Glenohumeral arthrodesis for malignant tumor of the shoulder girdle

Abstract

Arthrodesis of the shoulder joint using a free vascularized fibular graft has been performed as a reconstruction method after resection of bone sarcoma in the shoulder girdle. Postoperative fractures occasionally occur as a complication of arthrodesis of the shoulder joint using single-bone fusion (the conventional method). We hypothesized that the clinical results of shoulder arthrodesis using a double-barrel vascularized fibula graft for the malignant tumor of the shoulder girdle would achieve superior results compared with the conventional single-bone fusion method. The clinical results of 5 patients with a malignant bone and soft tissue tumor of the shoulder girdle were retrospectively reviewed. The factors evaluated were surgical margins, reconstruction procedures, postoperative complications, local recurrences, metastasis in lymph nodes or lung, or both, survival, and functional results assessed by the Musculoskeletal Tumor Society (MSTS) score. After surgical resection, arthrodesis of the shoulder joint was performed using a free vascularized fibula graft as a reconstructive procedure for the bone defect. Arthrodesis was by single-bone fusion in 3 of 5 patients, and a double-barrel vascularized fibula graft (dual-bone fusion) was used in 2 patients. The average MSTS scores were 58.3% in the group with single-bone fusion and 85.0% in the group with dual-bone fusion. The use of a double-barrel vascularized fibular graft may be useful in the reconstruction of large bone defects after wide excision of malignant tumors of the proximal humerus, with the advantage of avoiding postoperative fractures in shoulder arthrodesis.