PALO ALTO, Calif.--(Business Wire)--
When little Mark Blinder was diagnosed with a rare bone cancer, doctors at
Lucile Packard Children's Hospital gave his parents three agonizing options:
amputate the affected arm at the shoulder, irradiate the tumor and risk a second
malignancy, or try a limb-preserving surgery that had never been attempted in a
toddler.
Nearly a year later, Mark, now four, is thriving with a surgically implanted
artificial humerus inside his cancer-free right arm. He's believed to be the
first small child ever to receive a high-tech, telescoping prosthesis to replace
the entire upper arm bone.
"This was a very unusual and challenging case," said orthopedic surgeon Lawrence
Rinsky, MD, who implanted the custom-made, one-of-a-kind artificial bone he also
helped design.
"Little children with humerus tumors have very few limb-sparing options," added
Neyssa Marina, MD, the pediatric oncologist who oversaw Mark's chemotherapy
before and after surgery.
Rinsky and Marina aimed for a first-of-its-kind treatment that would cure Mark's
cancer, preserve his hand and allow his arm to keep growing. Designing and
implanting an artificial humerus bone that would grow with Mark had obvious
advantages over radiation, which would have killed the bone's growth plates, or
amputation. But the unconventional strategy came with no guarantees.
The prosthetic bone had to be small enough to fit in a three-year-old's arm,
strong enough to last a lifetime, and expandable, to allow for Mark`s growth.
Balancing these demands presented a significant engineering challenge. On top of
that, because Mark's entire humerus had to be removed, the prosthesis could
attach only to soft tissue. Most bone prosthetics replace half of a bone and are
cemented to healthy bone; Rinsky had to find another way to hook up this
implant. Even when the design was finalized with Indiana-based prosthetic
manufacturer Biomet, Inc., Rinsky wasn't sure the surgery would work.
Mark's parents, Alla Ostrovskaya and Gene Blinder, felt trepidation, too.
"It was hard because if we had chosen just radiation, no surgery, that would not
have been as physically painful for him," Alla said. Surgery seemed the best
choice for Mark's long-term well-being.
They first realized something was wrong when, in April 2008, Mark complained of
severe pain in his right arm, hand and wrist. After his July 2008 diagnosis with
a rare bone tumor called Ewing's sarcoma, Mark began chemotherapy. The
medications helped: the pain subsided and Mark began using his arm normally. But
chemotherapy alone wouldn't vanquish the tumor.
So, early on December 4, 2008, Mark was wheeled into the operating room. Rinsky
and his team, encased in space suit-like outfits to reduce infection risk,
worked with utmost care. "The surgery involved taking out the entire bone
without touching it," Rinsky said. The bone had cancer cells on its surface,
which could easily have spread to surrounding healthy tissue. "It was like
carving out a peach pit without ever touching the pit, staying in the pulp."
Once the cancerous bone was out, Rinsky implanted the artificial bone. The
prosthesis had a piece of Dacron fabric at the top, which he sewed to soft
tissue in Mark's shoulder. At the elbow, Rinsky saved Mark's ligaments and
placed those around the prosthesis as best he could. Then he started sewing up
Mark's arm. Luckily, the incision closed.
"Dr. Rinsky came out of the operating room and said, 'The prosthesis fit
perfectly fine, he is doing great,'" remembered Gene.
Soon, there was more good news: Mark's tumor was confined to the bone that had
been removed, and its malignant cells were dead, killed by chemotherapy. He
spent a month healing from surgery, then received more chemotherapy to reduce
the chance the cancer would return. He`ll have three to four minor surgeries
over the next several years, in which Rinsky will make a small incision at the
shoulder and use a few turns of a screwdriver to lengthen the implant as Mark
grows.
Gene and Alla knew Mark was truly feeling better when he began getting into
mischief again. In June, just before his final round of chemotherapy, he was
playing "strongman" and accidentally dropped a 2-pound dumbbell on his head. "It
was pure four-year-old," said Rinsky with a grin. (A CT scan showed no harm had
been done by the bump.) "He is a very spunky kid," said Marina.
Meanwhile, Mark is gradually re-learning to use his right hand and arm. He's
moving his right wrist and fingers, can pick up small objects, and is receiving
physiotherapy to rebuild strength and flexibility in his elbow and shoulder.
Although Mark won`t ever regain full function in these joints, he's using the
arm more each day, Alla said. As he often tells his family, "I have a special
arm."
About Lucile Packard Children's Hospital
Ranked as one of the nation's best pediatric hospitals by U.S.News & World
Report, Lucile Packard Children's Hospital at Stanford is a 312-bed hospital
devoted to the care of children and expectant mothers. Providing pediatric and
obstetric medical and surgical services and associated with the Stanford
University School of Medicine, Packard Children's offers patients locally,
regionally and nationally the full range of health care programs and services,
from preventive and routine care to the diagnosis and treatment of serious
illness and injury. For more information, visit www.lpch.org.
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Lucile Packard Children's Hospital
Robert Dicks, 650-497-8364
rdicks@lpch.org
Erin Digitale, 650-724-9175
digitale@stanford.edu
Copyright Business Wire 2009
