Reconstruction of Proximal Humeral Defect With Shoulder Arthrodesis Using Vascularized Fibular Autograft and Humeral Allograft

Abstract

Treatment of severe proximal bone loss resulting from treatment for infection following shoulder arthroplasty represents a reconstructive challenge. Shoulder arthrodesis is an appropriated salvage procedure for this indication. Arthrodesis can be performed using a vascularized fibular graft to overcome the associated bone loss. We present a technique of performing a scapulohumeral arthrodesis using a fibula autograft combined with a humeral allograft, after failed arthroplasty treatment and multiple debridements for recurrent infection. At the time of the operation there was a shortening in humerus length of 16 cm. The vascularized fibular autograft was harvested from the left lower leg. The fibular autograft was positioned inversely to the left upper arm so that vascular anastomosis could be preformed remotely from the scapulohumeral arthrodesis site. The antibiotic-immersed humeral allograft was prepared with a trough in the medial side to fit the fibular autograft and to provide extra bone stock to secure fixation. The technique to perform a shoulder arthrodesis with a vascularized fibular autograft in concordance with the use of a humeral allograft has never been described in the literature before. The advantage of using the allograft is to provide stability in the construct. The currently presented method of performing an arthrodesis can be identified as a new technique.