Reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular Graft: Surgical Technique.

Abstract

We describe upper-extremity reconstruction after proximal humeral bone loss by means of glenohumeral arthrodesis using a vascularized fibular graft and double plate fixation. Use preoperative imaging to estimate the length of the humeral defect, the absence or presence of a glenoid defect, and the available length of fibular graft. Place the patient in the beach-chair position, securing him/her with side supports. The approach is a typical anterior approach to the shoulder following an anterolateral approach to the humeral shaft. Harvest the full length of the fibula, after leaving 6 cm proximally and distally for ankle and knee stability. Ream the humeral medullary canal by hand to avoid fracture and prepare the profunda brachii or brachial artery as recipient vessels. Insert the bare osseous fibula into the humeral canal, pass the graft pedicle through the loose tunnel, and anastomose the vessels. It is very important to bend the lateral plate to match the contour of the osseous surfaces. Immobilize the shoulder until union is achieved and then start scapula-thoracic exercises. We recently reported on a retrospective series of nine shoulder arthrodeses performed with use of a free vascularized fibular graft. IndicationsContraindicationsPitfalls & Challenges.