Arthrodesis of the Shoulder after Tumor Resection

Biological reconstruction using massive bone allograft with intramedullary vascularized fibular flap after intercalary resection of humeral malignancy

“…It is commonly suggested Capanna's technique was not necessary for bone reconstruction of large diaphyseal defects in the humerus since the use of vascularized fibular flap solely could obtain good results. However, although free fibular flaps can hypertrophy, increasing in diameter by 40-100%, this process occurs gradually and may take more than 3 years and during this period stress fracture may be occur [44,45]. It is supported by the results of Gebert et al's [50] series in which stress fractures that ran through the drill hole of a fixation screw occurred in four of 11 patients when a vascularized fibular flap was used as the sole bony replacement in humeral reconstruction.…”

“…Vascularized fibula flaps are mainly used for intercalary reconstructions of the humerus and bony union is achieved in the majority of cases [8,13,15]. However, fibula diameter is smaller than that of humerus, subsequent stress fibula fractures is more than 30-50% during daily activities [44,45]. In addition, plate and screw fixation can compromise periosteal blood flow, therefore, intraoperatively adequate fixation of free fibular grafts can often be difficult [28,29].…”

Outcome After Reconstruction of the Proximal Humerus for Tumor Resection: A Systematic Review

“…Scapular crest and fibula grafts used various proximal fixation methods: plate [5,8,60] or wire [34], wire and tendon [59], suture [36], or none at all [7,21]. In addition, in three studies, it was reported that an allograft was used to strut the fibular grafts [7,21,60], and Kumar et al [34] reported that in one instance, an additional scapular crest graft was used. Arthoplasty prostheses, osteoarticular allografts, and allograft-prosthesis composites are comparable in the sense that they allow for reconstructions of a mobile glenohumeral joint and have similar indications, therefore only those reconstructions were included in our final analysis.…”

Vascularized clavicular rotation graft for revised shoulder arthrodesis after tumor resection of the proximal humerus: A case report

“…Complications, including postoperative fracture and infection, have also been reported. 2,5,10 In particular, as in our present case, when arthrodesis using nonvascularized bone, treated bone, or an allograft is undertaken and reinforced with a plate, short-term results may be favorable, but marked nonunion and fractures may limit its durability. Fuch et al 5 reported that rigid internal fixation with a vascularized bone graft and bulky dynamic compression plate, in addition to latissimus dorsi muscle pedicle flap transfer, are required to prevent postoperative complications and improve the results of arthrodesis.…”

“…Arthrodesis provides excellent function compared with other reconstructive procedures, but it is technically demanding and can be associated with serious postoperative complications such as infection, nonunion, and fracture. 2,5,10 In this report, we describe a patient with an osteosarcoma of the proximal humerus in which shoulder arthrodesis using a vascularized clavicular rotation graft was performed and resulted in complete bony union and good postoperative function. To our knowledge, the use of this procedure in such a case has not been previously described.…”