Fibular strut graft for humeral aneurysmal bone cyst with varus deformity

Proximal humerus is a common site for ABC and frequently associated with varus deformity that limits shoulder abduction. A prospective study was conducted to evaluate the use of intramedullary non-vascularised autogenous fibular strut graft for reconstruction without internal fixation.

A total of 20 patients (12 girls, 8 boys) were managed for proximal humeral ABC with varus deformity by extended curettage, osteotomy, intramedullary fibular graft and composite bone substitute. Their ages ranged from 10 to 17 years (average, 13.3 years). The lesion was juxtaphyseal in 16 patients and metaphyseal in 4. All cysts were active and centrally located type 2. The modified Enneking scoring system was used for final functional evaluation. Radiological assessment was done for the extent of defect healing, incorporation of the fibula and correction of the deformity.

After a mean follow-up of 41.2 months (range, 24-74) most of patients were satisfied and resumed daily activities without pain and with good range of shoulder movement. One patient complained of shoulder pain 10 months after surgery and was attributed to local recurrence. Limitation of recreational activity was experienced by one patient. There were no cases of deep infection, nerve deficit or pathological fracture. No cases of failed healing or incorporation of the fibula was detected. The improved shoulder abduction was closely related to the mean correction of the neck shaft angle.

The technique is proved to be effective in controlling disease, correcting deformity and improving function.