Biological Reconstruction of Proximal Humerus Primary Malignant Tumors with Free Vascularized Fibular Epiphyseal Autograft

Abstract

BackgroundPrimary malignant bone tumors of the proximal humerus in skeletally immature patients pose complex challenges due to the need for resection with safe margins while preserving joint function and growth potential. This study aims to evaluate the functional, radiological, and oncological outcomes, along with the complications, of biological reconstruction using free vascularized epiphyseal fibular autograft (FVEFG) following resection of proximal humerus primary malignant tumors in pediatric patients.MethodsTen patients (mean age: 10 years; range: 5-14) who underwent proximal humeral reconstruction with FVEFG between 2001 and 2022 were retrospectively analyzed. All patients had a minimum of 24 months of follow-up (mean: 39 months). Radiological outcomes were evaluated using the ISOLS scoring system, Boer and Wood index, and the annual graft growth rate. Functional results were assessed with the MSTS and TESS scoring systems. Oncological status and complications were also recorded.ResultsThe mean ISOLS radiographic score was 85%, Boer and Wood hypertrophy index was 68%, and the mean annual longitudinal growth was 4.7 mm/year. The average MSTS and TESS scores were 76.9% and 83%, respectively. One patient developed local recurrence, and one died of distant metastasis. No infections or non-unions were observed. Graft fracture occurred in 3 patients (30%), with successful healing in all. Peroneal nerve palsy (transient) occurred in two cases. No patient required conversion to non-biological reconstruction or amputation.ConclusionsFVEFG is a reliable biological reconstruction technique for proximal humerus osteoarticular defects following resection of primary malignant tumors in skeletally immature patients, yielding favorable functional and radiological outcomes with a relatively low complication rate. The technique preserves longitudinal growth potential and articular surface function. Meticulous graft harvesting and fixation techniques are essential for minimizing complications.