title: Reconstruction of proximal humeral defects with shoulder arthrodesis using free vascularized fibular graft.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Shoulder arthrodesis using free vascularized fibular graft with double plate fixation is a reliable salvage procedure in patients with major proximal humeral bone loss.
authors: Division of Hand Surgery, Department of Orthopaedic Surgery, School of Medicine, Ankara University, Samanpazari, 06100 Ankara, Turkey. ssbilgin@yahoo.com
authors: S Sinan
authors: SS
authors: Bilgin
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology