We describe upper-extremity reconstruction after proximal humeral bone loss by means of glenohumeral arthrodesis using a vascularized fibular graft and double plate fixation.
Step 1: Preoperative Evaluation and Planning
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.
Step 2: Position the Patient
Place the patient in the beach-chair position, securing him/her with side supports.
Step 3: Expose and Prepare the Shoulder
The approach is a typical anterior approach to the shoulder following an anterolateral approach to the humeral shaft.
Step 4: Harvest the Fibular Graft
Harvest the full length of the fibula, after leaving 6 cm proximally and distally for ankle and knee stability.
Step 5: Prepare the Humerus and Recipient Vessels in the Upper Arm
Ream the humeral medullary canal by hand to avoid fracture and prepare the profunda brachii or brachial artery as recipient vessels.
Step 6: Insert the Fibula Into the Proximal Part of the Humerus and Complete the Vascular Anastomosis
Insert the bare osseous fibula into the humeral canal, pass the graft pedicle through the loose tunnel, and anastomose the vessels.
Step 7: Double Plate Fixation
It is very important to bend the lateral plate to match the contour of the osseous surfaces.
Step 8: Follow-up and Rehabilitation
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.
What to Watch For
Pitfalls & Challenges