Mehmet Armangil1, S Sinan Bilgin1. 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.
Abstract
INTRODUCTION: 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. RESULTS: We recently reported on a retrospective series of nine shoulder arthrodeses performed with use of a free vascularized fibular graft. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: 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. RESULTS: We recently reported on a retrospective series of nine shoulder arthrodeses performed with use of a free vascularized fibular graft. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Bruno Fuchs; Mary I O'Connor; Denny J Padgett; Kenton R Kaufman; Franklin H Sim Journal: Clin Orthop Relat Res Date: 2005-07 Impact factor: 4.176