Epiphyseal fibula transfer to proximal humerus following resection for osteosarcoma surgical technique
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The proximal humerus is the fourth most common site for primary bone sarcomas, with up to 15% of osteosarcomas and 10% of Ewing’s sarcomas occurring at this site. Preserving growth and function following limb-salvage surgery in paediatric patients remains a challenge, as the proximal humeral physeal growth is responsible for 80% of the total growth of the humerus, and loss of one of the physes is associated with limb-length discrepancy. This is particularly challenging in small children in whom endoprosthetic replacements are often too large and expandable prostheses have higher rates of complications compared with adults.
Vascularised autografts may provide rapid biological incorporation with the potential for growth and a limb-salvage reconstruction with longevity.
Vascularised fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Failures are caused by avascular necrosis of the graft but the reported survival of the reconstruction is 82% at five years.
Author: Mr Jonathan Stevenson FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital ,Birmingham ,UK.