Akademik Veri Yönetim Sistemi
15th Asia-Pacific Musculoskeletal Tumor Society (APMSTS) Meeting, Denpasar, Endonezya, 8 - 11 Ekim 2025, ss.19, (Özet Bildiri)
Background:
Reconstruction of osteoarticular defects in the proximal humerus following resection of primary malignant bone tumors in pediatric patients presents unique challenges. These include the preservation of growth potential, joint function, and avoidance of complications associated with non-biological reconstructions such as endoprostheses or allografts. This study evaluates the outcomes of free vascularized epiphyseal fibular grafts (FVEFG) used for proximal humeral reconstruction in skeletally immature patients.
Methods:
A retrospective analysis was conducted on 10 pediatric patients (5 males, 5 females; mean age 10 years) who underwent FVEFG following wide resection of proximal humerus primary malignant tumors between 2001 and 2022. Diagnoses included 9 osteosarcomas and 1 Ewing’s sarcoma. All patients had at least 24 months of follow-up (mean 39 months). Functional outcomes were assessed using MSTS and TESS scores; radiological evaluation included ISOLS scoring and growth measurements using Boer & Wood and Innocenti indices. All reconstructions used the anterior tibial artery-based flap, preserving the muscular nerve branches during graft harvest.
Results:
The mean ISOLS radiographic score was 85%, indicating satisfactory graft incorporation. Boer & Wood index showed a mean hypertrophy of 68%, and mean annual longitudinal growth was 4.7 mm/year. Functional outcomes were favorable, with mean MSTS and TESS scores of 76.9% and 83%, respectively. Oncologically, 8 patients remained with no evidence of disease (NED), one was continuously disease-free (CDF), and one died of lung metastasis. No amputations or conversions to non-biological methods were necessary.
Complications:
The most common complication was graft fracture (3 patients, 30%), all of which healed—two conservatively, one with surgical fixation. Drop-foot due to transient peroneal nerve palsy occurred in two patients, resolving spontaneously. Graft resorption was noted in the two fracture cases. One patient developed gleno-fibular instability, successfully managed with capsular reconstruction. No infections, non-unions, or neurovascular injuries occurred. Donor-site morbidity was minimal, and no patient required secondary limb-lengthening surgery.
Discussion:
The FVEFG technique yielded reliable functional and radiological outcomes with lower complication rates compared to existing literature. Notably, our method preserved all muscular branches during graft harvesting and accessed anterior tibial vessels posteriorly, likely contributing to the low rate of peroneal nerve injuries and donor site morbidity. Compared to larger series reporting higher fracture and neuropathy rates, our complication profile was more favorable, possibly due to technical refinements and early soft tissue reconstructions.
Conclusion:
Free vascularized fibular epiphyseal autograft is a viable, effective, and durable biological reconstruction method for pediatric proximal humerus sarcoma patients. It enables preservation of shoulder mobility, longitudinal growth, and glenoid articulation with low complication and failure rates. Further prospective studies with larger cohorts and longer follow-up are recommended to validate and generalize these findings.