title: Scapulo-humeral arthrodesis using a pedicled scapular pillar graft following resection of the proximal humerus.
abstract: BACKGROUND
  Scapulo-humeral arthrodesis (SHA) is a proven reconstruction method in patients with proximal humerus malignancies requiring resection of the shoulder abduction apparatus (rotator cuff and deltoid muscles) or its nerve supply. Standard practice consists in using a pedicled fibular flap. We use instead a pedicled autologous bone graft harvested from the ipsilateral scapular pillar.
  
  
  OBJECTIVE
  The objective of this study was to assess functional outcomes and radiological healing after SHA using a pedicled scapular pillar graft.
  
  
  METHODS
  We retrospectively reviewed the charts of the 12 patients managed at a single center by a single surgeon between 1994 and 2011. SHA was performed using a vascularised ipsilateral scapular pillar graft after proximal humerus resection to treat a bone malignancy. The graft was harvested from the ipsilateral scapular pillar, pedicled on the circumflex scapular artery, fitted into the remaining proximal humerus, and secured to the glenoid using screws. A humerus-scapular spine plate was added to stabilize the arthrodesis. Radiographic results were assessed on standard radiographs obtained at last follow-up. Functional outcomes were evaluated using the MusculoSkeletalTumour Society (MSTS) score and Toronto Extremity Salvage Score (TESS).
  
  
  RESULTS
  After a mean follow-up of 4.9 years, 87.5% of SHA junctions were healed, mean MSTS score was 71%, and mean TESS score was 70%.
  
  
  CONCLUSIONS
  The outcomes in our patients were similar to those reported after SHA using a pedicled fibular flap. However, our technique does not require microsurgery. It is simple, reproducible, and effective. Its indications of choice are intra- or extra-articular resection of the proximal humerus including the attachments of the rotator cuff and deltoid muscle tendons or the nerves supplying these muscles.
  
  
  METHODS
  Level IV (retrospective study).
authors: Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors: G
authors: G
authors: Padiolleau
authors: Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors: J B
authors: JB
authors: Marchand
authors: Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Laboratoire de la physiopathologie de la résorption osseuse et des tumeurs osseuses primitives. Inserm UI957, faculté de Médecine, 44000 Nantes, France.
authors: G A
authors: GA
authors: Odri
authors: Service de chirurgie orthopédique infantile, CHU de Nantes, 7, Quai Moncousu, 44000 Nantes, France.
authors: A
authors: A
authors: Hamel
authors: Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Laboratoire de la physiopathologie de la résorption osseuse et des tumeurs osseuses primitives. Inserm UI957, faculté de Médecine, 44000 Nantes, France. Electronic address: francois.gouin@chu-nantes.fr.
authors: F
authors: F
authors: Gouin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis; D001859:Bone Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D006811:Humerus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D012540:Scapula / Q000601:surgery* / Q000637:transplantation*; D064171:Superficial Back Muscles / Q000637:transplantation; D013524:Surgical Flaps; D055815:Young Adult
keywords: Glenohumeral arthrodesis; Glenohumeral joint; Sarcoma; Scapula; Shoulder arthrodesis