Proximal Humerus Reconstruction in Skeletally Immature Patients

Proximal humerus reconstruction after oncologic resection is complex, with numerous muscular attachments, proximity of critical neurovascular structures, and dynamic stability granting multidirectional motion at the glenohumeral articulation. In skeletally immature patients, additional factors increase the complexity, including remaining limb growth and humerus size. Limb length discrepancy affects the limb's esthetics and function while the humerus size can limit fixation strategies and intramedullary device use. Reconstruction options used in isolation or combination include endoprostheses, osteoarticular allografts, allograft-prosthetic composites, autografts, and arthrodesis. Unique limb salvage options to address the unique factors in young, skeletally immature patients include vascularized fibular epiphyseal transfer, claviculo pro humeri, and expandible endoprostheses. Each option has advantages and disadvantages for anticipated function, durability, shoulder stability, and complications. This review aims to aid preoperative planning and decision making for surgeons and patients undergoing proximal humerus resection and reconstruction with notable remaining growth potential.