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Reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular GraftSurgical Technique
Mehmet Armangil, MD1; S. Sinan Bilgin, MD1
1 Ankara Üniversitesi İbni Sina Hastanesi El Cerrahisi Bilim Dalı sekreterliği Sıhhiye Samanpazarı, Çankaya Ankara, Turkey. E-mail address for M. Armangil: mehmetarmangil@yahoo.com. E-mail address for S.S. Bilgin: ssbilgin@yahoo.com
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Based on an original article: J Bone Joint Surg Am. 2012 Jul 3;94(13):e94.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Apr 24;3(2):e8 1-9. doi: 10.2106/JBJS.ST.L.00034
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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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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