Abstract
Introduction
Arthrodesis of the shoulder is a straightforward and established alternative to reconstruct the shoulder function after tumor resection of the proximal humerus. In most cases, some kind of intercalary bone graft is used to bridge the bony defect. However, due to low stability of a single fibula autograft and disadvantages of exogenous graft material when performing combined allo- and autograft reconstruction, efforts to develop new surgical techniques, with the intention to lower the complication rates, are ongoing.
Materials and methods
We present a detailed description of the surgical technique and the outcome of three patients with osteosarcomas of the proximal humerus, which were treated with tumor resection and autologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder. The construct was stabilized using a 4.5-mm pelvic reconstruction plate positioned on the scapular spine and the lateral aspect of the humerus.
Results
A wide surgical margin was achieved in all patients. Two of them could be reintegrated and are able to work with excellent shoulder function. In one patient, who developed metastasis, a deep infection under chemotherapy 16 months after index surgery complicated the postoperative course.
Conclusion
The fibula’s unique dual endosteal and periosteal blood supply makes it effective as a double-barrel bone graft for major long bone defects, which requires extra bone volume to prevent fractures until bone hypertrophy occurs. Additional bone and scar formation between the two struts are believed to provide a stable and long lasting construct, as seen in our patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Marcove RC, Lewis MM, Huvos AG (1977) En bloc upper humeral interscapulo-thoracic resection. The Tikhoff-Linberg procedure. Clin Orthop Relat Res 124:219–228
Fuchs B, O’Connor MI, Padgett DJ, Kaufman KR, Sim FH (2005) Arthrodesis of the shoulder after tumor resection. Clin Orthop Relat Res 436:202–207
O’Connor MI, Sim FH, Chao EY (1996) Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am 78(12):1872–1888
Probyn LJ, Wunder JS, Bell RS, Griffin AM, Davis AM (1998) A comparison of outcome of osteoarticular allograft reconstruction and shoulder arthrodesis following resection of primary tumours of the proximal humerus. Sarcoma 2(3–4):163–170
Kiss J, Sztrinkai G, Antal I, Kiss J, Szendrői M (2007) Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors. J Shoulder Elbow Surg 16(3):273–279
Enneking WF (1983) Musculoskeletal Tumor Surgery. Churchill Livingstone, New York
Wang J, Shen J, Dickinson IC (2011) Functional outcome of arthrodesis with a vascularized fibular graft and a rotational latissimus dorsi flap after proximal humerus sarcoma resection. Ann Surg Oncol 18(7):1852–1859
Getty PJ, Peabody TD (1999) Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am 81(8):1138–1146
Bilgin SS (2012) Reconstruction of proximal humeral defects with shoulder arthrodesis using free vascularized fibular graft. J Bone Joint Surg Am 94(13):e94
Scalise JJ, Iannotti JP (2008) Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty. J Bone Joint Surg 90(1):70–77
Viehweger E, Gonzalez J-F, Launay F, Legre R, Jouve J-L, Bollini G (2005) Shoulder arthrodesis with vascularized fibular graft after tumor resection of the proximal humerus. Rev Chir Orthop Reparatrice Appar Mot 91(6):523–529
Taylor GI, Miller GD, Ham FJ (1975) The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 55(5):533–544
Calori GM, Mazza E, Colombo M, Ripamonti C (2011) The use of bone-graft substitutes in large bone defects: any specific needs? Injury 42:56–63
Costain DJ, Crawford RW (2009) Fresh-frozen vs. irradiated allograft bone in orthopaedic reconstructive surgery. Injury 40(12):1260–1264
Manili M, Fredella N, Santori FS (2002) Shoulder prosthesis in reconstruction of the scapulohumeral girdle after wide resection to treat malignant neoformation of the proximal humerus. Chir Organi Mov 87(1):25–33
Wada T, Usui M, Isu K, Yamawakii S, Ishii S (1999) Reconstruction and limb salvage after resection for malignant bone tumour of the proximal humerus. A sling procedure using a free vascularised fibular graft. J Bone Joint Surg Br 81(5):808–813
Wittig JC, Bickels J, Kellar-Graney KL, Kim FH, Malawer MM (2002) Osteosarcoma of the proximal humerus: long-term results with limb-sparing surgery. Clin Orthop Relat Res 397:156–176
Ogilvie CM, Crawford EA, Hosalkar HS, King JJ, Lackman RD (2009) Long-term results for limb salvage with osteoarticular allograft reconstruction. Clin Orthop Relat Res 467(10):2685–2690
Safran O, Iannotti JP (2006) Arthrodesis of the shoulder. J Am Acad Orthop Surg 14(3):145–153
Banic A, Hertel R (1993) Double vascularized fibulas for reconstruction of large tibial defects. J Reconstr Microsurg 9(6):421–428
Bi Z-G, Han X-G, Fu C-J, Cao Y, Yang C-L (2008) Reconstruction of large limb bone defects with a double-barrel free vascularized fibular graft. Chin Med J 121(23):2424–2428
Chu C-H, Jou I-M, Shieh S-J (2009) Reconstruction of a massive femoral bone defect using a double-barreled free vascularized fibular bone graft after wide resection of femoral chondrosarcoma. Kaohsiung J Med Sci 25(10):552–558
Jones NF, Swartz WM, Mears DC, Jupiter JB, Grossman A (1998) The “double barrel” free vascularized fibular bone graft. Plast Reconstr Surg 81(3):378–385
Saint-Cyr M, Farkas J, Gupta A (2008) Double-barrel free fibula flap for treatment of infected non union of both forearm bones. J Reconstr Microsurg 24(08):583–587
Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41(1):27–37
Conflict of interest
The authors have no potential conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Wieser and Modaressi contributed equally to this work.
Rights and permissions
About this article
Cite this article
Wieser, K., Modaressi, K., Seeli, F. et al. Autologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder after tumor resection. Arch Orthop Trauma Surg 133, 1219–1224 (2013). https://doi.org/10.1007/s00402-013-1795-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1795-5