A Variable-Margin Scapula Resection: Clearing the Tumor While Preserving the Coracoid

Dr. Ahmad Shehadeh, King Hussein Cancer Center (KHCC), Amman, Jordan

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A partial scapula resection close to the acromion and coracoid process raises a question that goes beyond the tumor itself: how much margin can be taken without compromising the bone segments the shoulder still needs to function. Dr. Ahmad Shehadeh, referred this case with no reconstruction planned, resection alone.

The plan uses a variable margin: 5 mm along the plane closest to the coracoid process, and 10 mm along the two inferior cutting planes where more clearance is available. Three cutting planes in total, executed through a posterior approach with a single cutting guide.

A Guide Shaped Around the Acromion

The guide's medial section wraps around the acromion in a hook shape, giving a secure grip on this narrow bone and guiding the saw blade precisely while resecting the coracoid base anteriorly. It is held by four 2.0 mm K-wires, two of them placed at the intersections of the three cutting planes. Drilling depth at the acromial root is kept to roughly 35 mm, preserving the structural integrity of that segment.

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We thank Dr. Ahmad Shehadeh for his detailed input throughout the design process.