Reconstruction of proximal humeral defects with shoulder arthrodesis using free vascularized fibular graft.
ABSTRACT Treatment of proximal humeral bone loss resulting from tumor resection or from infection following shoulder arthroplasty represents a reconstructive challenge. Shoulder arthrodesis is an appropriate salvage procedure but is associated with a high rate of complications. The purpose of this report is to describe the surgical technique and report the functional outcomes in a series of patients treated with shoulder arthrodesis using free vascularized fibular graft.
Nine patients were included in this study. Two-stage reconstruction was performed in three patients with a methicillin-resistant Staphylococcus aureus infection following primary shoulder hemiarthroplasty. The remaining six patients had an aggressive or malignant tumor of the proximal aspect of the humerus, and tumor resection included the rotator cuff in all of these patients and the axillary nerve in three. All nine patients underwent shoulder arthrodesis using free vascularized fibular graft; eight patients had fixation with two plate-screw constructs, and one patient had fixation with only one plate and screws. Clinical and radiographic evaluation of all patients was performed at a mean of sixty months postoperatively. The Musculoskeletal Tumor Society (MSTS) function score and the Toronto Extremity Salvage Score (TESS) were used to assess overall function of the upper limb.
Mean active shoulder abduction and flexion were both 80° (range, 60° to 100°). All but one patient could bring the hand to the mouth. The mean MSTS function and TESS values were twenty-four of thirty and 82%, respectively, representing a good functional outcome. Two of nine patients had a major complication. Union and fibular hypertrophy were achieved in seven of the nine patients.
Shoulder arthrodesis using free vascularized fibular graft with double plate fixation is a reliable salvage procedure in patients with major proximal humeral bone loss.
SourceAvailable from: Derek Friedrich van Deurzen[Show abstract] [Hide abstract]
ABSTRACT: Treatment of severe proximal bone loss resulting from treatment for infection following shoulder arthroplasty represents a reconstructive challenge. Shoulder arthrodesis is an appropriated sal-vage procedure for this indication. Arthrodesis can be performed using a vascularized fibular graft to overcome the associated bone loss. We present a technique of performing a scapulohumeral arthrodesis using a fibula autograft combined with a humeral allograft, after failed arthroplasty treatment and multiple debridements for recurrent infec-tion. At the time of the operation there was a shortening in humerus length of 16 cm. The vascularized fibular autograft was harvested from the left lower leg. The fibular autograft was positioned inversely to the left upper arm so that vascular anastomosis could be preformed remotely from the scapulohumeral arthrodesis site. The antibiotic-immersed humeral allograft was prepared with a trough in the medial side to fit the fibular autograft and to provide extra bone stock to secure fixation. The technique to perform a shoulder arthrodesis with a vas-cularized fibular autograft in concordance with the use of a humeral allograft has never been described in the literature before. The advantage of using the allograft is to provide stability in the construct. The currently presented method of performing an arthrodesis can be identified as a new technique.Techniques in Shoulder and Elbow Surgery 01/2014; 15(2):63-65. DOI:10.1097/BTE.0000000000000019
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ABSTRACT: Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction.Seminars in Plastic Surgery 02/2015; 29(1):20-9. DOI:10.1055/s-0035-1544167
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ABSTRACT: Arthrodesis of the shoulder joint using a free vascularized fibular graft has been performed as a reconstruction method after resection of bone sarcoma in the shoulder girdle. Postoperative fractures occasionally occur as a complication of arthrodesis of the shoulder joint using single-bone fusion (the conventional method). We hypothesized that the clinical results of shoulder arthrodesis using a double-barrel vascularized fibula graft for the malignant tumor of the shoulder girdle would achieve superior results compared with the conventional single-bone fusion method.Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 08/2014; 24(2). DOI:10.1016/j.jse.2014.05.023 · 2.37 Impact Factor