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Reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular Graft: Surgical
Mehmet Armangil1, S Sinan Bilgin1
1Ankara 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.
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.
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