International Orthopaedics - 2026-07-09 - Journal Article
Vascularised fibular graft shoulder arthrodesis after proximal humeral tumour resection with sacrifice of the abductor mechanism.
Brotea-Mosoiu S, Cacuci OG, Bodog R, Samuila S, Bodog F, Khal AA
Topics
Key Takeaway
Shoulder arthrodesis with vascularized fibular graft after proximal humeral tumor resection achieves final union in 8/12 patients and a mean MSTS score of 25.5/30, but pseudarthrosis occurred in 5/12 and 100% of survivors reported cosmetic dissatisfaction.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study evaluated oncological and functional outcomes of shoulder arthrodesis with vascularized fibular graft in 12 patients requiring proximal humeral resection with sacrifice of the abductor mechanism between 2019 and 2025. Primary union was achieved in 7/12; 5 developed distal graft-host pseudarthrosis, with final union in 8/12 after revision in 2. Among survivors, mean MSTS was 25.5/30, active flexion 80°, scapulothoracic abduction 75°, mean graft hypertrophy 34%, and cosmetic dissatisfaction was universal.
Key Limitation
With only 12 patients across three distinct tumor diagnoses receiving different adjuvant regimens, the study is underpowered to isolate the effect of tumor biology or chemotherapy on union rates and functional outcomes.
Original Abstract
PURPOSE
Reconstruction after proximal humeral tumour resection remains challenging when tumour clearance requires sacrifice of the shoulder abductor mechanism. This study evaluated oncological, radiological, functional, and cosmetic outcomes after shoulder arthrodesis using a vascularized fibular graft.
METHODS
We retrospectively reviewed 12 patients who underwent proximal humeral tumour resection and shoulder arthrodesis with a vascularized fibular graft between 2019 and 2025. All resections involved the rotator cuff and resulted in loss of the functional deltoid mechanism. Outcomes included oncological status, union, graft hypertrophy, complications, MSTS score, range of motion, functional tasks, cosmetic outcome, and donor-site morbidity.
RESULTS
Mean age was 21 years and mean follow-up among survivors was 54 months. Diagnoses were osteosarcoma in nine patients, chondrosarcoma in two, and giant cell tumour in one. Margins were wide in 11 patients and marginal in one. Local recurrence occurred in one patient and distant metastases in three. Primary union was achieved in seven patients. Five developed distal graft-host pseudarthrosis; two underwent revision, of whom one united. Final bone union was achieved in eight patients. Among living patients, mean graft hypertrophy was 34%, mean MSTS score was 25.5/30, active flexion was 80°, and active scapulothoracic abduction was 75%. Cosmetic dissatisfaction was reported by all living patients.
CONCLUSION
Shoulder arthrodesis with a vascularized fibular graft can provide a stable, functionally useful limb after proximal humeral tumour resection involving the abductor mechanism, although pseudarthrosis and cosmetic dissatisfaction remain important limitations.