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Hiffernan-F 2

Frank Hiffernan

Omaha, Nebraska

Limb salvage procedure for osteosarcoma of proximal humerus by Dr. Sean McGarry

Because of my orthopaedic care, I can strum the guitar better than ever before. I realized that life is precious and every day counts.

Frank suffered a humerus fracture during a basketball game in 2010 that led Dr. Sean McGarry to discover a fast growing osteosarcoma.

X-rays indicated that the fracture was well aligned, and that they should let healing run its course without surgery. But follow-up x-rays six weeks later appeared abnormal. Concerned that the extent of Frank’s injury didn’t match its result, Frank’s physician referred him to Dr. Sean McGarry who specializes in cancers of the extremities.

Dr. McGarry conducted a biopsy to discover an osteosarcoma of the proximal humerus. The rare and aggressive bone cancer appears in roughly 1,000 children and adolescents each year. Osteosarcoma usually emerges as a painful mass, the ache of which won’t subside with medication. Due to the fracture, UNMC was fortunate to catch Frank’s tumor early – speculatively, halfway through its four- to six-month growth period. “It was about as quickly as we can typically get to a patient,” Dr. McGarry said.

As recently as 40 years ago, radiation and amputation were the immediate responses to osteosarcoma. Still, four in five patients died within the first five years. Around 1970, chemotherapy became the standard treatment – increasing five-year survival rates to roughly 70 percent – and, within the last 20 years, the standardized surgical procedure has evolved to limb-salvage.

About 90 percent of the time limb-salvage is feasible, and, although the tumor was large, Dr. McGarry wanted to save Frank’s arm. Frank would undergo three months of chemotherapy with a medical oncologist prior to surgery.

Originally, in the 1980s, 12 weeks of chemotherapy before surgery allowed time to have a custom prosthesis made. Incidentally, the protocol has enabled doctors to gauge how well the tumor is responding to chemotherapy and determine a prognosis.

Once Frank finished his initial chemotherapy, Dr. McGarry spent hours studying his new scans (x-ray, MRI and CT scans) before removing the tumor and replacing most of the humerus bone with a metal implant. Due to the amount of bone and muscle that had to be extracted, Frank does not have much shoulder function, but he can move normally from his elbow to his hand.

“All of the nerves to the hand were next to the tumorous bone, so, in surgery, I was peeling back all of the layers to save as much as possible. Now, watching him play guitar, I get tears in my eyes – knowing how close he was to not being able to do that,” Dr. McGarry said.

Dr. McGarry determined that the cancer was gone and Frank was doing very well after eight additional months of chemotherapy. “We were all so relieved and thankful that it was finally over,” Frank said of himself and his parents, Cristen and John Hiffernan, III. “I learned that life is precious and every day counts.”