# Three-Dimensional Printed Custom-Made Prostheses after Partial Scapullectomy: A Case Report
## 3 Discussion  
Malignant tumors of the scapula require surgery that is often highly destructive to obtain large surgical margins and reduce the risk of local recurrence. On some occasions, we find ourselves forced to perform complete scaplectomy operations with humeral suspension, with poor functional, motor, and aesthetic results for the patient [9]. Central low-grade osteosarcoma is one of those malignant forms which, though rarely, can affect the scapula [4; 5]. However, it is a malignant tumor with slow growth that often results in bone destruction [7]. The removal with wide margins allows for good overall survival and local control of the disease [5; 6; 8]. This form of cancer mainly affects a young age group, around the third decade of life [8]. Patients affected by this malignancy often require high functional results for a return to daily activities, a return to sport, and a return to playful activities. With new reconstructive technologies in the medical field, limb salvage, where possible, has become of extreme importance. Moreover, previous studies have shown that over 90% of limb salvage interventions showed no difference in terms of survival in patients with malignant tumors [18]. Various surgical options have been tried over the years. Total scaplectomy associated with humeral suspension is one of the most used surgical options; however, the functional limits for the patient are known. Humeral suspension limits movement significantly, making it difficult to lift the arm over the head, perform internal and external rotations, and do weightifiting with the operated limb [9; 19; 20]. Moreover, as previously mentioned, the limits of the aesthetic outcome of this procedure must be considered. The choice of scapula transplantation using homologous grafts has led to good functional results in the short and medium-term; however, bone resportions occurred in long-term follow-ups, resulting in loss of scapular muscle strength associated with graft fractures [21]. Over the years, scapula endoprostheses have improved outcomes in patients suffering from scapula tumors in aesthetic and functional terms. However, the presence of prostheses that do not reflect the patient's anatomical characteristics has determined functional motor aspects, which are good, but still need to be optimal [9; 22]. Faced with the need to obtain increasingly complex reconstructive results, the introduction of custom reconstruction techniques using 3D printing has led to significant changes in surgical outcomes in oncological and reconstructive orthopedics. Furthermore, using customized cutting masks on the patient's bone profile has increased the possibility of obtaining large surgical margins with increasingly complex osteectomies and subsequently allowing prosthetic reconstructions that adhere perfectly to the healthy portion of bone [23; 24]. In our case, the presence of central low-grade osteosarcoma involving the scapula at the level of the glenoid cavity with the involvement of part of the body and with a partial extension at the level of the acromial and coracoid process (Malawer S1 and S2), set the limit of a total scaplectomy. However, the young age of the patient, and the presence of a low-grade disease, without further visceral and lymph node localizations, placed us in front of the need to find a more functional reconstructive alternative. A cutting guide enabled a complex osteotomy that spared the entire medial portion of the scapula while maintaining wide surgical margins. Subsequently, the 3D customization allowed the medial margin of the patient's scapula to join to a prosthetic system that reconstructed the glenoid cavity, acromial, and coracoid processes and obtained excellent reconstructive results. The patient was followed up with a regular postoperative follow-up. After 12 months, the functional results were good, with extensive anterior elevation, abduction, and intra/extra rotation. The only complication was the mobilization of a Kirschner wire used for acromio clavicular stabilization.