Free Vascularized Fibula Physeal Transfer for Proximal Humerus Oncologic Reconstruction in Children: A Multiinstitutional Long-term Follow-up
Said C. Azoury, MD1, Ronnie Shammas, MD2, Sammy Othman, BA1, Amanda Sergesketter, MD2, Detlev Erdmann, MD PhD MHSc2, Brian Brigman, MD PhD2, Jie Nguyen, MD1, Alexander Arkader, MD1, Kristy L. Weber, MD1, L. Scott Levin, MD1, Stephen J. Kovach, MD1.
1University of Pennsylvania, Philadelphia, PA, USA, 2Duke University, Durham, NC, USA.
BACKGROUND- For skeletally immature patients with upper extremity (UE) osteosarcoma, reconstructive options to preserve bone growth and meet high functional demands are limited. The aim of this study was to review a multi-institutional experience in free vascularized fibula epiphyseal transfer for pediatric proximal humeral reconstruction and describe a reproducible method for tracking growth.
METHODS- A retrospective review (2004-2020) was conducted of pediatric patients (<18 years of age) undergoing free fibula transfer for proximal humeral reconstruction. Transfer was based on the anterior tibial artery in all cases. Post-operative radiographs were reviewed to assess for osseous union, growth, fractures and other complications. UE Measurements were performed following the guidance of a fellowship-trained pediatric musculoskeletal radiologist (JCN). The axial growth of the transferred bone was assessed by calculating the progressive increase in the distance of length measurements.
RESULTS- Overall, 8 patients, ages 5-11, with osteosarcoma of the proximal humerus were included for analysis. Reconstruction was performed in an immediate (n=7, 87.5%) and delayed fashion (n=1, 12.5%), utilizing plate fixation in 5 cases (62.5%) and screws in the remainder (n=3, 37.5%). All patients were alive at last follow-up (mean 70.8 months, range 3-186 months), and all bone grafts were viable. Four patients (50%) suffered fractures of the graft due to trauma. There was one case of avascular necrosis of the transferred proximal epiphysis and one case of proximal fibula head avulsion. Five of eight patients (62.5%) had foot drop at last follow-up and required an ankle-foot orthosis for ambulation. Longitudinal bone growth was confirmed in 6 of 8 cases (75%), at an average rate of 0.5 cm/year, with the proximal fibula physis contributing 71% of total growth. The two cases without documented growth suffered from avascular necrosis of the proximal fibula or avulsion of the proximal fibula head.
CONCLUSIONS Free fibula epiphyseal transfer preserves the potential for future bone growth in the pediatric patient requiring proximal humeral reconstruction. Peroneal nerve palsies and graft fractures are both commonly encountered post-operative complications. Despite this, patients are able to use their reconstructed limb in daily activities.
Back to 2020 Abstracts