium prosthesis. Fixation of the manubrium and clavicles was achieved with screws, and ligamentous stabilization was performed using multifilament sutures. Neocapsules were created with polytetrafluoroethylene, and muscular flaps were used for soft-tissue coverage. Results: Postoperative recovery was uneventful. Histopathological examination confirmed peripheral grade 1 chondrosarcoma. At one-year follow-up, imaging demonstrated stable reconstruction with minimal prosthetic displacement and no functional impairment. The patient maintained full range of motion of the upper limb and showed no evidence of tumor recurrence. Conclusions: Custom 3D-printed titanium prostheses represent a feasible reconstructive strategy for complex chest wall defects following oncologic resection. This approach allows precise anatomical reconstruction and preservation of shoulder girdle function, although further studies with larger cohorts and longer follow-up are required.