Resection arthrodesis of the shoulder with autogenous fibular bone grafts

We report the results of wide local excision of stage II8 proximal humeral tumors followed by reconstruction with parallel nonvascularized fibular bone grafts in three patients. Mean follow-up was 5 years (range 3 years to 8 years, 6 months). The pathologic diagnosis was osteogenic sarcoma in two patients and Ewing's sarcoma in one. The rotator cuff and deltoid were excised to achieve a wide margin around these tumors. All patients remain free from disease. They were able to return to previous work and sport activities. Two had a fracture of the graft; one fell from a mountain bike and the other fell at work. The former fracture united; the latter fracture required fixation and bone grafting to achieve union. By Enneking's 30-point functional evaluation, all three patients were in the excellent category with scores of 25, 26, and 28. We conclude that for the treatment of malignant tumors of the shoulder region with muscle involvement, excision followed by arthrodesis with parallel autogenous fibular bone grafts provides a method of retaining satisfactory upper limb function and acceptable cosmesis.